Tesis

Kepatuhan terhadap Timely Completion pada Kanker Serviks Stadium Lokal Lanjut dan Faktor-Faktor yang Berhubungan di RSUPN Dr. Cipto Mangunkusumo pada Tahun 2019 = Compliance Towards Timely Treatment in Locally Advanced Cervical Cancer: A Study of Influential Factors from Indonesia National General Hospital in 2019.

Latar belakang: Khemoradiasi adalah modalitas terapi utama pada kanker serviks stadium lokal lanjut. Terlepas dari durasi terapi yang panjang dan efek samping, keberhasilan terapi sangat bergantung pada kepatuhan terhadap timely completion. Hal ini penting karena penundaan terapi dapat meningkatkan risiko rekurensi lokal, meningkatkan angka morbiditas dan mortalitas dan biaya layanan kesehatan. Meskipun sebagian besar pengeluaran medis sudah ditanggung oleh asuransi kesehatan nasional, sebagian besar pasien masih belum bisa menyelesaikan terapi tepat waktu. Tujuan: Mengetahui faktor-faktor yang mempengaruhi kepatuhan pasien terhadap timely completion pada kanker serviks stadium lokal lanjut serta implikasinya Metode: Studi ini melibatkan 170 rekam medis pasien. Kami melakukan tabulasi variabel-variabel yang dapat mempengaruhi kepatuhan pasien terhadap timely completion seperti pendapatan, tingkat pendidikan, status pembiayaan dan efek samping serta data kepatuhan dari masing-masing pasien Hasil: Kami menemukan pasien berusia di atas 51 tahun (OR 2.6, 95% CI 1.00-6.72) dan yang mengalami efek samping hematologi (OR 4.25, 95% CI 1.40-12.88) kemungkinan besar tidak dapat menyelesaikan terapi tepat waktu. Studi ini tidak menemukan hubungan signifikan antara pendapatan, tingkat pendidikan dan timely completion. Studi ini juga meenggunakan analisis regresi logistik dengan mengembangkan sistem skor prediksi untuk mengidentifikasi pasien yang berisiko tidak patuh terhadap terapi radiasi. Performa studi dievaluasi dengan nilai area under the curve (AUC) sebesar 0.658 mengindikasikan tingkat akurasi prediksi sedang. Kesimpulan: Usia dan efek samping terapi radiasi dapat dianggap mempengaruhi timely completion dan berdampak buruk terhadap efektivitas terapi. Dibutuhkan kelompok dukungan khusus untuk pasien yang lebih tuda dan protokol untuk deteksi dini serta tata laksana efek samping perlu diformulasikan dan diterapkan.
Kata kunci: kepatuhan, timely completion, kanker serviks, terapi radiasi, efek samping hematologi, sistem skoring prediktif, pemahaman pasien, tata laksana anemia, skrining Psikiatri, angka kesintasan pascaterapi


Background: Chemoradiation is main modality treatment in locally advanced cervical cancer. Despite the long duration of therapy and side effects, successful treatment depends heavily on compliance towards timely completion. It holds pivotal role in cervical cancer as delay treatment may increase the risk of local recurrence, raising morbidity and mortality rate and also healthcare cost. Although most medical expense is covered by national health insurance, most patients were still unable to complete the therapy in timely fashion. Objective: We aim to understand the factors influencing patients' compliance with the timely completion of radiation therapy for advanced local-stage cervical cancer and its implications. Method: The study carried out 170 patients' medical records. We tabulate the possible variables influencing whether the patient achieves the timely completion of radiation therapy, such as income, education, financing status, and side effects, along with the compliance data of each patient. Results: We found that subjects over 51 years (OR 2.6, 95% CI 1.00-6.72) and those experiencing hematological side effects (OR 4.25, 95% CI 1.40-12.88) were likely not to complete the treatment on time. However, the study did not find a significant relationship between income, education level, and timely completion. The research also utilized multivariate logistic regression analysis, developing a predictive scoring system to identify patients at risk of non-compliance with radiation therapy. The study's performance was evaluated with an area under the curve (AUC) value of 0.658, indicating a moderate level of predictive accuracy. Conclusion: Age and concern about the side effects of radiation therapy can be considered to affect the timely completion and badly impact the treatment effectivity. The need for particular support groups for older patients is critical, and early detection and treatment of side effects protocol should be formulated and imposed.
Keywords: Compliance, Timely Completion, Cervical Cancer, Radiation Therapy, Hematological Side Effects, Predictive Scoring System, Patient Understanding, Anemia Management, Psychiatric Screening, Post-Therapy Survival Rates.