Susi Ari Kristina

Evaluation of Health-Related Quality of Life among Patients with Cervical Cancer in Indonesia

BACKGROUND Evaluation of health-related quality of life (HRQOL) in cervical cancer patients is important in order to design the interventions for improving patient outcomes. Reports of HRQOL among cervical cancer patients in Indonesia are limited. Moreover, measurement using EQ-5D-3L is to our best knowledge has hitherto not been performed. This study aimed to examine the HRQOL of cervical cancer patients in Indonesia using EQ- 5D-3L. MATERIALS AND METHODS A cross-sectional study was conducted by interviewing cervical cancer patients using the EQ-5D-3L questionnaire. Percentages of patients who reported having problems in each dimension of EQ-5D as well as EQ-5D index score (utility) were calculated. RESULTS Our findings indicated that the most frequent reported problems were pain/discomfort (67.8%) followed by anxiety/depression (57.5%). The mean of EQ-5D VAS was 75.8 (SD=17.0). The mean (SD) utility scores were 0.85 (0.19), 0.76 (0.20), 0.71 (0.21), and 0.77 (0.13) for cervical cancer patients in stage I, II, III, and IV, respectively. CONCLUSIONS Cervical cancer significantly affects patient HRQOL. Efforts should be made to improve the quality of life of cervical cancer patients especially in terms of pain /discomfort and anxiety/depression reduction.

Effectiveness of Tobacco Education for Pharmacy Students in Indonesia

BACKGROUND Smoking remains the major preventable cause of death worldwide, especially cancer-related death. Evidence clearly indicates that tobacco-related morbidity and mortality is reduced by smoking cessation. Pharmacists are well-positioned to provide tobacco cessation services an involvement of pharmacists in smoking cessation is encouraged by several organizations. While Indonesias prevalence of smoking is in the first rank in Asian countries, none of the pharmacy schools in Indonesia are currently offering tobacco-related courses in their existing curricula at present. Our study aimed to develop and to evaluate the effectiveness of tobacco education (TE) for pharmacy students in Indonesia. MATERIALS AND METHODS A 6-hour TE was developed and evaluated using pre-test/post-test with control group design. A total of 137 fifth-year pharmacy students at Gadjah Mada University (GMU), Yogyakarta, were chosen as an intervention group while a total of 105 fifth-year students of Islamic University of Indonesia, (UII) served as the control group. Knowledge, perceived-role, self-efficacy, and ability to perform counseling using the 5As framework were evaluated. RESULTS A significant improvement (P < 0.001) in knowledge, perceived-role, and self-efficacy was found in the intervention group but not in the control group. In addition, we revealed that 89.7% of the intervention group were able to perform counseling using 5As. CONCLUSIONS The developed TE significantly improved student knowledge, perceived-rolse, self-efficacy, and created an ability to perform cessation counseling. Integration of TE education in curricula of Indonesian pharmacy schools nation-wide should be encouraged.

Burden of cancer attributable to tobacco smoking in member countries of the Association of Southeast Asian Nations (ASEAN), 2012

BACKGROUND Cancer is an increasing problem in ASEAN (Association of Southeast Asian Nations). Tobacco use is a well-established risk factor for many types of cancers. Evidence on burden of cancer attributable to tobacco is essential to raise public and political awareness of the negative effects of tobacco on cancer and to be used to stimulate political action aims at reducing smoking prevalence in ASEAN member countries. The objective of this study was to estimate burden of cancer attributable to tobacco smoking in ASEAN, 2012. METHODS In this study, smoking prevalence was combined with Relative Risks (RRs) of cancer to obtain Smoking Attributable Fractions (SAFs). Cancer incidence and mortality data among individuals aged 15 years and older were derived from GLOBOCAN 2012. Fourteen types of cancer were included in the analysis. Sensitivity analyses were conducted to examine the impact of the use of alternative RRs and the use of alternative prevalence of smoking in some countries. RESULTS The findings showed that tobacco smoking was responsible for 131,502 cancer incidence and 105,830 cancer mortality in ASEAN countries in 2012. In other words, tobacco smoking was accounted for 28.4% (43.3% in male and 8.5% in female) of cancer incidence and 30.5% (44.2% in male and 9.4% in female) of cancer mortality in ASEAN. When looking at the types of cancer, lung cancer showed the strongest association with tobacco smoking. Incidence of cancer and cancer mortality attributable to tobacco smoking varied by countries due to the differences in size of population, background risk of cancer, and prevalence of smoking in each country. According to the sensitivity analyses, RRs of lung cancer, pharynx cancer, and larynx cancer used in the estimates have significant impact on the estimates. CONCLUSIONS As about one-third of cancer incidence and mortality in ASEAN are attributable to tobacco smoking ASEAN member countries are strongly encouraged to put in place stronger tobacco control policies and to strengthen the existing tobacco control measure in order to effectively control cancer.

