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Proporsi Kejadian Depresi Pasien Kanker di Ruang Rawat Singkat Rumah Sakit Kanker âDharmaisâ LUGITO, NATA; KARIM, BIRRY; KANSERA, DOLLY DOLVEN; KHORINAL, EKA WIDYA; YARUNTRADHANI, RIZKI; SUTANDYO, NOORWATI
Indonesian Journal of Cancer Vol 6, No 2 (2012): Apr - Jun 2012
Publisher : "Dharmais" Cancer Center Hospital

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Tujuan: mendapatkan dataÂ tentang proporsiÂ kejadian depresiÂ sertaÂ faktor yang berhubungan padaÂ pasienÂ kanker di ruang rawat singkat Rumah Sakit Kanker âDharmaisâ.Metode: studi potong lintang dilakukan terhadap 26 pasien dewasa ruang rawat singkat Rumah Sakit Kanker âDharmaisâ (RSKD) untuk menentukan proporsi kejadian depresi dan faktor yang mungkin berhubungan. Data demografik meliputi nama,Â usia, jenis kelamin, tempat tinggal, pekerjaan,Â pendidikan, status pernikahan, dan pembiayaan. Data yang berhubungan denganÂ kanker meliputiÂ jenisÂ kanker, lamaÂ terdiagnosis kanker, kemoterapi, danÂ terapiÂ lainnya (pembedahan dan radioterapi). Depresi dievaluasi menggunakan Beck Depression Inventory (BDI).Hasil: diperoleh 26 pasien kanker. Proporsi pasien yang mengalami depresi ambang, sedang, dan berat sebesar 13,1%; dan tidak ada pasien yang mengalami depresi sangat berat. Proporsi kejadian depresi lebih tinggi pada pasien dengan pembiayaan jaminan, sudah pensiun bekerja, dan menjalani pembedahan.Kesimpulan:Â proporsiÂ kejadian depresiÂ di Rumah Sakit Kanker âDharmaisâ sebanding denganÂ berbagaiÂ studi.Â Perlu dilakukan penapisan gejala depresiÂ pada pasienÂ kanker sebagaiÂ bagian penatalaksanaan kanker secara holistik serta rujukan untuk pasienÂ denganÂ risiko tinggi menderita depresiÂ dalam usahaÂ menurunkan morbiditas, perbaikanÂ luaran penyakit, penghematan biaya kesehatan, dan peningkatan kualitas hidup pasien.Kata Kunci: Beck Depression Index (BDI), depresi, kanker

Transfusi pada Pasien Kanker: Manfaat dan Resiko Sutandyo, Noorwati
Indonesian Journal of Cancer Vol 1, No 3 (2007): Jul - Sep 2007
Publisher : "Dharmais" Cancer Center Hospital

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Transfusi darah pada pasien kanker biasanya diperlukan pada terapi radiasi, terapi operasi, kemoterapi, terapi suportif/ paliatif. Walaupun saat ini transfusi darah diyakini lebih aman dibandingkan dengan masa-masa sebelumnya, namun transfusi juga masih memiliki banyak risiko, antara lain peristiwa yang menyimpang (adverse events), baik berupa peristiwa imunologik maupun non imunologik yang berpotensi fatal. Peristiwa imunologik antara lain berupa reaksi transfusi, alloimunisasi, transfussion-related acute lung injury (TRALI), dan transfussion-associated immunomodulation (TRIM), sedangkan peristiwa non-imunologik antara lain meliputi kelebihan beban volume, hemodilusi, dan infeksi. Selain itu, human error sering dikaitkan juga sebagai salah satu faktor risiko yang berakibat fatal. Dengan mengingat berbagai keterbatasan dan risiko yang dapat terjadi, maka perlu dipertimbangkan pemberian transfusi sesuai manfaat dan indikasinya.Kata kunci: transfusi darah, kanker imunologik, peristiwa menyimpang

Nutrisi pada Pasien Kanker Yang Mendapat Kemoterapi Sutandyo, Noorwati
Indonesian Journal of Cancer Vol 1, No 4 (2007): Oct - Dec 2007
Publisher : "Dharmais" Cancer Center Hospital

