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Kanker serviks uteri masih menjadi masalah kesehatan masyarakat di Indonesia. Kejadian kanker serviks uteri sebesar 12,6/100000 wanita dan angka kematiannya sebesar 7,0/100000 wanita (IARC, 2008). Hal ini dimungkinkan karena faktor resiko yang masih belum tertangani di masyarakat. Multi paritas (khususnya paritas > 4 kali) atau jumlah melahirkan pada wanita sebagai salah satu faktor resiko kanker serviks uteri ternyata masih tinggi di masyarakat. Penelitian ini ingin mengetahui pengaruh paritas > 4 kali terhadap kejadian kanker serviks uteri di 6 rumah sakit Indonesia. Penelitian dilakukan dengan desain kasus kontrol berbasis rumah sakit, dengan sampel sebanyak 364 wanita yang telah dipasangkan berdasarkan asal rumah sakit dan umur interval 10 tahun. Analisis multivariat menggunakan conditional logistic regression. Hasil menunjukkan bahwa paritas > 4 meningkatkan resiko kanker serviks uteri OR: 1,85 ; CI 95% (1,14 -3,02). Oleh karenanya usaha untuk pengembangan program yang dapat membatasi kelahiran seperti program Keluarga berencana akan membantu menurunkan terjadinya kasus serviks uteri.
Kanker merupakan salah satu masalah kesehatan masyarakat baik di dunia maupun di Indonesia. Kanker payudara merupakan kanker tertinggi pada perempuan di Indonesia dengan kecenderungan terus meningkat. Jumlah kasus kanker payudara di 5 provinsi di Indonesia, yaitu DKI Jakarta, Jawa Barat, Jawa Tengah, DI Yogyakarta, dan Jawa Timur, relatif lebih tinggi dibanding provinsi lain. Kanker payudara dipengaruhi oleh berbagai faktor termasuk penggunaan kontrasepsi oral yang merupakan metode kontrasepsi kedua terbesar setelah suntik. Dengan tingginya kanker payudara dan tingginya penggunaan kontrasepsi oral di 5 provinsi perlu diteliti pengaruh penggunaan kontrasepsi oral dengan kanker payudara pada 6 rumah sakit rujukan kanker di 5 provinsi tersebut.
Penelitian dilakukan dengan desain kasus-kontrol berbasis rumah sakit. Populasi sumber adalah pasien perempuan berusia 15 tahun atau lebih di 6 RS rujukan kanker di 5 provinsi yaitu RS Kanker Dharmais (DKI Jakarta), RS Cipto Mangunkusumo (DKI Jakarta), RS Hasan Sadikin (Bandung, Jawa Barat), RS Kariadi (Semarang, Jawa Tengah), RS Sardjito (DI Yogyakarta), dan RS dr. Soetomo (Surabaya, Jawa Timur). Populasi penelitian adalah pasien perempuan berusia 15 tahun atau lebih di bagian bedah pada 6 RS rujukan kanker tersebut.
Sampel penelitian yaitu kasus adalah pasien yang didiagnosa kanker payudara dengan konfirmasi histopatologi pada bagian rawat inap bedah dan kontrol adalah pasien pada bagian rawat jalan bedah yang tidak didiagnosa kanker payudara berdasarkan wawancara. Kriteria inklusi pada penelitian ini adalah pasien perempuan berusia 15 tahun atau lebih, sedangkan kriteria eksklusi adalah menggunakan kontrasepsi hormonal selain pil (suntik dan susuk) dan menggunakan terapi sulih hormon. Jumlah sampel eligible setelah dilakukan eksklusi dan matching rumah sakit asal dengan perbandingan 1:1 adalah 762 responden (381 kasus dan 381 kontrol).
Hasil analisa menunjukkan karakteristik responden dalam penggunaan kontrasepsi oral adalah yang menggunakan kontrasepsi oral < 6 tahun pada kasus 20,2% dan pada kontrol 13,9%, menggunakan kontrasepsi oral ≥ 6 tahun pada kasus 15,2% dan pada kontrol 6,3%. Penggunaan kontrasepsi oral terbukti meningkatkan risiko terjadinya kanker payudara. Setelah dikontrol variabel umur, status menyusui, diet tidak sehat, dan riwayat tumor jinak payudara, nilai Odds Ratio (OR) penggunaan kontrasespsi oral < 6 tahun sebesar 1,93 (95% CI 1,23 ? 3,03) dan OR menggunakan kontrasepsi oral ≥ 6 tahun sebesar 2,90 (95% CI 1,65 ? 5,09) dibanding tidak menggunakan kontrasepsi oral. Hasil-hasil penelitian ini dapat menjadi bahan masukan bagi perempuan pengguna kontrasepsi oral, BKKBN, Kemeterian Kesehatan, dan penelliti lain.
