Tesis

Kualitas Hidup dan Luaran Fungsional Pasien Tumor Ekstremitas Bawah yang Menjalani Prosedur Amputasi di RSUPN dr. Cipto Mangunkusumo = Quality of Life and Functional Outcome of Oncology Patient After Lower Extremity Amputation in Cipto Mangunkusumo Hospital .

Pendahuluan: Jumlah kasus tumor muskuloskeletal di Indonesia semakin meningkat. Di antara pilihan tata laksana yang ada, tindakan amputasi masih menjadi salah satu modalitas utama. Akan tetapi, kualitas hidup dan luaran fungsional pasien masih belum diperhatikan. Hingga saat ini, studi mengenai hal tersebut di Indonesia masih sangat terbatas. Metode: Penelitian ini merupakan studi analitik observasional potong lintang dengan subjek seluruh pasien tumor ekstremitas bawah yang menjalani prosedur amputasi di RSUPN dr. Cipto Mangunkusumo selama 2014-2019. Kualitas hidup dan luaran fungsional diukur menggunakan instrumen SF-36 dan MSTS. Hasil: Didapatkan 72 pasien amputasi tumor ekstremitas bawah dengan rerata usia 31 tahun dan 65% pria, 33 di antaranya teridentifikasi hidup. Mayoritas subjek memiliki diagnosis osteosarkoma (58%), dilakukan amputasi transfemoral (50%) dan lokasi tumor di distal femur (44,4%). Rerata SF-36 adalah 61,63, sementara skor MSTS adalah 35%. Hanya 1 pasien yang menggunakan prosthesis, di mana skor SF-36 pasien tersebut paling baik (74) di antara subjek lain. Diskusi: Rerata SF-36 lebih baik pada pria dibandingkan wanita (p=0,011). Skor MSTS lebih baik pada tingkat pendapatan menengah ke atas (p=0,04). Kesintasan 3 tahun pasca amputasi sebesar 45,8%. Tidak ada perbedaan kesintasan antara osteosarkoma dan tumor lain. Kesimpulan: Pasien tumor ekstremitas bawah yang menjalani prosedur amputasi memiliki kualitas hidup yang baik, namun luaran fungsionalnya kurang. Kualitas hidup berkaitan dengan faktor jenis kelamin dan penggunaan alat bantu, sementara luaran fungsional berkaitan dengan tingkat pendapatan.
Kata kunci: tumor ekstremitas bawah, amputasi, kualitas hidup, luaran fungsional, SF36, MSTS


Introduction: Amputation is often performed as a palliative or alternative procedure of limb salvage surgery. The main purpose of amputation is to improve quality of life and patient function. Although providing good clinical results, this procedure often has a negative psychosocial impact on the patient. Until now, studies on the quality of life and functional outcomes of oncology patients after post amputation in Indonesia are still limited. Methods: This study was a cross-sectional analytic study with subjects from all lower extremity tumor patients who underwent amputation procedures at Cipto Mangunkusumo National Center Hospital during the 2014-2019 period. Quality of life and functional outcome of the patients were measured by interviews using the SF-36 and MSTS questionnaires. Results: There were 72 patients with lower extremity tumor who underwent amputations. Subjects are 65% of men and have average age of 31 years. Among the patients, 34 of whom were identified alive and interviewed. Majority of the subjects had osteosarcoma patient (58%), transfemoral amputation (50%) and distal femoral tumors (44.4%). Physical functional outcomes in male patients were better than female (score 48/100, p = 0.003), gait function was better in patients with diagnosis of benign tumors and non-osteosarcoma malignant tumors (MSTS 40/100 and 30/100, p = 0.021), compared to the osteosarcoma patient group (MSTS 16). Three years survival rate of subjects are 45,8%, there were no difference between groups. No significant differences were found in the quality of life and functional outcome between variables of extremity side, tumor location and amputation level. Only 1 patient wears prosthesis after amputation. Discussion: Level of amputation in patients with lower extremities tumor does not cause significant differences in the aspects of quality of life or functional outcome. Conclusion: Patients with diagnosis of osteosarcoma have no different survival rate than patients with other malignant or benign tumor.
Keywords: tumor lower extremity, amputation, quality of life, functional outcome, SF36, MSTS score