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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.
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 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
ABSTRAK Nama : Nuraini Oktaviani Program Studi : Epidemiologi Judul : Analisis Kesintasan 5 Tahun Pasien Kanker Payudara Stadium Lanjut Lokal Berdasarkan Kemoterapi Neoadjuvan di Rumah Sakit Cipto Mangunkusumo Tahun 2011-2016 Latar belakang: Salah satu modalitas terapi yang digunakan untuk meningkatkan angka kesintasan hidup pasien kanker payudara adalah dengan pemberian kemoterapi neoadjuvan. Pada umumnya kemoterapi neoajuvan kanker payudara stadium lanjut lokal di RSCM menggunakan regimen doxorubicin based. Namun belum ada penelitian lebih lanjut mengenai perbandingan kesintasan hidup lima tahun pasien kanker payudara lanjut lokal yang mendapatkan kemoterapi neoadjuvan doxorubicin based dengan non-doxorubicin based di RSCM. Tujuan: Mengetahui angka kesintasan hidup lima tahun penderita kanker payudara stadium lanjut lokal yang diberikan kemoterapi neoadjuvan doxorubicin based dan non-doxorubicin based di RSCM tahun 2011 – 2016. Metode: Sebanyak 236 pasien kanker payudara stadium lanjut lokal yang mendapatkan kemoterapi neoadjuvan di RSCM tahun 2011-2016 menjadi sampel dalam penelitian ini. Analisis data dilakukan dengan metode Kapplan Meier, uji Log Rank dan Cox Regreession. Hasil penelitian: Angka kesintasan hidup lima tahun pasien kanker payudara stadium lanjut lokal yang diberi kemoterapi neoadjuvan doxorubicin based sebesar 37% dan non-doxorubicin based sebesar 48,9%. Pasien kanker payudara stadium lanjut lokal yang mendapatkan kemoterapi neoadjuvan doxorubicin based memiliki probabilitas 1,38 kali lebih cepat terjadinya kematian (95% CI 0,946 – 2,026) setelah dikontrol dengan variabel invasi pembuluh limfatik, respon klinis, stadium, radiasi, jenis histopatologi, grade, dan status menopause. Invasi pembuluh limfatik merupakan variabel dengan hazard ratio terbesar yaitu 4,74 (95% CI 3,213 – 7,284). Kesimpulan: Kemoterapi neoadjuvan non-doxorubicin based menunjukkan kesintasan hidup yang lebih tinggi dibandingkan kemoterapi neoadjuvan doxorubicin based. Kata kunci : doxorubicin based, non-doxorubicin based, kanker payudara, kemoterapi neoadjuvan
ABSTRACT Name : Nuraini Oktaviani Study Program : Epidemiologi : Survival Rate 5-years Breast Cancer Locally Advanced Based on Chemotherapy Neoadjuvan in Hospital Cipto Mangunkusumo 2011-2016 Background : One of the therapeutic modalities used to increase survival rates of breast cancer patients with neoadjuvan chemotherapy. In general, neoajuvan chemotherapy for locally advanced breast cancer at RSCM used a doxorubicinbased regimen. But there has been no further study on the survival comparison of five years of locally advanced breast cancer patients who are neoadjuvan chemotherapy doxorubicin based or non-doxorubicin based at RSCM. Title Objectives: This study is conducted for determine 5-years survival rate of locally advanced breast cancer who were given neoadjuvan chemotherapy doxorubicin based and non-doxorubicin based at RSCM in 2011 - 2016. Methods: A total of 236 patients with locally advanced stage breast cancer who received neoadjuvan chemotherapy at RSCM in 2011-2016 were sampled in the study. Data analysis was perfomed by Kapplan Meier method, Log Rank and Cox Regreession analysis. Results: 5-years survival rate of locally advanced breast cancer patients given neoadjuvan doxorubicin based chemotherapy is 37% and non-doxorubicin based is 48.9%. Locally advanced breast cancer patients receiving neoadjuvan doxorubicin based chemotherapy had a 1.38 times faster probability of death (95% CI 0.946 - 2.026) after controlled by invasive variation of lymphatic vein, clinical response, stage, radiation, histopathology, grade, And menopausal status. Invasion of lymphatic vessels is the variable with the largest hazard ratio of 4.74 (95% CI 3,213 - 7,284). Conclusions: Neoadjuvan chemotherapy non-doxorubicin based showed a higher survival than doxorubicin-based for locally advanced breast cancer. Keywords: doxorubicin based, non-doxorubicin based, breast cancer, neoadjuvan chemotherapy
Kata Kunci : Obesitas, Kanker Payudara, Wanita
The prevalence of breast cancer in Indonesia in 2013 amounted to 0.05% and is the second highest prevalence of cancer after cervical cancer. One of the risk factors for breast cancer is obesity. The prevalence of obesity in women based on Riskesdas 2007- 2013 significantly increased (13.9%, 15.5%, and 32.9%). The purpose of this study is to know the relationship of obesity with incidence of breast cancer in women in Indonesia. Based on analysis of IFLS (Indonesian Family Life Survey) 5 conducted in the Year 2014 obtained data about breast cancer, obesity and other factors in 13 Provinces. The study design is cross sectional and using Logistic Regression data analysis. The results showed that the proportion of obese women with breast cancer in 13 provinces in Indonesia was 0.3%. Logistic Regression Analysis showed that obese women had a protective effect of 0.5 times against breast cancer after being controlled by age variables (POR = 0.4999; 95% CI 0.275-0.906). The conclusions of this study were obesity statistically related to the protective effect on breast cancer in women in 13 provinces in Indonesia 2014 after being controlled by age. Nevertheless, the proportion of obesity and breast cancer in Indonesia tends to increase, therefore we need to control of non-communicable disease prevention program in Indonesia.
Keywords: Obesity, Breast Cancer, Women
High-risk Human Papillomavirus (HR-HPV) is the necessary factor for the development of cervical cancer. The use of hormonal contraception has been associated with HR-HPV risk infection. However, the existing study results are not conclusive. There is very limited relevant data available in Indonesia. Hence, this study is aimed to evaluate the association between the use of hormonal contraceptives and infection risk of HR-HPV based on data from a 2019 screening program held by Indonesian Cancer Foundation, Jakarta branch, in Jakarta. This is a case-control study using secondary data from a cervical cancer screening program in Jakarta during January-December 2019. The case group is subjects with positive HPV-DNA test results from Hybrid Capture 2. The control group is randomly selected from the screening participants with negative HPV-DNA test results, with a ratio with the case is 2:1, and frequency matched based on area of domicile. Data is analyzed using multivariate analysis, unconditional logistic regression. The number of case in this study is 172 and 344 subjects in the control group. The prevalence of HR-HPV infection from the whole screening program is 6,56%. Most study participants were not using any kind of contraception methods (62,79% cases; 49,13% control). The risk of HR-HPV is crude OR 0,64 (95% CI 0,39-1,04, p=0,06) and adjusted OR 0,97 (95% CI 0,53-1,79; p=0,93). in current user of hormonal contraceptives. Whilst the association in the past users of hormonal contraception prior the test is crude OR 0,55 (95%CI 0,37-0,83; p=0,002) and adjusted OR 0,53 (95% 0,34-0,82; p=0,005). There is no significant association between the current user of hormonal contraceptives and the risk of HR-HPV infection. On the other hand there is a significant negative association in the past user group.