Cancer is one public health program in the world and in Indonesia as well. Breast cancer is the most common cancer among women in Indonesia and is increasing. Breast cancer cases in 5 provinsces of Indonesia: Jakarta, West Java, Central Java, Jogjakarta, and East Java is relatively higher than other provinces. Breast cancer is influenced by many risk factors including oral contraceptives which is 2nd biggest contraceptive method in Indonesia. Because of high of breast cancer cases and high of oral contraceptive use in 5 provinces, it is needed to conduct research of influence of oral contraceptive to breast cancer in 5 provinces at 6 cancer-referral hospitals.
The design of this research is hospital based case-control.Base population of this study is women patients aged 15 years and above in 6 cancer-referral hospitals in 5 provinces: Dharmais hospital (Jakarta), Ciptomangunkusumo hospital (Jakarta), Hasan Sadikin hospital (Bandung, West Java), Kariadi hospital (Semarang, Central Java), Sardjito hospital (Jogjakarta), and Soetomo hospital (Surabaya, East Java). Study population is women patients aged 15 years and above in surgery ward of these hospitals.
Sample of this research is women patients diagnosed breast cancer cofirmed with histopathologic examination in inpatient surgery ward, and control is women patients whom are not diagnosed breast cancer based on interview in outpatient surgery ward. Inclusion criteria of the sample is women patients aged 15 years and above, mean while exclusion criteria is using hormonal contraceptive other than pill (injection and inplan) and using hormone replacement therapy. The number of eligible sample after exclution and matching to hospital is 762 (381 cases and 381 controls).
Result of the analyse shows that characteristic of respondent: using oral contraceptive < 6 years is 20.2% of cases and 13.9% of control, using oral contraceptive ≥ 6 years is 15.2% of cases and 6.3% of control. Using oral contraceptive is proven increase risk of breast cancer. Controlled by age, breast feeding status, unhealthy diet, and history of benign breast tumor, Odds Ratio (OR) of using contraceptive < 6 years is 1.93 (95% CI 1.23 ? 3.03) and OR using contraceptive ≥ 6 years is 2.90 (95% CI 1.65? 5.09) compare with never users. These results can be input for oral contraceptives users, BKKBN, Ministry of Health, and other researchers.
Cervical cancer is commonly occurs in woman. More than 1.4 million ofwomen suffer from this disease.In Indonesia the Incidence Rate of cervical canceris 13/100.000 woman. The result of early detection cervical cancer program withIVA method in Karawang revealed 246 cases from 2010-2013. In 2014 until Junethere are 56 cases. The increasing of divorced rate (200 cases/year)andprostitutions di Karawang District are the risk factor of cervical cancer. Thepurpose of this research is to know the risk factor of changed sex partner towardscervical cancer in Karawang District.A case control study design was conducted with two controls per case. Thesource of data identified from public health centre register and confirmed casesfrom hospital register of Karawang during 2014. Information collected onparticipants using pretested questionnaires, during household interviews includedage, education level, occupation, income, family cervical cancer history, age offirst sex, smoking, using hormonal contraception, parity and consumption pattern.We estimated odds ratio (OR) and confidence interval (CI 95%) usingmultivariate logistic regression.Fifty-two cases and 104 controls were enrolled. The bivariate model ofchanging sex partner towards cervical cancer showed (OR: 3.57 CI 95%: 1.67-7.6). The multivariate model included age, level education, income, familycervical cancer history, smoking active and passive, parity, age of first time sex,using hormonal contraception, and food contain carcinogen consumption. Theodds ratio adjusted (OR adj : 2.68, CI 95%: 1.03-6.9). The variable of age, level ofeducation, family cervical cancer history, active smoking and using hormonalcontraception are the confounders in relation between changing sex partner withcervical cancer.Woman with changing sex partner behaviour were more likely to havecervical cancer 2.68 times compared with women who did not changing sexpartner. District Health office of Karawang should increasing the health campaignof the risk factor of cervical cancer and preventing cervical cancer with earlydetection in public health centre.Key words: cervical cancer, changing sex partner, case control study
