13 research outputs found
Multicenter randomized crossover trial evaluating the provox luna in laryngectomized subjects
Objectives: The aim of this study was to compare the relative compliance and the dermatological and pulmonary
outcomes when the Provox Luna system (Atos Medical, Malmö, Sweden) is added during the night to the usual tracheastoma
care of laryngectomized subjects.
Methods: This wa
Short-Term Effect of Different Teaching Methods on Nasopharyngeal Carcinoma for General Practitioners in Jakarta, Indonesia
In Indonesia, Nasopharyngeal Carcinoma (NPC) is the most frequent cancer of the head and neck region. At first presentation in the hospital most patients already have advanced NPC. Our previous study showed that general practitioners (GPs) working in Yogyakarta, Indonesia lack the knowledge necessary for early detection of NPC. By providing training on early symptoms of NPC we hope that the diagnosis and referral will occur at an earlier stage. Here we assess the current NPC knowledge levels of GPs in Jakarta, evaluate improvement after training, compare the effectiveness of two training formats, and estimate the loss of recall over a two week period
Effectiveness of a multicentre nasopharyngeal carcinoma awareness programme in Indonesia
Objective: To evaluate the effectiveness of a
nasopharyngeal carcinoma (NPC) awareness
programme on the short-term and long-term
improvement of knowledge and referral of patients with
NPC by primary healthcare centres (PHCCs) staff in
Indonesia.
Design: The NPC awareness programme consisted of
12 symposia including a Train-The-Trainer component,
containing lectures about early symptoms and risk
factors of NPC, practical examination and the referral
system for NPC suspects. Before and after training
participants completed a questionnaire. The Indonesian
Doctors Association accredited all activities.
Participants: 1 representative general practitioner
(GP) from each PHCC attended an NPC awareness
symposium. On the basis of the Train-The-Trainer
principle, GPs received training material and were
obligated to train their colleagues in the PHCC.
Results: 703 GPs attended the symposia and trained
1349 staff members: 314 other GPs, 685 nurses and
350 midwives. After the training, respondents’ average
score regarding the knowledge of NPC symptoms
increased from 47 points (of the 100) to 74 points
(p<0.001); this increase was similar between
symposium and Train-The-Trainer component
(p=0.88). At 1½ years after the training, this
knowledge remained significantly increased at 59
points (p<0.001).
Conclusions: The initial results of this NPC
awareness programme indicate that the programme
effectively increases NPC knowledge in the short and
long term and therefore should be continued. Effects
of the improved knowledge on the stage at diagnoses
of the patients with NPC will still need to be
scrutinised. This awareness programme can serve as a
blueprint for other cancer types in Indonesia and for
other developing countries
Primary treatment results of Nasopharyngeal Carcinoma (NPC) in Yogyakarta, Indonesia
INTRODUCTION Nasopharyngeal Carcinoma (NPC) is a major health problem in southern and eastern Asia. In Indonesia NPC is the most frequent cancer in the head and neck area. NPC is very sensitive to radiotherapy resulting in 3-year disease-free and overall survival of approximately 70% and 80%, respectively. Here we present routine treatment results in a prospective study on NPC in a top referral; university hospital in Indonesia. METHODS All NPC patients presenting from September 2008 till January 2011 at the ear, nose and throat (ENT) department of the Dr. Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia, were possible candidates. Patients were included if the biopsy was a histological proven NPC without distant metastasis and were assessed during counselling sessions prior to treatment, as being able to complete the entire treatment. RESULTS In total 78 patients were included for treatment analysis. The median time between diagnosis and start of radiotherapy is 120 days. Forty-eight (62%) patients eventually finished all fractions of radiotherapy. The median duration of the radiotherapy is 62 days for 66 Gy. Median overall survival is 21 months (95% CI 18–35) from day of diagnosis. CONCLUSION The results presented here reveal that currently the treatment of NPC at an Indonesian hospital is not sufficient and cannot be compared to the treatment results in literature. Main reasons for these poor treatment results are (1) a long waiting time prior to the start of radiotherapy, (2) the extended overall duration of radiotherapy and (3) the advanced stage of disease at presentation.Maarten A. Wildeman, Renske Fles, Camelia Herdini, Rai S. Indrasari, Andrew D. Vincent, Maesadji Tjokronagoro, Sharon Stoker, Johan Kurnianda, Baris Karakullukcu, Kartika W. Taroeno- Hariadi, Olga Hamming-Vrieze, Jaap M. Middeldorp, Bambang Hariwiyanto, Sofia M. Haryana, I. Bing Ta
A prospective study: current problems in radiotherapy for nasopharyngeal carcinoma in yogyakarta, indonesia
Nasopharyngeal carcinoma (NPC) has a high incidence in Indonesia. Previous study in Yogyakarta revealed a complete response of 29% and a median overall survival of less than 2 years. These poor treatment outcome are influenced by the long diagnose-to-treatment interval to radiotherapy (DTI) and the extended overall treatment time of radiotherapy (OTT). This study reveals insight why the OTT and DTI are prolonged. All patients treated with curative intent radiotherapy for NPC between July 2011 until October 2012 were included. During radiotherapy a daily diary was kept, containing information on DTI, missed radiotherapy days, the reason for missing and length of OTT. Sixty-eight patients were included. The median DTI was 106 days (95% CI: 98-170). Fifty-nine patients (87%) finished the treatment. The median OTT for radiotherapy was 57 days (95% CI: 57-65). The main reason for missing days was an inoperative radiotherapy machine (36%). Other reasons were patient's poor condition (21%), public holidays (14%), adjustment of the radiation field (7%), power blackout (3%), inoperative treatment planning system (2%) and patient related reasons (9%). Patient's insurance type was correlated to DTI in disadvantage for poor people. Yogyakarta has a lack of sufficient radiotherapy units which causes a delay of 3-4 months, besides the OTT is extended by 10-12 days. This influences treatment outcome to a great extend. The best solution would be creating sufficient radiotherapy units and better management in health care for poor patients. The growing economy in Indonesia will expectantly in time enable these solutions, but in the meantime solutions are needed. Solutions can consist of radiation outside office hours, better maintenance of the facilities and more effort from patient, doctor and nurse to finish treatment in time. These results are valuable when improving cancer care in low and middle income countrie
Overall treatment time and missed days.
<p>OTT =  overall treatment time, IQR =  inter quartile range, CI =  confidence interval.</p
Distribution of overall treatment time and insurance type.
<p>The dark line in the middle of the boxes is the median. The bottom and top of the boxes indicate the 25th and the 75th percentile. The T-bars are the inner fences of all subjects and extend to a maximum of 1.5 times the inter quartile range. * are outliers until 3 times the inter quartile range. <sup>0</sup> are outliers exceeding 3 times the quartile range.</p