Palliative Care on Cancer Patients at Sanglah General Hospital, Denpasar Bali.
Palliative Care on Cancer Patients at Sanglah General Hospital,
Denpasar Bali*
IGAA Jayanthi Wulan Utami1, Putu Anda Tusta Adiputra2
1
2
Undergraduate Student Faculty of Medicine Udayana University
Oncology Division, Surgery Department Sanglah General Hospital / Faculty of Medicine Udayana University
*Has been presented on The 23rd Asia Pacific Cancer Conference (APCC) 2015
ABSTRACT
Background: Palliative care is a treatment option for cancer patients who have entered the
final stage / terminal phase. Often cancer patients die in a state of pain. Palliative care in
cancer patients can improve the quality of life of cancer patients. Palliative care in Indonesia
has been running more than a decade but the development of this field is not as fast as other
fields.
Methods: The data was collected using retrospective method by looking at the secondary
data obtained from Sanglah Hospital in 2013. As well as by reviewing the literature study
based on the results of an assessment of the literature that the validity has been tested and
issues relevant to the topic.
Results: There were a number of 122 cancer patients who received palliative care at the
Central General Hospital (RSUP) Sanglah in 2013 with the ratio of men and women was 1:
1.65. Cervical cancer was the type of cancer that affects most patients receiving palliative
care in 2013. While based on the classification of age, the age group 41-60 years was the age
group in which most patients received palliative care at Sanglah Hospital in 2013.
Conclusions: Palliative care in cancer patients at RSUP Sanglah was done comprehensively
and focused not only to the general state of the patient but also on the patient's psychosocial
approach to form holistic treatments to improve the quality of life of cancer patients.
Keywords: palliative, cancer, quality of life, treatment of cancer
1
Palliative Care on Cancer Patients at Sanglah General Hospital,
Denpasar Bali*
IGAA Jayanthi Wulan Utami1, Putu Anda Tusta Adiputra2
1
2
Undergraduate Student Faculty of Medicine Udayana University
Oncology Division, Surgery Department Sanglah General Hospital / Faculty of Medicine Udayana University
*Has been presented on The 23rd Asia Pacific Cancer Conference (APCC) 2015
ABSTRACT
Background: Palliative care is a treatment option for cancer patients who have entered the
final stage / terminal phase. Often cancer patients die in a state of pain. Palliative care in
cancer patients can improve the quality of life of cancer patients. Palliative care in Indonesia
has been running more than a decade but the development of this field is not as fast as other
fields.
Methods: The data was collected using retrospective method by looking at the secondary
data obtained from Sanglah Hospital in 2013. As well as by reviewing the literature study
based on the results of an assessment of the literature that the validity has been tested and
issues relevant to the topic.
Results: There were a number of 122 cancer patients who received palliative care at the
Central General Hospital (RSUP) Sanglah in 2013 with the ratio of men and women was 1:
1.65. Cervical cancer was the type of cancer that affects most patients receiving palliative
care in 2013. While based on the classification of age, the age group 41-60 years was the age
group in which most patients received palliative care at Sanglah Hospital in 2013.
Conclusions: Palliative care in cancer patients at RSUP Sanglah was done comprehensively
and focused not only to the general state of the patient but also on the patient's psychosocial
approach to form holistic treatments to improve the quality of life of cancer patients.
Keywords: palliative, cancer, quality of life, treatment of cancer
1
INTRODUCTION
Cancer is a group of diseases characterized
by
abnormal
cell
growth
and
1
uncontrolled. Cancer is a chronic disease
that can be caused by both external factors
(tobacco,
viruses,
chemicals,
and
radiation) and internal factors (gene
mutations, hormones, immune conditions,
and metabolic disorders). Those causal
factors can initiate or trigger the growth of
cancer cells.
Based on data from the Centers for
Diseases Control and Prevention (CDC),
cancer is the second leading cause of death
in the United States. One in four deaths in
the United States are caused by this
disease. According to the United States
Cancer Statistics, approximately 1,575
people per day died of cancer in the United
States in 2010.2 In Indonesia, cancer is the
7th leading cause of death based on the
Basic Health Research (RISKESDAS)
conducted by the National Health
Department of Indonesia in 2007.3
The choice of therapy for cancer varies
depending on the stage of the disease.
Treatment performed can be surgery,
radiation therapy, chemotherapy, hormonal
therapy, targeted therapy as well as
biological therapy.4 Cancers often cause
various complaints and the treatment given
was often yielding side effects for cancer
patients. Therefore, cancer patients are
sometimes also given treatment to relieve
symptoms caused. Curing a cancer patients
often are not possible. If the cancer has
metastasized to other organs or if treatment
is not successful then the cancer can be
classified into advanced or terminal
cancer. For cancer patients diagnosed with
advanced cancer, cancer treatment will be
focused on palliative care.
In Indonesia, palliative care has evolved in
Surabaya and Jakarta since 1992.5
Currently, there have been six health
centers that provide palliative care, i.e. 2 in
Jakarta, as well as each one in Surabaya,
Denpasar Bali, Yogyakarta and Makassar
South Sulawesi.5.6
Sanglah General Hospital is the main
referral hospital in Denpasar. As a main
hospital, Sanglah Hospital provides
palliative care for cancer patients. But
unfortunately until now, the field of
palliative care is still not much recognized
as other treatments. In fact, some studies
suggest that palliative care can improve the
quality of life of cancer patients.7
Unfortunately, there is still little interest in
palliative care research.8 Especially very
few research on how palliative care in
Indonesia and Bali occurred.
Based on the background described above,
it can be formulated several problems,
namely how palliative care in cancer
patients at RSUP Sanglah and how the
characteristics of cancer patients who
receive palliative care Sanglah Hospital in
Denpasar.
In terms of theoretical research, it is
expected that this research can be useful in
terms of reference for the development of
subsequent research and development of
science in the field of health, especially in
the field of palliative care.
RESEARCH METHOD AND SAMPLE
This research is categorical descriptive
using retrospective research study designs.
All data from this study were analyzed
descriptively and some of the results are
displayed in tables, pie charts and bar
charts.
2
Samples were taken from the Central
General Hospital (RSUP) Sanglah as a
government referral for doing palliative
care services. Samples taken are cancer
patients who receive care by a team of Poli
Palliative Sanglah Hospital in 2013. The
inclusion criteria for the search of samples
in this study were patients with cancer who
undergo inpatient or outpatient treatment
at Sanglah Hospital who were diagnosed
based on physical examination, imaging,
and histopathologic. While exclusion
criteria were cancer patients undergoing
inpatient or outpatient treatment at Sanglah
Hospital who did not get palliative care.
DATA ANALYSIS
Once the necessary data collected, data
processing and arrangement is done in a
systematic and logical manner. Data
analysis used is descriptive argumentative
data analysis. The formulation of the
problem, research objectives, and the
discussion was analyzed then connected to
draw general conclusions. The collected
data were grouped by gender, age, and
type of cancer.