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Dukungan nutrisi merupakan bagian dari terapi suportif pada kanker. Tujuan terapi nutrisi pada pasien kanker dititikberatkan terutama pada efek potensial dalam meningkatkan kualitas hidup. Kondisi nutrisi yang cukup berhubungan dengan prognosis yang baik. Kemoterapi merupakan terapi yang bertujuan untuk menghentikan pertumbuhan sel kanker, namun memiliki efek samping yang berhubungan dengan gangguan saluran cerna dengan manifestasi kurangnya asupan makanan dan gangguan pencernaan selama kemoterapi. Skrining dan evaluasi nutrisi secara dini dapat mengidentifikasi masalah yang mungkin mempengaruhi keberhasilan terapi kanker. Penemuan masalah nutrisi dan terapinya membantu pasien meningkatkan respon terapi dan menurunkan komplikasi.Kata kunci: nutrisi, pasien kanker, kemoterapi

Transfusi pada Pasien Kanker: Manfaat dan Resiko Sutandyo, Noorwati
Indonesian Journal of Cancer Vol 1, No 3 (2007): Jul - Sep 2007
Publisher : National Cancer Center - Dharmais Cancer Hospital

Transfusi darah pada pasien kanker biasanya diperlukan pada terapi radiasi, terapi operasi, kemoterapi, terapi suportif/ paliatif. Walaupun saat ini transfusi darah diyakini lebih aman dibandingkan dengan masa-masa sebelumnya, namun transfusi juga masih memiliki banyak risiko, antara lain peristiwa yang menyimpang (adverse events), baik berupa peristiwa imunologik maupun non imunologik yang berpotensi fatal. Peristiwa imunologik antara lain berupa reaksi transfusi, alloimunisasi, transfussion-related acute lung injury (TRALI), dan transfussion-associated immunomodulation (TRIM), sedangkan peristiwa non-imunologik antara lain meliputi kelebihan beban volume, hemodilusi, dan infeksi. Selain itu, human error sering dikaitkan juga sebagai salah satu faktor risiko yang berakibat fatal. Dengan mengingat berbagai keterbatasan dan risiko yang dapat terjadi, maka perlu dipertimbangkan pemberian transfusi sesuai manfaat dan indikasinya.Kata kunci: transfusi darah, kanker imunologik, peristiwa menyimpang

Removal of Mimosine from Leucaena leucocephala (Lam.) de Wit Seeds to Increase Their Benefits as Nutraceuticals Wardatun, Sri; Harahap, Yahdiana; Mun'im, Abdul; Saputri, Fadlina Chany, Dr.; Sutandyo, Noorwati
Pharmaceutical Sciences and Research Vol. 7, No. 3
Publisher : UI Scholars Hub

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The Leucaena leucocephala (Lam.) de Wit tree contains pharmacologically active compounds and can easily be found in abundant quantities. The utilization of this tree as a source of nutraceuticals would increase its value. The extraction yields show the number of compounds that have been extracted by solvent. However, Leucaena leucocephala (Lam.) de Wit seeds also contain mimosine, which can cause hair loss. The present study investigated the process of removing mimosine from the seeds. Three treatments were applied to these seeds: treatment without soaking, soaking with distilled water for 24 hours, and splitting the seeds in half and then soaking with distilled water for 24 hours. The seeds were dried, ground, and then extracted with different concentrations of ethanol solvent. The mimosine levels of the extracts were measured with a JascoV-730 spectrophotometer using ferry chloride as a reagent. The results showed that the soaking process and the concentration of ethanol had significant effects on the extract yields and mimosine levels. The unsoaked seeds, extracted with 70% ethanol, produced the highest ratio of extract yield to mimosine level. Therefore, 70% ethanol can be used as a solvent to utilize unsoaked seeds as nutraceuticals.

