Quality of Life Assessment in Patient who Underwent Chemotherapy in Gynaecologic Oncology Division: Penilaian Kualitas Hidup pada Pasien yang menjalani Kemoterapi di Divisi Onkologi Ginekologi

Abstract Objective: To determine the quality of life in cancer patients who underwent chemotherapy treatment.Methods: A cross-sectional study was conducted from June to August 2019. Patients with cancer, who had undergone chemotherapy and willing to participate were included in this study. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ–30) questionnaire was used as the measurement tool. The patients were grouped into three groups based on the cycles of chemotherapy.Results: Sixty three responders participated in the study. As the treatment progressed, there was a signifi cant decrease in Global Health Status (GHS) and social function. In symptom scales, there was a signifi cant increase in nausea and vomiting, pain, and insomnia.Conclusions: There was a decrease in the quality of life in patients with gynecological cancer who underwent chemotherapy in dr. Cipto Mangunkusumo National General Hospital. This result should be an evaluation for the healthcare provider to implement a holistic approach in managing cancer patients.Keywords: chemotherapy, gynaecological cancer, quality of life.  Abstrak Tujuan: Untuk menilai kualitas hidup pasien kanker yang menjalani kemoterapi.Metode: Penelitian dilakukan dengan metode potong lintang, dilakukan dari Juni hingga Agustus 2019. Semua pasien dengan kanker yang menjalani kemoterapi dan bersedia mengikuti penelitian diikutsertakan dalam penelitian ini. Penilaian dilakukan menggunakan kuisioner dari The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ- 30) digunakan. Pasien dikelompokkan menjadi 3 kelompok berdasarkan siklus kemoterapinya.Hasil: Terdapat 63 pasien yang berpartisipasi dalam penelitian ini. Seiring pengobatan, terdapat penurunan signifikan pada global health status (GHS) dan fungsi sosial. Gejala yang meningkat secara signifi kan antara lain mual dan muntah, nyeri, dan insomnia.Kesimpulan: Terdapat penurunan kualitas hidup pada pasien kanker ginekologi yang menjalani kemoterapi di Rumah Sakit Dr. Cipto Mangunkusumo. Hasil penelitian ini menjadi evaluasi untuk penyedia layanan kesehatan agar dapat menangani pasien kanker secara holistik.Kata kunci: kanker ginekologi, kemoterapi, kualitas hidup

Augmented Reality Application for Surgery Simulation: Circumcision Augmented Reality Simulation (CARS)

As one of the most common minor surgical procedure performed globally, male circumcision has some complications when performed by medically trained providers and non-medically trained providers. Presently, there is no standardized circumcision training approach, and there have been variable resources and materials used. We constructed a low-cost, and mobile circumcision training application augmented reality called Circumcision Augmented Reality Simulation (CARS). CARS is built in a computer with minimum processor 4Ghz (RAM 4GB, VGA 2GB) and smartphone with Blender, Inkscape, Audacity and Unity3D software. Features that are provided in CARS are including 3D models, animation and sound of circumcision procedure. CARS was tested through several steps including black box technique, response time loading and layer resolution examination. The trial is also done with various smartphones. The angles detected ranging from 20o-90o, with a maximum distance of 4 m using markers measuring 20x22 cm. Based on the percentage of the enclosed barrier, the marker can be detected between 0-90 percent. CARS as an example of augmented reality application for surgery simulation has been successfully built with features performing circumcision simulation and suitable for potential users (medical students and doctors). Implications for future research include assessing reliability and validity by growing its use to a broader population, creating another surgery procedure simulation with augmented reality technology using smartphone

Radiotherapy Response of Cervical Cancer Patients at a Tertiary Referral Hospital in Indonesia