By age group, cancer patients who receive
palliative care in 2013 aged 60 years were 22% (28).
Based on the type of cancer, most cancer
patients who received palliative care was
that of cervical cancer by 41 patients.
Nasopharyngeal cancer were 17, 11 lung
cancer patients, 9 patients with breast
cancer, 5 patients with ovarian cancer, 5
patients with pancreatic cancer, prostate
cancer 3 patients, 2 patients with colon
cancer, penile cancer 1 patient, as well as
other types of cancer (sinus and nasal
cancer, thyroid gland cancer, malignant
melanoma, non-Hodgkin lymphoma, etc.)
28 patients.
Bar Chart 1. Cancer Patients Getting
Palliative Care at Sanglah General Hospital
Based on Gender
RESULTS
Patient data used is cancer patients data
who were hospitalized at Sanglah Hospital
and received palliative care by 2013.
Characteristics of patients sought was
based on the patient's gender, age of the
patient, as well as the type of cancer that
suffered by the patient. Of the 122 cancer
patients who were treated by a team of
Palliative at RSUP Sanglah, as much as
38% (46 people) male and 62% (76
people) were female. Ratio of male and
female patients, were up to 1: 1.65.
3
Bar Chart 2. Cancer Patient who Receive Palliative Care at Sanglah General Hospital
Based on Age Group
(59%)
(22,97%)
(16,39%)
(1,64%)
Table 1. Cancer Patient Getting Palliative Care at Sanglah General Hospital BaseType
of Cancer
Jenis Kanker
Cervical cancer
Jumlah Pasien (%)
41 (33.6 %)
Nasopharinx cancer
17 (14 %)
Lung cancer
11 (9 %)
Breast cancer
9 (7.5%)
Ovarium cancer
5 (4%)
Pancreatic cancer
5 (4%)
Prostate cancer
3 (2,5 %)
Colon cancer
2 (1,6 %)
Penile cancer
1 (0,08 %)
Other types of cancer
(Nasal and sinus cancer, Thyroid cancer,
melanoma maligna, limpoma non-
28 (23 %)
hodgkin, etc)
4
DISCUSSION
1. Palliative Care on Cancer Patients in
Sanglah Central General Hospital
According to WHO, palliative care is
defined as an approach that aims to
improve the quality of life of patients and
their families in dealing with the problems
associated with life-threatening illness, by
preventing and relieving suffering through
early identification and assessment and
treatment of pain and other problems-both
physical , psychosocial and spiritual.9,10
Palliative care improve the quality of life
of cancer patients not only by freeing the
patient from pain, but also from the
spiritual and psychosocial support that
may be needed by patients since the
beginning of the diagnosis until the death
of the patient. Palliative care helps the
patient to appreciate life and accept death
as a natural process, so as to improve the
quality of life of patients holistically and
also can provide a positive influence for
cancer disease suffered by the patients.
Palliative care in Sanglah General Hospital
was conducted by a team of multidisciplinary specialists from as many as 13
doctors and 2 nurses as care performer.
Palliative care given to cancer patients
varies according to the patient's
complaints. If the patient does not have
complaints, follow-up of patients is still
being done every day. The aspects that are
assessed
include
pain
assessment,
effectiveness of treatment, and the patient's
general condition.
For pain management, WHO has
developed a three-step ladder for cancer
pain management in adults.11,12 When pain
is felt by the patient, the treatment
sequence starting from the class
nonopioids (aspirin and paracetamol); then
if it has not sufficiently followed by mild
opioids (codeine); and strong opioids such
as morphine, until the patient felt pain free.
To dampen anxiety, the patient may also
be given an additional form of adjuvant
drugs. To achieve pain relief, treatment
should be administered in a manner "by
the clock" ie, every 3 to 6 hours, and not
only when necessary. If the approach to
the way this is done at the right time and
dose then 80% -90% can overcome pain
effectively.12 Unlike in pediatric patients,
pain management just made up the second
ladder.
2. Characteristics of the Cancer Patients
Getting Palliative Care at Sanglah
Hospital in 2013
From the research, it was found that in
2013 there were 129 cancer patients who
received palliative care. But the 7 patients
in the processing of data obtained were
excluded because of incomplete data. Of
the 122 cancer patients, most cancer
patients was female which amounted to
62% and male patients as much as 38%.
The ratio of male patients and female was
1: 1.65. This relates to the type of cancer
that receive palliative care in 2013 in
which patients with cervical cancer is a
type of cancer that affects most patients
receiving palliative care at Sanglah
Hospital in 2013 as many as 33.6% (41
patient). According to the age group,
cancer patients who received palliative
care were most of the 41-60 years age
group for about 59% (72 patients).
5
CONCLUSION
Palliative care in cancer patients at RSUP
Sanglah was done comprehensively, not
just focused on the reduction of pain, the
effectiveness of treatment, and the patient's
general condition, but treatment is also
done in terms of patient’s psychosocial to
form holistic treatments to improve the
quality of life of cancer patients. Cancer
patients who receive palliative care at
Sanglah Hospital in 2013 as many as 122
people with a ratio of men and women
about 1: 1.65. Cervical cancer is a type of
cancer that affects most patients receiving
palliative care at Sanglah Hospital in 2013.
While based on age, the age group 41-60
years is the age group in which most
patients received palliative care at Sanglah
Hospital in 2013.
REFERENCES
1.
2.
3.
4.
American Cancer Society. Cancer
Facts & Figures 2012. Atlanta:
American Cancer Society; 2012.
World Health Organization. The
Global Burden of Disease: 2004
Update. Geneva: World Health
Organization; 2008.
Disease Statistics Data in Indonesia
[Internet] 2010. [cited 2013 November
20].
Available
from
:
http://www.riskesdas.litbang.depkes.g
o.id/
download/TabelRiskesdas2010.pdf
American
Society
of
Clinical
Oncology [Internet] [updated April
2013; cited 2013 November 24].
Available
from
:
http://www.cancer.net/all-about-
cancer/treating-cancer/caringsymptoms-cancer-and-its-treatment
5. Bruera E, Higginson IJ, Ripamonti C,
Von Gunten C. Textbook of Palliative
Medicine.
London: Hodder
Arnold; 2006
6. Kim A, Fall P, Wang D. Palliative
Care: Optimizing Quality of Life. The
Journal of The American Osteophatic
Association.
7. Bakitas M, Lyons KD; Hegel MT,
Balan S, Brokaw FC, Seville J, Hull
JG, Li Z, Tosteson TD, Byock IR,
Ahles TA. Effects of a Palliative Care
Intervention on Clinical Outcomes in
Patients With Advanced CancerThe
Project ENABLE II Randomized
Controlled
Trial.
JAMA. 2009;302(7):741-749.
8. MacDonald N. Palliative Care-An
Essential Component of Cancer
Control.