Change of Coagulation Status in Solid Cancer Patients Undergoing Chemotherapy in Indonesia: A Prospective Cohort Study Sutandyo, Noorwati; Setyawan, Lyana
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 1
Publisher : UI Scholars Hub

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Neutrophil Lymphocyte Ratio as A Predictor of The First Onset Acute Neutropenia After R-CHOP Chemotherapy in Diffuse Large B-cell Lymphoma Patients Christine, Griskalia; Sukrisman, Lugyanti; Sutandyo, Noorwati; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
Publisher : UI Scholars Hub

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Background. Diffuse Large B-cell Lymphoma (DLBCL) is the most common lymphoma in Indonesia. R-CHOP chemotherapy has a moderate risk for neutropenia / febrile neutropenia. Lymphocytes can describe host immunity, while neutrophils and monocytes can describe the inflammatory response. No study has assessed differential count of leukocytes as a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients. This study aimed to determine the relationship between differential count of leukocytes before chemotherapy as a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients. Methods. A retrospective cohort study was conducted among 18–60 years old DLBCL patients with ECOG 0–1 and no comorbidity related to chemotherapy 18–60 years old. Subjects were given with the first 3 cycles of R-CHOP chemotherapy without G-CSF prophylaxis. Results. Of the 95 patients, first onset acute neutropenia after chemotherapy occurred in 83 (87.4%) subjects or 83 (55.3%) cycles of 150 chemotherapy cycles. Febrile neutropenia occurs in 50.6% of the onset of neutropenia. Severe neutropenia occurs in 34 (41.0%) cycles of 83 neutropenic episodes. The first onset of acute neutropenia was the most common at 7–15 days after chemotherapy. The AUC of neutrophil lymphocyte ratio was 0.74 (95% CI 0.65–0.82); while absolute lymphocytes, absolute neutrophils, absolute monocytes, and monocyte lymphocyte ratios were 4.1 neutrophil lymphocyte ratio were able to predict the first onset of acute neutropenia after RCHOP chemotherapy in DLBCL patients (sensitivity 71.1%; specificity 64.2%; positive predictive value 71.1%; negative predictive value 64.2%). Conclusion. Neutrophil lymphocyte ratio before chemotherapy > 4.1 is a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients.

Validity and Reliability Test of European Organization for Research and Treatment of Cancer Quality of Life QuestionnaireBreast 23 in Breast Cancer Patient on Treatment Adli, Mizanul; Shatri, Hamzah; Sutandyo, Noorwati; Suwarto, Suhendro
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
Publisher : UI Scholars Hub

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Introduction. Improved survival of breast cancer patients are not necessarily followed by improvement of quality of life. According to the European Organization for Research and Treatment of Cancer (EORTC), cancer patients’ quality of life are very important to be evaluated. In Indonesia, breast cancer patients cannot be assessed their quality of life accurately because there is no valid and reliable questionnaire. This study aims to prove that the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Breast 23 (EORTC QLQ-BR23) is a valid and reliable measuring instrument to be used in Indonesia. Methods. This study was a cross-sectional study. The EORTC QLQ-BR23 questionnaire was first translated into Indonesian language before being tested on 10 respondents. The translation results were then used in 100 breast cancer patients. Test-retest was assessed with intraclass correlation coefficient (ICC), while the internal consistency was assessed by Cronbach’s alpha. Construct validity was assessed by multi-trait scaling analysis and the criteria validity assessed by identifying the correlation between domains of European Organization for Research and Treatment of Cancer Quality of Life QuestionnaireCancer 30 (EORTC QLQC30) and EORTC QLQ-BR23 with Short Form 36 (SF36). Results. From September to October 2015, a total of 100 breast cancer patients on treatment were enrolled in this study. ICC value (1 hour interval) of all EORTC QLQ-BR23 domains were very good (ICC> 0.8). ICC values (30 day interval) decrease in all EORTC QLQ-BR23 domains. Almost all of the EORTC QLQ-BR23 domains have a cronbach’s alpha value > 0.7 except for the arm symptom domain (Cronbach’s alpha: 0.643). Multi-trait scaling analysis showed a fairly high correlation between the score of the questions with a score of his own domain, while the relationship of the questions to different domains always have a lower correlation than the domain itself. In criteria validity test, obtained 19 correlation with r > 0.3 between domains of EORTC QLQ-C30 and EORTC QLQ-BR23 with SF36. Conclusion. EORTC QLQ-BR23 is a valid and reliable instrument for assessing quality of life of breast cancer patients in Indonesia

