Tesis

Hubungan Antara Lama Waktu Tunggu Operasi Dengan Perbedaan Status Performa dan Perburukan Klinis Pada Pasien Kanker Ovarium Stadium Lanjut Di RSUPNCM = Association between Waiting Time for Therapy with Performance Status and Clinical Worsening on Patients with Ovarian Cancer in Cipto Mangunkusumo National Hospital .

Latar belakang: Kanker ovarium merupakan salah satu penyebab kematian utama pada wanita di seluruh dunia. Waktu tunggu operasi dan status performa merupakan penentu penting prognosis kanker ovarium. Di RSUPNCM, pasien kanker ovarium stadium lanjut di poliklinik seringkali menunggu lama untuk mendapatkan terapi. Pemanjangan waktu tunggu operasi ini mengakibatkan perburukan klinis dan harapan hidup pasien. Tujuan: (1) Menentukan hubungan antara lama waktu tunggu operasi pasien kanker ovarium terhadap perburukan klinis pada pasien kanker ovarium stadium lanjut. (2) Menentukan cut-off waktu tunggu operasi sebagai prediktor perburukan klinis pasien kanker ovarium stadium lanjut. Metode: Penelitian kohort retrospektif dilakukan pada pasien kanker ovarium stadium lanjut di poliklinik kebidanan dan kandungan RSUPNCM periode JanuariJuni 2019. Setiap subyek yang memenuhi kriteria inklusi dan eksklusi ditelusuri data kunjungan pertama, tanggal operasi, status performa, dan perburukan klinisnya melalui rekam medis. Perburukan klinis didefinisikan sebagai peningkatan ECOG > 1 poin, perubahan klasifikasi nyeri berdasarkan WHO, penurunan klasifikasi IMT berdasarkan WHO, anemia berat, dan hipoalbumin ( < 3.5 g/dl). Hasil: Didapatkan 90 subjek penelitian dengan waktu tunggu 81 (7-360) hari. Terdapat hubungan bermakna antara waktu tunggu terapi dengan perburukan klinis pasien kanker ovarium dengan nilai p = 0,049 (OR 1,009, CI95% 1,00-1,02). Cutoff waktu tunggu terapi 73 hari dengan sensitivitas 60,9% dan spesifisitas 57,1% sebagai prediktor perburukan klinis (AUC 0,661; p = 0,026). Kesimpulan: Waktu tunggu terapi yang semakin lama berhubungan dengan perburukan klinis pasien kanker ovarium stadium lanjut.
Kata kunci: perburukan klinis, kanker ovarium, status performa, waktu tunggu


Background: Ovarian cancer remains accountable as a major cause of death among women acroos the globe. Management waiting time and performance status are integral determinants of ovarian cancer prognosis. In Cipto Mangunkusumo Hospital, patients with ovarian cancer often have to queue to obtain therapy. Longer waiting time for therapy leads to clinical worsening and lower survival rate. Aim: (1) To determine the association between waiting time for therapy with performance status of patients with advanced stage ovarian cancer. (2) To determine cut-off of waiting time for therapy as predictor of clinical worsening in patients with advanced stage ovarian cancer. Method: A retrospective cohort was conducted on patients with advanced ovarian cancer in Cipto Mangunkusumo National Hospital Obstetrics and Gynecology Clinic in a period of January-June 2019. Data of first visit, date of therapy, performance status, clinical worsening were obtained through medical records. Clinical worsening was defined as increase of ECOG >1 point, change of WHO classification pain scale, decrease in BMI WHO classification, severe anemia, and hypoalbuminemia ( < 3.5 g/dl). Result: A total of 90 subjects were included. waiting time for therapy of 81 (7-360) days. There was significant association between waiting time for therapy and clinical worsening in patients with advanced stage ovarian cancer (p = 0,049; OR 1,009, CI95% 1,00-1,02). A cut-off of 73 days waiting time for therapy had 60,9% sensitivity and 57,1% specificity as a predictor of clinical worsening (AUC 0,661; p = 0,026). Conclusion: Longer waiting time for therapy is associated with clinical worsening in patients with advanced stage ovarian cancer.
Keyword: clinical worsening, ovarian cancer, status performance, waiting time