Canadian
Medical
Association. June 30 1998; 158 (13)
9. Guidelines & Protocols Advisory
Committee Palliative Care for the
Patient with Incurable Cancer or
Advanced Diseases. Family Practice
Oncology Network and the Guidelines
and
Protocols
Advisory
Committee. 2010
10. Eguchi K. Development of Palliative
Medicine for Cancer Patients in Japan:
From Isolated Voluntary Effort to
Integrated Multidisciplinary Network.
Jpn J Clin Oncol, vol. 40, 2010,
p.870-875; 17
11. Eldridge L. Lung Cancer [Internet]
2012. [Updated 2012 October 2; Cited
2013 November 24]. Available from :
http://lungcancer.about.com/od/treatm
entoflungcancer/f/palliativechemo.htm
12. World Health Organization. WHO’s
Pain Ladder for Adults [Internet].
http://www.who.int/cancer/palliative/p
ainladder/en/index.html
6
Palliative Care on Cancer Patients at Sanglah General Hospital,
Denpasar Bali*
IGAA Jayanthi Wulan Utami1, Putu Anda Tusta Adiputra2
1
2
Undergraduate Student Faculty of Medicine Udayana University
Oncology Division, Surgery Department Sanglah General Hospital / Faculty of Medicine Udayana University
*Has been presented on The 23rd Asia Pacific Cancer Conference (APCC) 2015
ABSTRACT
Background: Palliative care is a treatment option for cancer patients who have entered the
final stage / terminal phase. Often cancer patients die in a state of pain. Palliative care in
cancer patients can improve the quality of life of cancer patients. Palliative care in Indonesia
has been running more than a decade but the development of this field is not as fast as other
fields.
Methods: The data was collected using retrospective method by looking at the secondary
data obtained from Sanglah Hospital in 2013. As well as by reviewing the literature study
based on the results of an assessment of the literature that the validity has been tested and
issues relevant to the topic.
Results: There were a number of 122 cancer patients who received palliative care at the
Central General Hospital (RSUP) Sanglah in 2013 with the ratio of men and women was 1:
1.65. Cervical cancer was the type of cancer that affects most patients receiving palliative
care in 2013. While based on the classification of age, the age group 41-60 years was the age
group in which most patients received palliative care at Sanglah Hospital in 2013.
Conclusions: Palliative care in cancer patients at RSUP Sanglah was done comprehensively
and focused not only to the general state of the patient but also on the patient's psychosocial
approach to form holistic treatments to improve the quality of life of cancer patients.
Keywords: palliative, cancer, quality of life, treatment of cancer
1
INTRODUCTION
Cancer is a group of diseases characterized
by
abnormal
cell
growth
and
1
uncontrolled. Cancer is a chronic disease
that can be caused by both external factors
(tobacco,
viruses,
chemicals,
and
radiation) and internal factors (gene
mutations, hormones, immune conditions,
and metabolic disorders). Those causal
factors can initiate or trigger the growth of
cancer cells.
Based on data from the Centers for
Diseases Control and Prevention (CDC),
cancer is the second leading cause of death
in the United States. One in four deaths in
the United States are caused by this
disease. According to the United States
Cancer Statistics, approximately 1,575
people per day died of cancer in the United
States in 2010.2 In Indonesia, cancer is the
7th leading cause of death based on the
Basic Health Research (RISKESDAS)
conducted by the National Health
Department of Indonesia in 2007.3
The choice of therapy for cancer varies
depending on the stage of the disease.
Treatment performed can be surgery,
radiation therapy, chemotherapy, hormonal
therapy, targeted therapy as well as
biological therapy.4 Cancers often cause
various complaints and the treatment given
was often yielding side effects for cancer
patients. Therefore, cancer patients are
sometimes also given treatment to relieve
symptoms caused. Curing a cancer patients
often are not possible. If the cancer has
metastasized to other organs or if treatment
is not successful then the cancer can be
classified into advanced or terminal
cancer. For cancer patients diagnosed with
advanced cancer, cancer treatment will be
focused on palliative care.
In Indonesia, palliative care has evolved in
Surabaya and Jakarta since 1992.5
Currently, there have been six health
centers that provide palliative care, i.e. 2 in
Jakarta, as well as each one in Surabaya,
Denpasar Bali, Yogyakarta and Makassar
South Sulawesi.5.6
Sanglah General Hospital is the main
referral hospital in Denpasar. As a main
hospital, Sanglah Hospital provides
palliative care for cancer patients. But
unfortunately until now, the field of
palliative care is still not much recognized
as other treatments. In fact, some studies
suggest that palliative care can improve the
quality of life of cancer patients.7
Unfortunately, there is still little interest in
palliative care research.8 Especially very
few research on how palliative care in
Indonesia and Bali occurred.
Based on the background described above,
it can be formulated several problems,
namely how palliative care in cancer
patients at RSUP Sanglah and how the
characteristics of cancer patients who
receive palliative care Sanglah Hospital in
Denpasar.
In terms of theoretical research, it is
expected that this research can be useful in
terms of reference for the development of
subsequent research and development of
science in the field of health, especially in
the field of palliative care.
RESEARCH METHOD AND SAMPLE
This research is categorical descriptive
using retrospective research study designs.
All data from this study were analyzed
descriptively and some of the results are
displayed in tables, pie charts and bar
charts.
2
Samples were taken from the Central
General Hospital (RSUP) Sanglah as a
government referral for doing palliative
care services. Samples taken are cancer
patients who receive care by a team of Poli
Palliative Sanglah Hospital in 2013. The
inclusion criteria for the search of samples
in this study were patients with cancer who
undergo inpatient or outpatient treatment
at Sanglah Hospital who were diagnosed
based on physical examination, imaging,
and histopathologic. While exclusion
criteria were cancer patients undergoing
inpatient or outpatient treatment at Sanglah
Hospital who did not get palliative care.
DATA ANALYSIS
Once the necessary data collected, data
processing and arrangement is done in a
systematic and logical manner. Data
analysis used is descriptive argumentative
data analysis. The formulation of the
problem, research objectives, and the
discussion was analyzed then connected to
draw general conclusions. The collected
data were grouped by gender, age, and
type of cancer.
By age group, cancer patients who receive
palliative care in 2013 aged 60 years were 22% (28).
Based on the type of cancer, most cancer
patients who received palliative care was
that of cervical cancer by 41 patients.
Nasopharyngeal cancer were 17, 11 lung
cancer patients, 9 patients with breast
cancer, 5 patients with ovarian cancer, 5
patients with pancreatic cancer, prostate
cancer 3 patients, 2 patients with colon
cancer, penile cancer 1 patient, as well as
other types of cancer (sinus and nasal
cancer, thyroid gland cancer, malignant
melanoma, non-Hodgkin lymphoma, etc.)
28 patients.
Bar Chart 1. Cancer Patients Getting
Palliative Care at Sanglah General Hospital
Based on Gender
RESULTS
Patient data used is cancer patients data
who were hospitalized at Sanglah Hospital
and received palliative care by 2013.