Comparison of Chemotherapy Regiments between CisplatinEtoposide and Cisplatin-Docetaxel on 2-Year and ProgressionFree Survival in Late-Stage Non-Small Cell Lung Cancer Patients Harahap, Salman Paris; Sutandyo, Noorwati; Rumende, Cleopas Martin; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 2
Publisher : UI Scholars Hub

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Introduction. Chemotherapy is one of therapy choices for the advanced Non-Small Cell Lung Cancer (NSCLC). The success in therapy is measured with the 1-year survival, 2-year survival and the Progression Free Survival (PFS). The success is influenced by many factors: resistant to the citostatic, dosage, administer intensity, chemotherapy regiment, type histology, stage, performance status, comorbidity and social economic. In Indonesia, funding and chemotherapy regiment become the challenge for the success of therapy. Methods. The study used the Retrospective Cohort study with survival analysis. The Patients included in this study were the advanced NSC Lung Cancer (At least Stadium IIIa) who came to RSKD and RSCM during Jan 2006 – December 2010 for their first chemotherapy until finished the cycle (6 times) and had monitored for 2 years. Data was analyzed using cox regression analysis SPSS 16.0, and featured on the Kaplan Meier Curve. Results. Fifty five patients used EC and the other 55 patients used DC. There’s difference on survival where 1 year survival EC is 30,9% and DC is 47,3%, with p 0.030. Two year survival CE is 0% and for DC is 5.5%, with p 0.003. Also with the Median time survival between EC for 27 weeks and DC for 38 weeks with p < 0.016. Compared to DC, EC chemotherapy can increase the death risk by HR 1,684 (CI 95% 1,010-2,810), twenty four weeks PFS with EC is 54.5%, DC is 32.7% with p= 0.022. Conclusions. The survival with cisplatin-docexatel is better compared to cisplatin-etoposide, this applies to PFS as well.

Peran Pemeriksaan Penanda Tumor Cairan Pleura dalam Diagnosis Efusi Pleura Maligna Akibat Kanker Paru Primer Rumende, Cleopas M; Sutandyo, Noorwati; Hanafi, Arif R; Rumende, Samuel K; Susanto, Erwin C; Sitorus, Truely P
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Introduction. Pleural effusion is a frequently acquired lung disorder and based on the type of cause it is divided into malignant and non-malignant pleural effusion. Cytological examination of pleural fluid to differentiate between malignant and non-malignant pleural effusion shows varying sensitivity. Research regarding the benefits of CEA and Cyfra 21-1 pleural fluid examination to detect malignant pleural effusion due to primary lung cancer in Indonesia is still very limited. The aims of this study is to determine the sensitivity and specificity of CEA and Cyfra 21-1 pleural fluid in diagnosing malignant pleural effusion due to primary lung camcer. Methods. A cross-sectional diagnostic study was conducted on patients with exudative pleural effusion at Dr. Cipto Mangunkusumo National Hospital (RSCM) and Darmais Cancer Hospital between September 2015 and May 2016. Patients underwent examinations for carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (Cyfra 21-1) in their pleural fluid. The ROC curves were generated to determine the optimal cut-off values for CEA and Cyfra 21-1 concentrations in pleural effusion, considering the area under the curve (AUC) obtained. Chi-square tests were performed to assess sensitivity and specificity, as well as to calculate positive predictive value, negative predictive value, and accuracy for each cut-off value for both CEA and Cyfra 21-1. Results. A total of 122 patients with exudative pleural effusion, positive cytology results were obtained in 80 patients. By using the CEA cut-off value of 4.23 ng/ml, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87.50%, 80.95%, 89.74%, 77.27% and 85.25% with an AUC value of 0.878 (0.814 - 0.942). By using the Cyfra 21-1 cut-off value of 26.9 ng/ml, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 78.75%, 71.43%, 84.00%, 63.82% and 76.23% with an AUC value of 0.817 (0.739 - 0.896). Conclusion. Examination of CEA and Cyfra 21-1 level in pleural fluid can be used to support the diagnose of malignant pleural effusion due to primary lung cancer.

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