Objective: To investigate the response of radiotherapy and related clinicopathologic characterictics on cervical cancer patients. Methods: This was a retrospective study. Subjects were patients diagnosed with cervical cancer stage IIA-IIIB who had undergone radiation therapy based on standard protocol in our hospital, during the period of January 2014 to December 2015. The clinical factors of those patients, such as age, Body Mass Index, blood pressure, hemoglobin level, blood leucocyte count, serum albumin, largest tumor diameter, the International Federation of Gynecology and Obstetrics (FIGO) staging, as well as pathologic characteristic, i.e histopathology and grading were recorded. During radiation protocol until 3 months post radiation, we also noted any side effects of gastrointestinal tract, genitourinary tract, and hematologic. Evaluation of radiotherapy response was based on Response Evaluation Criteria in Solid Tumors (RECIST).  Results: A total of 123 subjects were enrolled in this study. 84 cases or 68.29% was complete response, 30 cases or 24.39% was partial response, 6 cases or 4.88% was stabile response, and 3 cases or 2.44% was progressive. Based on gastrointestinal side effect, there was no side effect or grade 0 on 99 cases (80.49%), grade 1 on 20 cases (16.26%), grade 2 on 4 cases (3.25%), grade 3 on 0 case (0%). Based on side effect of genitourinary, there was no side effect or grade 0 on 105 cases (85.37%), grade 1 on 17 cases (13.82%), grade 2 on 1 case (0.81%), grade 3 on 0 case (0%). Based on hematologic side effects, there was no side effect on 108 cases (87.80%), grade 1 on 15 cases (12.20%), grade 2 on 0 case (0%), grade 3 on 0 case (0%). Largest tumor diameter was statistically significant, with p=0.036 (RR 2.64 (1.07-6.56)). Conclusion: The majority of definitive-curative radiotherapy response on cervical cancer stage IIA-IIIB was complete (68.29%). Acute side effects involving the gastrointestinal, genitourinary, and hematologic system were commonly can be tolerable during and 3 months post radiation therapy. Clinicopathologic characteristics significantly associated with the complete response of radiotherapy was the largest tumor diameter. Keywords: largest tumor diameter, radiation response, radiation side effec

The Prevalence of Occult Omental Metastases in Patients with Epithelial Ovarian Cancer

Objective: Studies regarding omentectomy on epithelial ovarian cancer are scarce with conflicting results; this study is aimed to investigate the prevalence of occult metastases in patients with epithelial ovarian cancer of the omentum. Methods: A cross-sectional study design was used by evaluating the medical records of surgically staged ovarian cancer patients in Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia during the period of January 2009 to December 2015. Results: A total of 51 subjects were involved in this study. One (2%) of 51 subjects was found to have occult metastases in the omentum. The prevalence of metastases of early stage epithelial ovarian cancer in 2009-2015 is 33.3% (17 out of 51 subjects), whereas the omental involvement is found only in 2% subjects (1 out of 51). Conclusion: The prevalence of occult metastases of early stage epithelial ovarian cancer in Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from 2009-2015 in 2% (1/51 subjects). [Indones J Obstet Gynecol 2018; 6-2: 119-122] Keywords: cancer, epithelial, metastases, omentum, ovarian cancer, ovary, prevalenc

Plasma MicroRNA-200c as A Prognostic Biomarker for Epithelial Ovarian Cancer

BACKGROUND: Ovarian cancer is the 8th most prevalent cancer in women in the world. Current biomarker prognosis for ovarian cancer has numerous limitations, thus new biomarkers are needed. MicroRNAs (miRs) are considered as potential biomarkers in ovarian cancer as they are stable in blood. One candidate is miR-200c, the main regulator in epithelial transition to the mesenchyme. The aim of this study is to determine the role of miR-200c as prognostic biomarker for epithelial ovarian cancer (EOC).METHODS: This is a prospective cohort study conducted at Dr. Sardjito Central General Hospital in Yogyakarta from September 2015 to July 2018. Sampling was done using consecutive sampling method. Forty plasma samples of EOC subjects were included in this study. miR-200c expression was quantified using Reverse Transcriptase Quantitative Quantitative Polymerase Chain Reaction (RTqPCR) with miR-16 as the reference gene.RESULTS: The expression of miR-200c was significantly higher in the group of subjects with preoperative CA-125 levels >500 U/mL (p=0.009) than the group of subjects with preoperative CA-125 levels <500 U/mL. Subjects with higher miR-200c expression had lower survival rate than subjects with lower miR-200c expression, although not statistically significant.CONCLUSION: The miR-200c could be a promising biomarker for EOC. Further studies with larger sample sizes are needed to clarify the prognostic value of miR200c.KEYWORDS: miR-200c, epithelial ovarian cancer, prognosis, overall surviva

Radiotherapy Response of Cervical Cancer Patients at a Tertiary Referral Hospital in Indonesia: Respon Terapi Radiasi Pasien Kanker Serviks pada suatu Rumah Sakit Rujukan Tersier