Characteristics of patients sought was
based on the patient's gender, age of the
patient, as well as the type of cancer that
suffered by the patient. Of the 122 cancer
patients who were treated by a team of
Palliative at RSUP Sanglah, as much as
38% (46 people) male and 62% (76
people) were female. Ratio of male and
female patients, were up to 1: 1.65.
3
Bar Chart 2. Cancer Patient who Receive Palliative Care at Sanglah General Hospital
Based on Age Group
(59%)
(22,97%)
(16,39%)
(1,64%)
Table 1. Cancer Patient Getting Palliative Care at Sanglah General Hospital BaseType
of Cancer
Jenis Kanker
Cervical cancer
Jumlah Pasien (%)
41 (33.6 %)
Nasopharinx cancer
17 (14 %)
Lung cancer
11 (9 %)
Breast cancer
9 (7.5%)
Ovarium cancer
5 (4%)
Pancreatic cancer
5 (4%)
Prostate cancer
3 (2,5 %)
Colon cancer
2 (1,6 %)
Penile cancer
1 (0,08 %)
Other types of cancer
(Nasal and sinus cancer, Thyroid cancer,
melanoma maligna, limpoma non-
28 (23 %)
hodgkin, etc)
4
DISCUSSION
1. Palliative Care on Cancer Patients in
Sanglah Central General Hospital
According to WHO, palliative care is
defined as an approach that aims to
improve the quality of life of patients and
their families in dealing with the problems
associated with life-threatening illness, by
preventing and relieving suffering through
early identification and assessment and
treatment of pain and other problems-both
physical , psychosocial and spiritual.9,10
Palliative care improve the quality of life
of cancer patients not only by freeing the
patient from pain, but also from the
spiritual and psychosocial support that
may be needed by patients since the
beginning of the diagnosis until the death
of the patient. Palliative care helps the
patient to appreciate life and accept death
as a natural process, so as to improve the
quality of life of patients holistically and
also can provide a positive influence for
cancer disease suffered by the patients.
Palliative care in Sanglah General Hospital
was conducted by a team of multidisciplinary specialists from as many as 13
doctors and 2 nurses as care performer.
Palliative care given to cancer patients
varies according to the patient's
complaints. If the patient does not have
complaints, follow-up of patients is still
being done every day. The aspects that are
assessed
include
pain
assessment,
effectiveness of treatment, and the patient's
general condition.
For pain management, WHO has
developed a three-step ladder for cancer
pain management in adults.11,12 When pain
is felt by the patient, the treatment
sequence starting from the class
nonopioids (aspirin and paracetamol); then
if it has not sufficiently followed by mild
opioids (codeine); and strong opioids such
as morphine, until the patient felt pain free.
To dampen anxiety, the patient may also
be given an additional form of adjuvant
drugs. To achieve pain relief, treatment
should be administered in a manner "by
the clock" ie, every 3 to 6 hours, and not
only when necessary. If the approach to
the way this is done at the right time and
dose then 80% -90% can overcome pain
effectively.12 Unlike in pediatric patients,
pain management just made up the second
ladder.
2. Characteristics of the Cancer Patients
Getting Palliative Care at Sanglah
Hospital in 2013
From the research, it was found that in
2013 there were 129 cancer patients who
received palliative care. But the 7 patients
in the processing of data obtained were
excluded because of incomplete data. Of
the 122 cancer patients, most cancer
patients was female which amounted to
62% and male patients as much as 38%.
The ratio of male patients and female was
1: 1.65. This relates to the type of cancer
that receive palliative care in 2013 in
which patients with cervical cancer is a
type of cancer that affects most patients
receiving palliative care at Sanglah
Hospital in 2013 as many as 33.6% (41
patient). According to the age group,
cancer patients who received palliative
care were most of the 41-60 years age
group for about 59% (72 patients).
5
CONCLUSION
Palliative care in cancer patients at RSUP
Sanglah was done comprehensively, not
just focused on the reduction of pain, the
effectiveness of treatment, and the patient's
general condition, but treatment is also
done in terms of patient’s psychosocial to
form holistic treatments to improve the
quality of life of cancer patients. Cancer
patients who receive palliative care at
Sanglah Hospital in 2013 as many as 122
people with a ratio of men and women
about 1: 1.65. Cervical cancer is a type of
cancer that affects most patients receiving
palliative care at Sanglah Hospital in 2013.
While based on age, the age group 41-60
years is the age group in which most
patients received palliative care at Sanglah
Hospital in 2013.
REFERENCES
1.
2.
3.
4.
American Cancer Society. Cancer
Facts & Figures 2012. Atlanta:
American Cancer Society; 2012.
World Health Organization. The
Global Burden of Disease: 2004
Update. Geneva: World Health
Organization; 2008.
Disease Statistics Data in Indonesia
[Internet] 2010. [cited 2013 November
20].
Available
from
:
http://www.riskesdas.litbang.depkes.g
o.id/
download/TabelRiskesdas2010.pdf
American
Society
of
Clinical
Oncology [Internet] [updated April
2013; cited 2013 November 24].
Available
from
:
http://www.cancer.net/all-about-
cancer/treating-cancer/caringsymptoms-cancer-and-its-treatment
5. Bruera E, Higginson IJ, Ripamonti C,
Von Gunten C. Textbook of Palliative
Medicine.
London: Hodder
Arnold; 2006
6. Kim A, Fall P, Wang D. Palliative
Care: Optimizing Quality of Life. The
Journal of The American Osteophatic
Association.
7. Bakitas M, Lyons KD; Hegel MT,
Balan S, Brokaw FC, Seville J, Hull
JG, Li Z, Tosteson TD, Byock IR,
Ahles TA. Effects of a Palliative Care
Intervention on Clinical Outcomes in
Patients With Advanced CancerThe
Project ENABLE II Randomized
Controlled
Trial.
JAMA. 2009;302(7):741-749.
8. MacDonald N. Palliative Care-An
Essential Component of Cancer
Control.
Canadian
Medical
Association. June 30 1998; 158 (13)
9. Guidelines & Protocols Advisory
Committee Palliative Care for the
Patient with Incurable Cancer or
Advanced Diseases. Family Practice
Oncology Network and the Guidelines
and
Protocols
Advisory
Committee. 2010
10. Eguchi K. Development of Palliative
Medicine for Cancer Patients in Japan:
From Isolated Voluntary Effort to
Integrated Multidisciplinary Network.
