Stefanus Gunawan

Socio-economic Status Plays Important Roles in Childhood Cancer Treatment Outcome in Indonesia

BACKGROUND The influence of parental socio-economic status on childhood cancer treatment outcome in low-income countries has not been sufficiently investigated. Our study examined this influence and explored parental experiences during cancer treatment of their children in an Indonesian academic hospital. MATERIALS AND METHODS Medical charts of 145 children diagnosed with cancer between 1999 and 2009 were reviewed retrospectively. From October 2011 until January 2012, 40 caretakers were interviewed using semi-structured questionnaires. RESULTS Of all patients, 48% abandoned treatment, 34% experienced death, 9% had progressive/ relapsed disease, and 9% overall event-free survival. Prosperous patients had better treatment outcome than poor patients (P<0.0001). Odds-ratio for treatment abandonment was 3.3 (95%CI: 1.4-8.1, p=0.006) for poor versus prosperous patients. Parents often believed that their childs health was beyond doctor control and determined by luck, fate or God (55%). Causes of cancer were thought to be destiny (35%) or Gods punishment (23%). Alternative treatment could (18%) or might (50%) cure cancer. Most parents (95%) would like more information about cancer and treatment. More contact with doctors was desired (98%). Income decreased during treatment (55%). Parents lost employment (48% fathers, 10% mothers), most of whom stated this loss was caused by their childs cancer (84% fathers, 100% mothers). Loss of income led to financial difficulties (63%) and debts (55%). CONCLUSIONS Treatment abandonment was most important reason for treatment failure. Treatment outcome was determined by parental socio-economic status. Childhood cancer survival could improve if financial constraints and provision of information and guidance are better addressed.

Health‐care providers' perspectives on childhood cancer treatment in Manado, Indonesia

Childhood cancer survival in low‐income countries is low.

Comparing Health-Care Providers’ Perspectives on Complementary and Alternative Medicine in Childhood Cancer Between Netherlands and Indonesia

Use of complementary and alternative medicine (CAM) is common among patients with childhood cancer. Health‐care providers (HCP) should address this need properly. Geographical and cultural differences seem likely. This study explores perspectives on CAM of HCP involved in the care of children with cancer in Netherlands and Indonesia. Health beliefs, components of CAM, encouraging or discouraging CAM, and knowledge about CAM were assessed.

Parental Experiences with Chemotherapy-Induced Alopecia among Childhood Cancer Patients in Indonesia.

BACKGROUND This study assessed parental experiences with chemotherapy-induced alopecia among children with cancer treated at an Indonesian academic hospital. MATERIALS AND METHODS Fifty parents of childhood cancer patients were interviewed using semi-structured questionnaires. RESULTS The moment that hair fell out was the moment that parents (84%) had to admit their child had cancer. Alopecia was a traumatizing painful experience (46%). Active strategies to hide alopecia, mainly hats, were used by 66% of children, while 34% never covered their bald head. If money had not been an issue, 40% would use another strategy. Alopecia made children limit outdoor daily activities (78%) and engagement with others (60%). Significantly more children from high-educated (95%) than low-educated (60%) parents received sympathy from other people (P=0.012). Significantly more Christian (29%) than Muslim (0%) families confirmed that alopecia lowered the quality of life (P=0.046). Most parents (82%) had no prior plans about alopecia management, yet for significantly more girls (26%) than boys (0%) such plans existed (P=0.044). Parents received most information about alopecia from other parents (66%). Parents (92%) needed more alopecia education from doctors. Of all school-attending children, 53% were bullied and 47% did not want to attend school due to alopecia. Significantly more high-educated than low-educated families received pity from teachers and pupils (94% vs. 0%, P=0.004), and acceptance by pupils (81% vs. 0%, P=0.021). CONCLUSIONS Alopecia is a severe, far-stretching side-effect of chemotherapy with physical, psychological and social consequences for children and parents. Parents should be better informed about occurrence and impact of alopecia. Extra attention is required to facilitate childrens return to school. Health- care providers should facilitate optimal supportive care through open dialogue and provision of educational materials for parents, children and their community.