ABSTRAK Nama : Hairida Anggun Kusuma Program Studi : Pascasarjana Ilmu Kesehatan Masyarakat Judul : Faktor-faktor yang Berhubungan dengan Kejadian Lesi Prakanker Serviks di Kabupaten Kotawaringin Timur Tahun 2017 Permasalahan kanker serviks di Indonesia sangat khas yaitu banyak dan lebih dari 70% kasus ditemukan pada stadium lanjut pada saat datang ke rumah sakit. Peningkatan upaya penanganan kanker serviks, terutama dalam bidang pencegahan dan deteksi dini sangat diperlukan oleh setiap pihak yang terlibat. Penelitian kasus kontrol ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengan kejadian lesi prakanker serviks. Penelitian melibatkan 102 kasus dan 306 kontrol dari cacatan medis pemeriksaan deteksi dini kanker leher rahim dan payudara tahun 2013 – 2016. Penelitian di 11 puskesmas yang telah melaksanakan pemeriksaan IVA di Kabupaten Kotawaringin Timur. Analisis data dilakukan secara univariat, bivariat dengan chi square dan multivariat dengan regresi logistik ganda untuk mengetahui faktor yang paling dominan. Sebagian besar umur responden ≤35 tahun, pendidikan dasar, tidak bekerja, tidak mempunyai riwayat kanker, usia melakukan hubungan seksual >17 tahun, punya pasangan seksual satu, tidak pernah menggunakan kontrasepsi oral >5 tahun, paritas ≥4 dan tidak pernah pap smear. Sedangkan untuk paparan asap rokok sama besar antara yang terpapar dan tidak terpapar. Hasil regresi logistik ganda menemukan terpapar asap rokok dengan (OR 1,9 95% CI 1,1 – 3), riwayat kanker keluarga (OR 2,5 95% CI 1,3-4,6), paritas ≥4 (OR 2 95% CI 0,9 – 4,4) dan jumlah pasangan seksual lebih dari 1 (OR 1,5 95% CI 0,9 – 2,8) dan faktor yang paling dominan adalah riwayat kanker keluarga. Kata kunci: Lesi prakanker serviks; paparan asap rokok; riwayat kanker keluarga.
ABSTRACT Name : Hairida Anggun Kusuma Study Program : Postgraduate Public Health Faculty Title : Factors Related to Cervical Precancerous Lesions in East Kotawaringin District 2017 The problem of cervical cancer in Indonesia is very distinctive that many and more than 70% of cases are found at an advanced stage upon arrival to the hospital. Increased efforts to treat cervical cancer, especially in the field of prevention and early detection is needed by each party involved. This case-control study aims to determine risk factors associated with the incidence of cervical precancer lesions. The study included 102 cases and 306 controls derived from medical records examining early detection of cervical and breast cancers from 2013 to 2016. The study was at 11 puskesmas who had performed VIA examination in East Kotawaringin District. Data analysis was done univariat, bivariate with chi square and multivariate with logistic regression to know the most dominant factor. Most of the respondents aged ≤35 years, primary education, unemployment, no history of cancer, age of sexual intercourse >17 years, had one sexual partner, never used oral contraceptives >5 years, parity ≥4 and never pap smear. As for exposed by smoke as large between the exposed and not exposed. The result of logistic regression showed exposed to cigarette smoke (OR 1,9 95% CI 1,1 – 3), family cancer history (OR 2,5 95% CI 1,3-4,6), parity ≥4 (OR 2 95% CI 0,9 – 4,4) dan sexual multipartner (OR 1,5 95% CI 0,9 – 2,8) and the more dominant risk factor was family history of cancer. Keywords: cervical precancerous lesions;exposed by smoke; family history of cancer
Transition of epidemiology has made a non-communicable diseases becoming the new health problems in the world. Cervical cancer is one of the problems. Globocan study in 2008 have shown that cervical cancer is the second most common cancer that leading causes more than 80% of deaths in women living in developing countries. In Indonesia there are 15.000 new cases of cervical cancer reported each year.
Cervicitis is one of the Sexually Transmitted Infections (STIs). There is a correlation between socio-demographic development and migration with increase of the number of high-risk populations. WHO estimates there are 376 million new infections by 1 out of 4 STIs, such as chlamydia (127 million), gonorrhea (87 million), syphilis (6.3 million) and trichomoniasis (156 million). Gatot et al, showed that 11.9% of patients had cervicitis. Iskandar, et al, also showed the prevalence of cervical infections (chlamydia 9,3% and 1,2% gonorrhea). Based on the results of the SDKI, there had been an increasing trend in contraceptive use in Indonesia from 1991 to 2017. There was a statistically significant association between cervicitis and HPV infection. It will increase the risk of getting infected by HPV if cervicitis is left untreated. Additionally, a person with mucopurulent cervicitis symptoms has an increased risk of cervical cancer. This study aims to determine the relationship between the use of hormonal contraceptives and the incidence of cervicitis. This is a quantitative study with a cross sectional study design. This study used secondary data from the results of the VIA examination at the primary health care supervised by the Female Cancer Program (FcP) in DKI Jakarta in 2017-2019. The number of samples were 3563 people, who met the inclusion and exclusion criteria. This study used logistic regression to analyze the data. The prevalence of cervicitis in this study was 11.20%. There is a relationship between hormonal contraceptive use and the incidence of cervicitis which is statistically significant with p-value<0.0001. Thus, it is necessary to carry out periodic checks on women who use hormonal contraception to prevent cervicitis and cervical cancer.