Jpn J Clin Oncol, vol. 40, 2010,
p.870-875; 17
11. Eldridge L. Lung Cancer [Internet]
2012. [Updated 2012 October 2; Cited
2013 November 24]. Available from :
http://lungcancer.about.com/od/treatm
entoflungcancer/f/palliativechemo.htm
12. World Health Organization. WHO’s
Pain Ladder for Adults [Internet].
http://www.who.int/cancer/palliative/p
ainladder/en/index.html
6
Denpasar Bali*
IGAA Jayanthi Wulan Utami1, Putu Anda Tusta Adiputra2
1
2
Undergraduate Student Faculty of Medicine Udayana University
Oncology Division, Surgery Department Sanglah General Hospital / Faculty of Medicine Udayana University
*Has been presented on The 23rd Asia Pacific Cancer Conference (APCC) 2015
ABSTRACT
Background: Palliative care is a treatment option for cancer patients who have entered the
final stage / terminal phase. Often cancer patients die in a state of pain. Palliative care in
cancer patients can improve the quality of life of cancer patients. Palliative care in Indonesia
has been running more than a decade but the development of this field is not as fast as other
fields.
Methods: The data was collected using retrospective method by looking at the secondary
data obtained from Sanglah Hospital in 2013. As well as by reviewing the literature study
based on the results of an assessment of the literature that the validity has been tested and
issues relevant to the topic.
Results: There were a number of 122 cancer patients who received palliative care at the
Central General Hospital (RSUP) Sanglah in 2013 with the ratio of men and women was 1:
1.65. Cervical cancer was the type of cancer that affects most patients receiving palliative
care in 2013. While based on the classification of age, the age group 41-60 years was the age
group in which most patients received palliative care at Sanglah Hospital in 2013.
Conclusions: Palliative care in cancer patients at RSUP Sanglah was done comprehensively
and focused not only to the general state of the patient but also on the patient's psychosocial
approach to form holistic treatments to improve the quality of life of cancer patients.
Keywords: palliative, cancer, quality of life, treatment of cancer
1
Palliative Care on Cancer Patients at Sanglah General Hospital,
Denpasar Bali*
IGAA Jayanthi Wulan Utami1, Putu Anda Tusta Adiputra2
1
2
Undergraduate Student Faculty of Medicine Udayana University
Oncology Division, Surgery Department Sanglah General Hospital / Faculty of Medicine Udayana University
*Has been presented on The 23rd Asia Pacific Cancer Conference (APCC) 2015
ABSTRACT
Background: Palliative care is a treatment option for cancer patients who have entered the
final stage / terminal phase. Often cancer patients die in a state of pain. Palliative care in
cancer patients can improve the quality of life of cancer patients. Palliative care in Indonesia
has been running more than a decade but the development of this field is not as fast as other
fields.
Methods: The data was collected using retrospective method by looking at the secondary
data obtained from Sanglah Hospital in 2013. As well as by reviewing the literature study
based on the results of an assessment of the literature that the validity has been tested and
issues relevant to the topic.
Results: There were a number of 122 cancer patients who received palliative care at the
Central General Hospital (RSUP) Sanglah in 2013 with the ratio of men and women was 1:
1.65. Cervical cancer was the type of cancer that affects most patients receiving palliative
care in 2013. While based on the classification of age, the age group 41-60 years was the age
group in which most patients received palliative care at Sanglah Hospital in 2013.
Conclusions: Palliative care in cancer patients at RSUP Sanglah was done comprehensively
and focused not only to the general state of the patient but also on the patient's psychosocial
approach to form holistic treatments to improve the quality of life of cancer patients.
Keywords: palliative, cancer, quality of life, treatment of cancer
1
INTRODUCTION
Cancer is a group of diseases characterized
by
abnormal
cell
growth
and
1
uncontrolled. Cancer is a chronic disease
that can be caused by both external factors
(tobacco,
viruses,
chemicals,
and
radiation) and internal factors (gene
mutations, hormones, immune conditions,
and metabolic disorders). Those causal
factors can initiate or trigger the growth of
cancer cells.
Based on data from the Centers for
Diseases Control and Prevention (CDC),
cancer is the second leading cause of death
in the United States. One in four deaths in
the United States are caused by this
disease. According to the United States
Cancer Statistics, approximately 1,575
people per day died of cancer in the United
States in 2010.2 In Indonesia, cancer is the
7th leading cause of death based on the
Basic Health Research (RISKESDAS)
conducted by the National Health
Department of Indonesia in 2007.3
The choice of therapy for cancer varies
depending on the stage of the disease.
Treatment performed can be surgery,
radiation therapy, chemotherapy, hormonal
therapy, targeted therapy as well as
biological therapy.4 Cancers often cause
various complaints and the treatment given
was often yielding side effects for cancer
patients. Therefore, cancer patients are
sometimes also given treatment to relieve
symptoms caused. Curing a cancer patients
often are not possible. If the cancer has
metastasized to other organs or if treatment
is not successful then the cancer can be
classified into advanced or terminal
cancer. For cancer patients diagnosed with
advanced cancer, cancer treatment will be
focused on palliative care.
In Indonesia, palliative care has evolved in
Surabaya and Jakarta since 1992.5
Currently, there have been six health
centers that provide palliative care, i.e. 2 in
Jakarta, as well as each one in Surabaya,
Denpasar Bali, Yogyakarta and Makassar
South Sulawesi.5.6
Sanglah General Hospital is the main
referral hospital in Denpasar. As a main
hospital, Sanglah Hospital provides
palliative care for cancer patients. But
unfortunately until now, the field of
palliative care is still not much recognized
as other treatments. In fact, some studies
suggest that palliative care can improve the
quality of life of cancer patients.7
Unfortunately, there is still little interest in
palliative care research.8 Especially very
few research on how palliative care in
Indonesia and Bali occurred.
Based on the background described above,
it can be formulated several problems,
namely how palliative care in cancer
patients at RSUP Sanglah and how the
characteristics of cancer patients who
receive palliative care Sanglah Hospital in
Denpasar.
In terms of theoretical research, it is
expected that this research can be useful in
terms of reference for the development of
subsequent research and development of
science in the field of health, especially in
the field of palliative care.
RESEARCH METHOD AND SAMPLE
This research is categorical descriptive
using retrospective research study designs.
All data from this study were analyzed
descriptively and some of the results are
displayed in tables, pie charts and bar
charts.
2
Samples were taken from the Central
General Hospital (RSUP) Sanglah as a
government referral for doing palliative
care services. Samples taken are cancer
patients who receive care by a team of Poli
Palliative Sanglah Hospital in 2013. The
inclusion criteria for the search of samples
in this study were patients with cancer who
undergo inpatient or outpatient treatment
at Sanglah Hospital who were diagnosed
based on physical examination, imaging,
and histopathologic. While exclusion
criteria were cancer patients undergoing
inpatient or outpatient treatment at Sanglah
Hospital who did not get palliative care.
DATA ANALYSIS
Once the necessary data collected, data
processing and arrangement is done in a
systematic and logical manner. Data
analysis used is descriptive argumentative
data analysis. The formulation of the
problem, research objectives, and the
discussion was analyzed then connected to
draw general conclusions. The collected
data were grouped by gender, age, and
type of cancer.