Objective: To investigate the response of radiotherapy and related clinicopathologic characterictics on cervical cancer patients. Methods: This was a retrospective study. Subjects were patients diagnosed with cervical cancer stage IIA-IIIB who had undergone radiation therapy based on standard protocol in our hospital, during the period of January 2014 to December 2015. The clinical factors ofthose patients, such as age, Body Mass Index, blood pressure, hemoglobin level, blood leucocyte count, serum albumin, largest tumor diameter, the International Federation of Gynecology and Obstetrics (FIGO) staging, as well as pathologic characteristic, i.e histopathology and grading were recorded. During radiation protocol until 3months post radiation, we also noted any side effects of gastrointestinal tract, genitourinary tract, and hematologic. Evaluation of radiotherapy response was based on Response Evaluation Criteria in Solid Tumors (RECIST).&nbsp; Results: A total of 123 subjects were enrolled in this study. 84 cases or 68.29% was complete response, 30 cases or 24.39% was partial response, 6 cases or 4.88% was stabile response, and 3 cases or 2.44% was progressive. Based on gastrointestinal side effect, there was no side effect or grade 0 on 99 cases (80.49%), grade 1 on 20 cases (16.26%), grade 2 on 4 cases (3.25%), grade 3 on 0 case (0%). Based on side effect of genitourinary, there was no side effect or grade 0 on 105 cases (85.37%), grade 1 on 17 cases (13.82%), grade 2 on 1 case (0.81%), grade 3 on 0 case (0%). Based on hematologic side effects, there was no side effecton 108 cases (87.80%), grade 1 on 15 cases (12.20%), grade 2 on 0 case (0%), grade 3 on 0 case (0%). Largest tumor diameter was statistically significant, with p=0.036 (RR 2.64 (1.07-6.56)). Conclusion: The majority of definitive-curative radiotherapy response on cervical cancer stage IIA-IIIB was complete (68.29%). Acute side effects involving the gastrointestinal, genitourinary, and hematologic system were commonly can be tolerable during and 3 months post radiation therapy. Clinicopathologic characteristics significantly associated with the complete response of radiotherapy was the largest tumor diameter. Keywords: largest tumor diameter, radiation response, radiationside effec

The Role of Thrombocytosis as a Prognostic Factor for Epithelial Ovarian Cancer: Peran Trombositosis sebagai Faktor Prognostik pada Kanker Ovarium Jenis Epitelial

Objective: To determine whether thrombocytosis is a prognostic factor for epithelial ovarian cancer and its relationship with 3-year overall survival in epithelial ovarian cancer patients.Methods: This study is a retrospective cohort study using medical record of patients with epithelial ovarian cancer registered in cancer registry of Oncology Division in Obstetrics and Gynecology Department, Dr. Cipto Mangunkusumo National General Hospital from January 2014 - July 2016. Data were collected when subjects were first until diseases outcomes identified in 3 years.Results: : Out of 220 subjects, 132 (60%) were patients with advanced stage epithelial ovarian cancer (stage II/III/IV). 94 (42.7%) subjects had thrombocytosis. Patients with advanced stage of disease had higher risk of having thrombocytosis than the ones with earlier stage (p=0.005; OR=2.329). Correlation between thrombocytosis and 3-year overall survival was known to be insignificant (p=0.555). There was shorter mean time survival between patients with thrombocytosis and the ones without but the there was no significant difference in hazard ratio between the two groups (p&nbsp; = 0.399).Conclusion :Thrombocytosis is not a prognostic factor in patients with epithelial ovarian cancer. There is also no significant difference of 3-year overall survival between patients with or without thrombocytosis.Keywords: epithelial ovarian carcinoma, prognosis,&nbsp; thrombocytosis. &nbsp; Abstrak Tujuan: Membuktikan bahwa trombositosis sebagai faktor prognosis kesintasan pada pasien kanker ovarium jenis epitelial dan hubungannya terhadap kesintasan 3 tahun pasien kanker ovarium&nbsp; jenis epitelial.Metode: Penelitian ini merupakan studi kohort retrospektif menggunakan data rekam medis pasien kanker ovarium epitelial yang terdaftar pada cancer registry Departemen Obstetri dan Ginekologi Divisi Onkologi Rumah Sakit Cipto Mangunkusumo pada tahun Januari 2014-Juli 2016. Pengamatan dilakukan saat subjek pertama kali didiagnosis akhir pengamatan selama 3 tahun.Hasil: Didapatkan 220 subjek penelitian yang merupakan populasi terjangkau dan memenuhi kriteria inklusi dan eksklusi. Dari 220 subjek penelitian, 132 (60%) dari 220 subjek penelitian merupakan pasien dengan kanker ovarium stadium lanjut (Stadium II/III/IV). Trombositosis didapatkan pada 94 orang subjek penelitian (42,7%). Pasien dengan kanker stadium lanjut memiliki risiko trombositosis yang lebih tinggi dibandingkan subjek pada stadium awal (p=0,005;OR=2,329). Trombositosis secara statistik tidak bermakna pada kesintasan 3 tahun (p=0,555). Terdapat mean time survival yang lebih rendah pada pasien dengan trombositosis tetapi tidak ada perbedaan hazard ratio yang bermakna antara subjek dengan atau tanpa trombositosis (p=0,399).Kesimpulan : Trombositosis bukan merupakan faktor prognostik pada pasien kanker ovarium jenis epitelial dan tidak terdapat hubungan antara trombositosis dan 3 tahun pada pasien dengan kanker ovarium jenis epithelial.Kata kunci: karsinoma ovarium epithelial, &nbsp;prognosis, trombositosi

