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Adherence to Guidelines: Evaluation of Opioid Usage According to the Who Step Ladder Guideline in Inpatient Cancer Patients Eko Adhi Pangarsa; Budi Setiawan; Damai Santosa; Daniel Rizky; Vina Yunarvika; Catharina Suharti
Indonesian Journal of Global Health Research Vol 7 No 4 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i4.6343

Abstract

WHO analgesic step-ladder is still the mainstay guideline in managing pain. However, pain in cancer patients developed from a more complex pathomechanism, hence requiring special consideration. This study aimed to compare the visual analog scale (VAS) of opioid and non-opioid analgesia in treating cancer patients and evaluate its rationality with World health organization (WHO) analgesic step-ladder.Method: A single-center, cross-sectional and analytic-descriptive study conducted in our centre. The population of this study comprised all cancer patients receiving analgesic therapy. The sampling technique used was consecutive, involving patients who met the inclusion and exclusion criteria. A total of 62 patients were included in the study as the research sample. Pain level was measured before and between 12 – 24 hours after analgesia, using VAS and divided into mild, moderate, or severe. Analgesic regimens were documented, and the daily opioid dose was presented on milligram morphine equivalent. Statistical analysis was performed to compare the variables before and after analgesia using the Wilcoxon signed-rank test, with a p-value <0.05 considered statistically significant.Result: From 62 patients, 46 subjects were included. Median milligram morphine equivalent was 20 mg (0-60). While the majority of patients experienced mild pain, 13 patients (27.7%) had moderate to severe pain. The most commonly used opioid was intravenous fentanyl, administered to 13 patients (27.7%), with a median morphine equivalent dose of 20 mg/day. Only 1 patient received opioid rationally according to WHO. Both non-opioid and opioid group had significant VAS differences before and after therapy (p = 0.014 and p <0.001). In both non-opioid and opioid groups, there were differences of VAS scores in the post-administration of analgesic, but these differences were not statistically significant (p= 0.885). Conclusion: The study concludes that, although most analgesics were not administered in accordance with the WHO step-ladder guideline, both opioid and non-opioid analgesics were effective in reducing pain in palliative cancer patients.
Healthcare Financing for Bone Marrow Transplants: A Scoping Review Damai Santosa; Chriswardani Suryawati; Ayun Sriatmi
Indonesian Journal of Global Health Research Vol 7 No 5 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i5.7125

Abstract

Bone marrow transplantation (BMT) is a life-saving procedure for haematological malignancies and other severe blood disorders. It is need resource-intensive treatment with significant financial implications. The cost of BMT varies across different countries and healthcare systems, influenced by factors such as treatment protocols, hospital infrastructure, medication expenses, and post-transplant care. Understanding the financial aspects of BMT is crucial for improving accessibility and ensuring sustainable healthcare service. Objective to analyse the cost of BMT across different regions, identify sources of financing, and explore financial challenges and potential solutions for patients undergoing BMT. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases from 2001 - 2025. MeSH Terms using ((haematology malignancy OR leukaemia OR acute leukaemia OR acute myeloid leukaemia OR acute lymphoblastic leukaemia OR myeloma OR lymphoma OR thalassemia) AND (bone marrow transplantation OR stem cell transplantation OR haematopoetic stem cell transplantation OR hematopoietic stem cell transplantation OR allogeneic transplantation ) AND (OR costing OR payer)). Data were extracted on total BMT costs, cost components, sources of financing, and financial challenges associated with the procedure. The analysis followed the Cochrane Handbook for Systematic Reviews of Interventions. Out of 528 initially screened studies, 19 articles met the inclusion criteria. The cost of BMT varied significantly by country, with developed nations reporting higher costs than developing countries. The primary cost components included hospital and treatment expenses, medications, and follow-up care. Financing sources varied across regions, including private health insurance, government-funded healthcare programs, non-profit organisations, fundraising efforts, and out-of-pocket payments. Many patients in low- and middle-income countries face financial barriers due to limited insurance coverage and high out-of-pocket expenses. BMT remains a costly procedure with significant financial challenges, particularly in regions with limited healthcare funding.