By age group, cancer patients who receive
palliative care in 2013 aged 60 years were 22% (28).
Based on the type of cancer, most cancer
patients who received palliative care was
that of cervical cancer by 41 patients.
Nasopharyngeal cancer were 17, 11 lung
cancer patients, 9 patients with breast
cancer, 5 patients with ovarian cancer, 5
patients with pancreatic cancer, prostate
cancer 3 patients, 2 patients with colon
cancer, penile cancer 1 patient, as well as
other types of cancer (sinus and nasal
cancer, thyroid gland cancer, malignant
melanoma, non-Hodgkin lymphoma, etc.)
28 patients.
Bar Chart 1. Cancer Patients Getting
Palliative Care at Sanglah General Hospital
Based on Gender
RESULTS
Patient data used is cancer patients data
who were hospitalized at Sanglah Hospital
and received palliative care by 2013.
Characteristics of patients sought was
based on the patient's gender, age of the
patient, as well as the type of cancer that
suffered by the patient. Of the 122 cancer
patients who were treated by a team of
Palliative at RSUP Sanglah, as much as
38% (46 people) male and 62% (76
people) were female. Ratio of male and
female patients, were up to 1: 1.65.
3
Bar Chart 2. Cancer Patient who Receive Palliative Care at Sanglah General Hospital
Based on Age Group
(59%)
(22,97%)
(16,39%)
(1,64%)
Table 1. Cancer Patient Getting Palliative Care at Sanglah General Hospital BaseType
of Cancer
Jenis Kanker
Cervical cancer
Jumlah Pasien (%)
41 (33.6 %)
Nasopharinx cancer
17 (14 %)
Lung cancer
11 (9 %)
Breast cancer
9 (7.5%)
Ovarium cancer
5 (4%)
Pancreatic cancer
5 (4%)
Prostate cancer
3 (2,5 %)
Colon cancer
2 (1,6 %)
Penile cancer
1 (0,08 %)
Other types of cancer
(Nasal and sinus cancer, Thyroid cancer,
melanoma maligna, limpoma non-
28 (23 %)
hodgkin, etc)
4
DISCUSSION
1. Palliative Care on Cancer Patients in
Sanglah Central General Hospital
According to WHO, palliative care is
defined as an approach that aims to
improve the quality of life of patients and
their families in dealing with the problems
associated with life-threatening illness, by
preventing and relieving suffering through
early identification and assessment and
treatment of pain and other problems-both
physical , psychosocial and spiritual.9,10
Palliative care improve the quality of life
of cancer patients not only by freeing the
patient from pain, but also from the
spiritual and psychosocial support that
may be needed by patients since the
beginning of the diagnosis until the death
of the patient. Palliative care helps the
patient to appreciate life and accept death
as a natural process, so as to improve the
quality of life of patients holistically and
also can provide a positive influence for
cancer disease suffered by the patients.
Palliative care in Sanglah General Hospital
was conducted by a team of multidisciplinary specialists from as many as 13
doctors and 2 nurses as care performer.
Palliative care given to cancer patients
varies according to the patient's
complaints. If the patient does not have
complaints, follow-up of patients is still
being done every day. The aspects that are
assessed
include
pain
assessment,
effectiveness of treatment, and the patient's
general condition.
For pain management, WHO has
developed a three-step ladder for cancer
pain management in adults.11,12 When pain
is felt by the patient, the treatment
sequence starting from the class
nonopioids (aspirin and paracetamol); then
if it has not sufficiently followed by mild
opioids (codeine); and strong opioids such
as morphine, until the patient felt pain free.
To dampen anxiety, the patient may also
be given an additional form of adjuvant
drugs. To achieve pain relief, treatment
should be administered in a manner "by
the clock" ie, every 3 to 6 hours, and not
only when necessary. If the approach to
the way this is done at the right time and
dose then 80% -90% can overcome pain
effectively.12 Unlike in pediatric patients,
pain management just made up the second
ladder.
2. Characteristics of the Cancer Patients
Getting Palliative Care at Sanglah
Hospital in 2013
From the research, it was found that in
2013 there were 129 cancer patients who
received palliative care. But the 7 patients
in the processing of data obtained were
excluded because of incomplete data. Of
the 122 cancer patients, most cancer
patients was female which amounted to
62% and male patients as much as 38%.
The ratio of male patients and female was
1: 1.65. This relates to the type of cancer
that receive palliative care in 2013 in
which patients with cervical cancer is a
type of cancer that affects most patients
receiving palliative care at Sanglah
Hospital in 2013 as many as 33.6% (41
patient). According to the age group,
cancer patients who received palliative
care were most of the 41-60 years age
group for about 59% (72 patients).
5
CONCLUSION
Palliative care in cancer patients at RSUP
Sanglah was done comprehensively, not
just focused on the reduction of pain, the
effectiveness of treatment, and the patient's
general condition, but treatment is also
done in terms of patient’s psychosocial to
form holistic treatments to improve the
quality of life of cancer patients. Cancer
patients who receive palliative care at
Sanglah Hospital in 2013 as many as 122
people with a ratio of men and women
about 1: 1.65. Cervical cancer is a type of
cancer that affects most patients receiving
palliative care at Sanglah Hospital in 2013.
While based on age, the age group 41-60
years is the age group in which most
patients received palliative care at Sanglah
Hospital in 2013.
REFERENCES
1.
2.
3.
4.
American Cancer Society. Cancer
Facts & Figures 2012. Atlanta:
American Cancer Society; 2012.
World Health Organization. The
Global Burden of Disease: 2004
Update. Geneva: World Health
Organization; 2008.
Disease Statistics Data in Indonesia
[Internet] 2010. [cited 2013 November
20].
Available
from
:
http://www.riskesdas.litbang.depkes.g
o.id/
download/TabelRiskesdas2010.pdf
American
Society
of
Clinical
Oncology [Internet] [updated April
2013; cited 2013 November 24].
Available
from
:
http://www.cancer.net/all-about-
cancer/treating-cancer/caringsymptoms-cancer-and-its-treatment
5. Bruera E, Higginson IJ, Ripamonti C,
Von Gunten C. Textbook of Palliative
Medicine.
London: Hodder
Arnold; 2006
6. Kim A, Fall P, Wang D. Palliative
Care: Optimizing Quality of Life. The
Journal of The American Osteophatic
Association.
7. Bakitas M, Lyons KD; Hegel MT,
Balan S, Brokaw FC, Seville J, Hull
JG, Li Z, Tosteson TD, Byock IR,
Ahles TA. Effects of a Palliative Care
Intervention on Clinical Outcomes in
Patients With Advanced CancerThe
Project ENABLE II Randomized
Controlled
Trial.
JAMA. 2009;302(7):741-749.
8. MacDonald N. Palliative Care-An
Essential Component of Cancer
Control.