Hubungan Ketebalan Intima Media Arteri Karotis dan Massa Ventrikel Kiri pada Remaja Obes

Latar belakang. Obesitas pada anak berhubungan dengan peningkatan risiko kematian yang disebabkan aterosklerosis dan kardiomiopati pada saat dewasa. Ketebalan intima media (KIM) arteri karotis dan massa ventrikel kiri (MVK) adalah penanda awal aterosklerosis dan kardiomiopati yang dapat diperiksa sejak usia dini. Tujuan .Mengetahui hubungan antara KIM arteri karotis dan MVK pada remaja obes. Metode. Penelitian observasional analitik dengan pendekatan potong lintang terhadap 45 remaja usia 13-18 tahun dari bulan November 2013 – Februari 2014. Subyek dibagi menjadi obes dan tidak obes berdasarkan IMT menurut umur dan jenis kelamin. Penilaian KIM dan MVK dengan ekokardiografi. Pengolahan data dengan uji Mann-Whitney, uji t tidak berpasangan. Hubungan antara KIM dengan MVK ditentukan dengan uji regresi linier. Hasil. Terdapat perbedaan bermakna antara KIM remaja obes (rerata 0,79 mm, SB 0,77) dibandingkan tidak obes (rerata 0,23 mm, SB 0,22) (p<0,001). Rerata MVK remaja obes 456,75 g (SB 204,39) berbeda bermakna dengan rerata MVK tidak obes 138,24 g (SB 24,19) (p<0,001). Terdapat hubungan antara KIM dengan MVK pada remaja obes (r=0,374 p=0,006). Kesimpulan. Ketebalan intima media arteri karotis dan MVK pada remaja obes berbeda bermakna dibandingkan tidak obes. Pada remaja obes terjadi peningkatan KIM dan MVK. Terdapat hubungan peningkatan KIM arteri karotis dengan peningkatan MVK pada remaja obes.

Treatment of ulcerated hemangiomas with propranolol: an evidence-based case report

Hemangiomas are the most frequent vascular tumors observed in early childhood. The presentation is unique, with an initial phase of proliferation, followed by a phase of slow, spontaneous regression after the age of 1 year.1,2 Most hemangiomas are uncomplicated and do not require intervention. However, therapy may be needed if the hemangioma is located at certain body sites, such as the face, or if it results in a functional handicap, such as limitation of eye opening. In addition, ulcerated, rapidly growing hemangiomas may require treatment.3

Febrile neutropenia in childhood leukemia: Manado experience 1997 - 2006

Background Febrile neutropenia (FNP) is a common complication of therapy among children with cancer. It is one of the causes of significant morbidity and mortality in children and young adults treated for cancer. With aggressive management of FNP, the outcome of episodes in children has improved dramatically. Objective To determine factors associated with FNP, to assess how varied the current management, and to evaluate the outcome of FNP in childhood leukemia in Manado over the last 10 years. Methods Data from medical records was collected retrospectively from January 1997 to December 2006. Variables studied were: age, sex, nutritional status, sosio-economic status, type of leukemia, degree of fever, ANC at fever, phase of chemotherapy, antibiotic used, episodes ofFNP and the outcome of patients. Results Twenty of ninety one patients were studied. The mortality rate was crucial i.e., 11 of20, it was higher in boys than that in girls. Most children have severe to very severe neutropenia and more than half died (7 /13). Seven out of 12 malnourished patients died. Sixteen children are suffered from acute lymphoblastic leukemia (ALL). The outcome of high risk (HR) patients was worse than that of standard risk (SR). FNP occurred along the phase of chemotherapy. None of the factors studied showed significant difference. The choice of antibiotics is varied. Conclusion The outcome of FNP in our institution is grave. There is a need to evaluate application and compliance to the standard guidelines.