HE4 has a High Diagnostic Value to Detect Epithelial Ovarian Cancer

Objective: To find out the diagnostic value of CA125 and HE4 as a tumor marker, and also RMI and ROMA as a malignancy predictor in patients with ovarian tumors. Methods: This study was a diagnostic study using cross-sectional design.This study was performed in Jakarta from November 2010 to May 2011. One hundred and twenty eight serum samples of patients diagnosed with ovarian tumors were collected before undergoing surgery in Dr. Cipto Mangunkusumo General Hospital. The CA125 and HE4 levels were then examined. The histopathological examination of tissue specimens were performed in Department of Pathology Anatomy in RSCM. For statistical analysis, we used a 2x2 table to produce ROC-AUC curve. Results: The median value of HE4 and CA125 serum concentrations was higher and more significant on patients with ovarian malignancy than patients with benign ovarian tumor (p<0.05). Using the cut-off standard, HE4 had the highest accuracy value (76.5%). On the premenopausal group, HE4 and ROMA had the same AUC value, that is 85.0 % (95% CI: 0.73-0.96), whereas on the postmenopausal group, ROMA had the highest AUC value of 96.9 % (95% CI: 0.92-1.00). Conclusion: HE4 has a high diagnostic value as a single tumor marker to detect epithelial ovarian cancer and its combination with CA125 (ROMA) gives an even better result.  Keywords: epithelial ovarian cancer, human epididymis protein 4, risk of ovarian malignancy algorithm, tumor marke

EVALUATION OF MYOMETRIAL INVASION AND CERVICAL INVOLVEMENT IN TYPE I ENDOMETRIAL CANCER USING DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING

Objective: Surgical procedure and adjuvant treatment of type I endometrial cancer were affected by some variables assessed preoperatively. Diffusion-weighted magnetic resonance imaging (DWI) is a promising modality in evaluating myometrial invasion and cervical involvement, investigating the diagnostic values of DWI in assessing myometrial invasion and cervical involvement. Methods: A cross-sectional study was conducted. This study involved all type I endometrial cancer patients in Dr. Cipto Mangunkusumo Hospital from April 2016 until April 2019. The depth of myometrial invasion and cervical involvement was examined using 1.5-T MR unit. The result was compared to the surgical pathologic findings as the reference standard. Results: 34 types I endometrial cancer patients were enrolled in this study. The sensitivity of DWI in evaluating myometrial invasion and cervical involvement in type I endometrial cancer was 94.12% and 57.14%, while the specificity was 64.71% and 92.59%, respectively. Conclusion: DWI can provide reliable prognostic variable information about the myometrial invasion and cervical involvement in the preoperative preparation of endometrial cancer patients

PERSPECTIVE OF JUNIOR RESIDENTS ON THE ROLE OF CHIEF RESIDENT AS A TEACHER IN OBSTETRICS AND GYNECOLOGY DEPARTMENT, UNIVERSITAS INDONESIA

Objective: Resident juniors are often exposed and taught by the Chief Residents in daily routines. However, there are no data regarding the quality of senior residents as teachers. We conducted a questionnaire-based evaluation to determine the quality of Chief Residents from a junior resident's perspective. Methods: This study was conducted from May to July 2019 in the Department of Obstetrics and Gynecology. Fifteen questions regarding the quality of chief residents as teachers, which consist of a safe learning environment, team working, coaching by demonstration and observation, stimulating learning and role modeling from junior’s perspective and one open question for suggestions were given using the Google Form internet-based application. Data were analyzed using Ms. Excel. Results: 75 junior residents (100%) participated in this study. Ten out of 15 questions were answered and agreed that the chief resident had qualifications as a teacher (88%). The most valued performances were the ability in selecting patients to the junior based on their level of competency and allowing them to do procedures (92%), while the most undervalued was chief resident’s ability to teach as good as their consultant (45%). Conclusion: Our study showed that most of the junior residents agreed that the presence of their senior is compulsory to their learning experience. Learning from seniors, including the consultant, will make a better learning environment