Canadian
Medical
Association. June 30 1998; 158 (13)
9. Guidelines & Protocols Advisory
Committee Palliative Care for the
Patient with Incurable Cancer or
Advanced Diseases. Family Practice
Oncology Network and the Guidelines
and
Protocols
Advisory
Committee. 2010
10. Eguchi K. Development of Palliative
Medicine for Cancer Patients in Japan:
From Isolated Voluntary Effort to
Integrated Multidisciplinary Network.
Jpn J Clin Oncol, vol. 40, 2010,
p.870-875; 17
11. Eldridge L. Lung Cancer [Internet]
2012. [Updated 2012 October 2; Cited
2013 November 24]. Available from :
http://lungcancer.about.com/od/treatm
entoflungcancer/f/palliativechemo.htm
12. World Health Organization. WHO’s
Pain Ladder for Adults [Internet].
http://www.who.int/cancer/palliative/p
ainladder/en/index.html
6
Palliative Care on Cancer Patients at Sanglah General Hospital,
Denpasar Bali*
IGAA Jayanthi Wulan Utami1, Putu Anda Tusta Adiputra2
1
2
Undergraduate Student Faculty of Medicine Udayana University
Oncology Division, Surgery Department Sanglah General Hospital / Faculty of Medicine Udayana University
*Has been presented on The 23rd Asia Pacific Cancer Conference (APCC) 2015
ABSTRACT
Background: Palliative care is a treatment option for cancer patients who have entered the
final stage / terminal phase. Often cancer patients die in a state of pain. Palliative care in
cancer patients can improve the quality of life of cancer patients. Palliative care in Indonesia
has been running more than a decade but the development of this field is not as fast as other
fields.
Methods: The data was collected using retrospective method by looking at the secondary
data obtained from Sanglah Hospital in 2013. As well as by reviewing the literature study
based on the results of an assessment of the literature that the validity has been tested and
issues relevant to the topic.
Results: There were a number of 122 cancer patients who received palliative care at the
Central General Hospital (RSUP) Sanglah in 2013 with the ratio of men and women was 1:
1.65. Cervical cancer was the type of cancer that affects most patients receiving palliative
care in 2013. While based on the classification of age, the age group 41-60 years was the age
group in which most patients received palliative care at Sanglah Hospital in 2013.
Conclusions: Palliative care in cancer patients at RSUP Sanglah was done comprehensively
and focused not only to the general state of the patient but also on the patient's psychosocial
approach to form holistic treatments to improve the quality of life of cancer patients.
Keywords: palliative, cancer, quality of life, treatment of cancer
1
INTRODUCTION
Cancer is a group of diseases characterized
by
abnormal
cell
growth
and
1
uncontrolled. Cancer is a chronic disease
that can be caused by both external factors
(tobacco,
viruses,
chemicals,
and
radiation) and internal factors (gene
mutations, hormones, immune conditions,
and metabolic disorders). Those causal
factors can initiate or trigger the growth of
cancer cells.
Based on data from the Centers for
Diseases Control and Prevention (CDC),
cancer is the second leading cause of death
in the United States. One in four deaths in
the United States are caused by this
disease. According to the United States
Cancer Statistics, approximately 1,575
people per day died of cancer in the United
States in 2010.2 In Indonesia, cancer is the
7th leading cause of death based on the
Basic Health Research (RISKESDAS)
conducted by the National Health
Department of Indonesia in 2007.3
The choice of therapy for cancer varies
depending on the stage of the disease.
Treatment performed can be surgery,
radiation therapy, chemotherapy, hormonal
therapy, targeted therapy as well as
biological therapy.4 Cancers often cause
various complaints and the treatment given
was often yielding side effects for cancer
patients. Therefore, cancer patients are
sometimes also given treatment to relieve
symptoms caused. Curing a cancer patients
often are not possible. If the cancer has
metastasized to other organs or if treatment
is not successful then the cancer can be
classified into advanced or terminal
cancer. For cancer patients diagnosed with
advanced cancer, cancer treatment will be
focused on palliative care.
In Indonesia, palliative care has evolved in
Surabaya and Jakarta since 1992.5
Currently, there have been six health
centers that provide palliative care, i.e. 2 in
Jakarta, as well as each one in Surabaya,
Denpasar Bali, Yogyakarta and Makassar
South Sulawesi.5.6
Sanglah General Hospital is the main
referral hospital in Denpasar. As a main
hospital, Sanglah Hospital provides
palliative care for cancer patients. But
unfortunately until now, the field of
palliative care is still not much recognized
as other treatments. In fact, some studies
suggest that palliative care can improve the
quality of life of cancer patients.7
Unfortunately, there is still little interest in
palliative care research.8 Especially very
few research on how palliative care in
Indonesia and Bali occurred.
Based on the background described above,
it can be formulated several problems,
namely how palliative care in cancer
patients at RSUP Sanglah and how the
characteristics of cancer patients who
receive palliative care Sanglah Hospital in
Denpasar.
In terms of theoretical research, it is
expected that this research can be useful in
terms of reference for the development of
subsequent research and development of
science in the field of health, especially in
the field of palliative care.
RESEARCH METHOD AND SAMPLE
This research is categorical descriptive
using retrospective research study designs.
All data from this study were analyzed
descriptively and some of the results are
displayed in tables, pie charts and bar
charts.
2
Samples were taken from the Central
General Hospital (RSUP) Sanglah as a
government referral for doing palliative
care services. Samples taken are cancer
patients who receive care by a team of Poli
Palliative Sanglah Hospital in 2013. The
inclusion criteria for the search of samples
in this study were patients with cancer who
undergo inpatient or outpatient treatment
at Sanglah Hospital who were diagnosed
based on physical examination, imaging,
and histopathologic. While exclusion
criteria were cancer patients undergoing
inpatient or outpatient treatment at Sanglah
Hospital who did not get palliative care.
DATA ANALYSIS
Once the necessary data collected, data
processing and arrangement is done in a
systematic and logical manner. Data
analysis used is descriptive argumentative
data analysis. The formulation of the
problem, research objectives, and the
discussion was analyzed then connected to
draw general conclusions. The collected
data were grouped by gender, age, and
type of cancer.
By age group, cancer patients who receive
palliative care in 2013 aged 60 years were 22% (28).
Based on the type of cancer, most cancer
patients who received palliative care was
that of cervical cancer by 41 patients.
Nasopharyngeal cancer were 17, 11 lung
cancer patients, 9 patients with breast
cancer, 5 patients with ovarian cancer, 5
patients with pancreatic cancer, prostate
cancer 3 patients, 2 patients with colon
cancer, penile cancer 1 patient, as well as
other types of cancer (sinus and nasal
cancer, thyroid gland cancer, malignant
melanoma, non-Hodgkin lymphoma, etc.)
28 patients.
Bar Chart 1. Cancer Patients Getting
Palliative Care at Sanglah General Hospital
Based on Gender
RESULTS
Patient data used is cancer patients data
who were hospitalized at Sanglah Hospital
and received palliative care by 2013.