Kanker payudara merupakan kanker yang paling banyak diderita oleh wanita di dunia, khususnya di Indonesia. Pengobatan yang lama dan berat memiliki dampak psikologis yang berpengaruh terhadap kualitas hidup pasien. Dukungan sosial penting untuk kualitas hidup pasien kanker payudara. Penelitian ini bertujuan untuk menganalisis pengaruh dukungan sosial terhadap kualitas hidup pasien kanker payudara di Rumah Sakit Kanker Dharmais. Penelitian ini menggunakan pendekatan kuantitatif dengan desain studi longitudinal dan kualitatif dengan case study. Sampel penelitian ini adalah pasien kanker payudara yang berobat dan tercatat pada di RS Kanker Dharmais periode bulan Agustus-Desember 2023 yang memenuhi syarat kriteria inklusi dan eksklusi penelitian sebanyak 190 pasien. Pengukuran kualitas hidup dengan kuesioner EORTC QLQ 30 dan BR-23 Pengukuran dukungan sosial dengan kuesioner Multidimensional Scale of Perceived Social Support (MSPSS). Pengumpulan data kualitatif dengan kelompok focus group discussion (FGD) dan wawancara mendalam. Analisis data menggunakan analisis regresi logistik untuk pengukuran data berulang pada data kategorik dengan General Estimation of Equotion (GEE). Dukungan sosial mempengaruhi kualitas hidup pasien kanker payudara sebesar 3,9 kali (OR=3,9; 95% CI: 3,3-4,6) setelah dikontrol faktor umur dan stadium kanker payudara. Sumber dukungan yang paling berpengaruh yaitu dukungan keluarga (OR=5,2 CI 95% 2,8-7,6) dan tenaga kesehatan (OR=2,0 CI 95% 1,3-3,1). Bentuk dukungan sosial yang paling berpengaruh yaitu dukungan emosional (OR=5,3 CI 95% 3,0-9,0), nyata (OR=3,6 CI 95% 2,5-5,2), dan informasi (OR=2,4 CI 95% 1,4-4,3). Pengaruh dukungan sosial terhadap kualitas hidup berdasarkan waktu terdapat penurunan seiring berjalannya waktu. Diharapkan untuk peningkatan dukungan sosial dari keluarga, tanaga Kesehatan dalam bentuk dukungan emosianal, nyata dan informasi. Rumah Sakit Kanker Dharmais juga diharapkan untuk mengoptimalkan program paliatif dan NAPAK sebagai bentuk dukungan sosial terhadap pasien kanker payudara. Kata Kunci : Kualitas Hidup, Dukungan Sosial, Pasien Kanker Payudara
Breast cancer is the most common type of cancer affecting women worldwide, particularly in Indonesia. The lengthy and intensive treatment process often has psychological impacts that affect patients' quality of life. Social support plays a crucial role in improving the quality of life of breast cancer patients. This study aims to analyze the effect of social support on the quality of life of breast cancer patients at Dharmais Cancer Hospital. A mixed-methods design was used, combining a quantitative longitudinal approach with a qualitative case study. The sample consisted of 190 breast cancer patients who were treated and registered at Dharmais Cancer Hospital between August and December 2023, and who met the study's inclusion and exclusion criteria. Quality of life was measured using the EORTC QLQ-C30 and BR-23 questionnaires, while social support was assessed using the Multidimensional Scale of Perceived Social Support (MSPSS). Qualitative data were collected through focus group discussions (FGDs) and in-depth interviews. Data were analyzed using logistic regression for repeated measurements, employing the Generalized Estimating Equation (GEE) method for categorical data. The results showed that social support significantly influenced the quality of life of breast cancer patients, increasing the odds by 3.9 times (OR = 3.9; 95% CI: 3.3–4.6) after controlling for age and cancer stage. The most influential sources of support were family (OR = 5.2; 95% CI: 2.8–7.6) and healthcare workers (OR = 2.0; 95% CI: 1.3–3.1). The most impactful forms of support were emotional (OR = 5.3; 95% CI: 3.0–9.0), tangible (OR = 3.6; 95% CI: 2.5–5.2), and informational support (OR = 2.4; 95% CI: 1.4–4.3). However, the effect of social support on quality of life was found to decrease over time. It is therefore recommended to enhance social supports particularly from family and healthcare professionals through emotional, tangible, and informational forms. Dharmais Cancer Hospital is also expected to optimize its palliative care and NAPAK programs as a structured form of social support for breast cancer patients. Keywords: Quality of Life, Social Support, Breast Cancer Patients