Characteristics of patients sought was
based on the patient's gender, age of the
patient, as well as the type of cancer that
suffered by the patient. Of the 122 cancer
patients who were treated by a team of
Palliative at RSUP Sanglah, as much as
38% (46 people) male and 62% (76
people) were female. Ratio of male and
female patients, were up to 1: 1.65.
3
Bar Chart 2. Cancer Patient who Receive Palliative Care at Sanglah General Hospital
Based on Age Group
(59%)
(22,97%)
(16,39%)
(1,64%)
Table 1. Cancer Patient Getting Palliative Care at Sanglah General Hospital BaseType
of Cancer
Jenis Kanker
Cervical cancer
Jumlah Pasien (%)
41 (33.6 %)
Nasopharinx cancer
17 (14 %)
Lung cancer
11 (9 %)
Breast cancer
9 (7.5%)
Ovarium cancer
5 (4%)
Pancreatic cancer
5 (4%)
Prostate cancer
3 (2,5 %)
Colon cancer
2 (1,6 %)
Penile cancer
1 (0,08 %)
Other types of cancer
(Nasal and sinus cancer, Thyroid cancer,
melanoma maligna, limpoma non-
28 (23 %)
hodgkin, etc)
4
DISCUSSION
1. Palliative Care on Cancer Patients in
Sanglah Central General Hospital
According to WHO, palliative care is
defined as an approach that aims to
improve the quality of life of patients and
their families in dealing with the problems
associated with life-threatening illness, by
preventing and relieving suffering through
early identification and assessment and
treatment of pain and other problems-both
physical , psychosocial and spiritual.9,10
Palliative care improve the quality of life
of cancer patients not only by freeing the
patient from pain, but also from the
spiritual and psychosocial support that
may be needed by patients since the
beginning of the diagnosis until the death
of the patient. Palliative care helps the
patient to appreciate life and accept death
as a natural process, so as to improve the
quality of life of patients holistically and
also can provide a positive influence for
cancer disease suffered by the patients.
Palliative care in Sanglah General Hospital
was conducted by a team of multidisciplinary specialists from as many as 13
doctors and 2 nurses as care performer.
Palliative care given to cancer patients
varies according to the patient's
complaints. If the patient does not have
complaints, follow-up of patients is still
being done every day. The aspects that are
assessed
include
pain
assessment,
effectiveness of treatment, and the patient's
general condition.
For pain management, WHO has
developed a three-step ladder for cancer
pain management in adults.11,12 When pain
is felt by the patient, the treatment
sequence starting from the class
nonopioids (aspirin and paracetamol); then
if it has not sufficiently followed by mild
opioids (codeine); and strong opioids such
as morphine, until the patient felt pain free.
To dampen anxiety, the patient may also
be given an additional form of adjuvant
drugs. To achieve pain relief, treatment
should be administered in a manner "by
the clock" ie, every 3 to 6 hours, and not
only when necessary. If the approach to
the way this is done at the right time and
dose then 80% -90% can overcome pain
effectively.12 Unlike in pediatric patients,
pain management just made up the second
ladder.
2. Characteristics of the Cancer Patients
Getting Palliative Care at Sanglah
Hospital in 2013
From the research, it was found that in
2013 there were 129 cancer patients who
received palliative care. But the 7 patients
in the processing of data obtained were
excluded because of incomplete data. Of
the 122 cancer patients, most cancer
patients was female which amounted to
62% and male patients as much as 38%.
The ratio of male patients and female was
1: 1.65. This relates to the type of cancer
that receive palliative care in 2013 in
which patients with cervical cancer is a
type of cancer that affects most patients
receiving palliative care at Sanglah
Hospital in 2013 as many as 33.6% (41
patient). According to the age group,
cancer patients who received palliative
care were most of the 41-60 years age
group for about 59% (72 patients).
5
CONCLUSION
Palliative care in cancer patients at RSUP
Sanglah was done comprehensively, not
just focused on the reduction of pain, the
effectiveness of treatment, and the patient's
general condition, but treatment is also
done in terms of patient’s psychosocial to
form holistic treatments to improve the
quality of life of cancer patients. Cancer
patients who receive palliative care at
Sanglah Hospital in 2013 as many as 122
people with a ratio of men and women
about 1: 1.65. Cervical cancer is a type of
cancer that affects most patients receiving
palliative care at Sanglah Hospital in 2013.
While based on age, the age group 41-60
years is the age group in which most
patients received palliative care at Sanglah
Hospital in 2013.
REFERENCES
1.
2.
3.
4.
American Cancer Society. Cancer
Facts & Figures 2012. Atlanta:
American Cancer Society; 2012.
World Health Organization. The
Global Burden of Disease: 2004
Update. Geneva: World Health
Organization; 2008.
Disease Statistics Data in Indonesia
[Internet] 2010. [cited 2013 November
20].
Available
from
:
http://www.riskesdas.litbang.depkes.g
o.id/
download/TabelRiskesdas2010.pdf
American
Society
of
Clinical
Oncology [Internet] [updated April
2013; cited 2013 November 24].
Available
from
:
http://www.cancer.net/all-about-
cancer/treating-cancer/caringsymptoms-cancer-and-its-treatment
5. Bruera E, Higginson IJ, Ripamonti C,
Von Gunten C. Textbook of Palliative
Medicine.
London: Hodder
Arnold; 2006
6. Kim A, Fall P, Wang D. Palliative
Care: Optimizing Quality of Life. The
Journal of The American Osteophatic
Association.
7. Bakitas M, Lyons KD; Hegel MT,
Balan S, Brokaw FC, Seville J, Hull
JG, Li Z, Tosteson TD, Byock IR,
Ahles TA. Effects of a Palliative Care
Intervention on Clinical Outcomes in
Patients With Advanced CancerThe
Project ENABLE II Randomized
Controlled
Trial.
JAMA. 2009;302(7):741-749.
8. MacDonald N. Palliative Care-An
Essential Component of Cancer
Control.
Canadian
Medical
Association. June 30 1998; 158 (13)
9. Guidelines & Protocols Advisory
Committee Palliative Care for the
Patient with Incurable Cancer or
Advanced Diseases. Family Practice
Oncology Network and the Guidelines
and
Protocols
Advisory
Committee. 2010
10. Eguchi K. Development of Palliative
Medicine for Cancer Patients in Japan:
From Isolated Voluntary Effort to
Integrated Multidisciplinary Network.
Jpn J Clin Oncol, vol. 40, 2010,
p.870-875; 17
11. Eldridge L. Lung Cancer [Internet]
2012. [Updated 2012 October 2; Cited
2013 November 24]. Available from :
http://lungcancer.about.com/od/treatm
entoflungcancer/f/palliativechemo.htm
12. World Health Organization. WHO’s
Pain Ladder for Adults [Internet].
http://www.who.int/cancer/palliative/p
ainladder/en/index.html
6