Burden of Cancers Related to Smoking among the Indonesian Population: Premature Mortality Costs and Years of Potential Life Lost

BACKGROUND As smoking is the leading preventable cause of multiple diseases and premature cancer deaths, estimating the burden of cancer attributable to smoking has become the standard in documenting the adverse impact of smoking. In Indonesia, there is a dearth of studies assessing the economic costs of cancers related to smoking. This study aimed to estimate indirect mortality costs of premature cancer deaths and years of potential life lost (YPLL) attributable to smoking among the Indonesian population. MATERIALS AND METHODS A prevalence based method was employed. Using national data, we estimated smoking-attributable cancer mortality in 2013. Premature mortality costs and YPLL were estimated by calculating number of cancer deaths, life expectancy, annual income, and workforce participation rate. A human capital approach was used to calculate the present value of lifetime earnings (PVLE). A discount rate of 3% was applied. RESULTS The study estimated that smoking attributable cancer mortality was 74,440 (30.6% of total cancer deaths), comprised of 95% deaths in men and 5% in women. Cancers attributed to smoking were responsible for 1,207,845 YPLL. Cancer mortality costs caused by smoking accounted for USD 1,309 million in 2013. Among all cancers, lung cancer is the leading cause of death and economic burden. CONCLUSIONS Cancers related to smoking pose an enormous economic burden in Indonesia. Therefore, tobacco control efforts need to be prioritized in order to prevent more losses to the nation. The data of this study are important for advocating national tobacco control policy.

Estimating the Burden of Cancers Attributable to Smoking Using Disability Adjusted Life Years in Indonesia

Tobacco use is a well-established risk factor for many types of cancers. Recent data on selected cancer incidence and mortality related to smoking in the Indonesian population are provided in this study. Morbidity and mortality data were derived from GLOBOCAN 2012 and the population attributable fraction (PAF) was estimated using the standard methodology developed by the World Health Organization. Using these data, we calculated disability adjusted life year (DALY) values for smoking-related cancer. The DALY was estimated by summation of the years lived with disability (YLD) and years life lost due to premature death (YLL). The cancer cases related to smoking in Indonesia numbered 45,132, accounting for 35,580 cancer deaths. The morbidity and mortality of lung cancer can be considered as the highest priority in both men and women. Furthermore the greatest YLD due to smoking in Indonesian men and women were from pancreas and lung cancers. For YLL among men, the highest years lost were from lung and liver cancers. On the other hand, among women lung oral cavity and lip were most important. Based on the DALY indicator, burden priorities for Indonesian men were lung cancer (298,980), liver cancer (60,367), and nasopharynx (46,185), while among Indonesian women they were lung cancer (34,119), cervix uteri (9,213) and pancreas cancer (5,433). In total, Indonesian burden of cancers attributed to smoking was 638,682 DALY. This study provides evidence about the burden of cancers caused by smoking as a rational basis for initiating national tobacco control policies in Indonesia.

Early experience with a health promotion course for pharmacy students in Indonesia

Objective: To implement a new health promotion course as part of pharmacy public health practices and to identify pharmacy students’ knowledge, perceived role and self-efficacy with respect to what was learned through this. Method: A total of 119 fifth-year pharmacy students undertook a new health promotion course in a pharmacy school in Yogyakarta. A questionnaire consisting of 30-item knowledge scale, a 6-item perceived-role scale, and a 9-adjective self-efficacy scale was used to measure students’ knowledge and attitudes before and after the new course. Results: Of the 119 pharmacy students completing the questionnaire, 77% were female, with a mean age of 22.8 years, and 79% had BPharm degree with a grade point average in excess of 3.00. A significant post intervention improvement (p < .001) was found in terms of knowledge, perceived role and self-efficacy. The majority of students perceived that their involvement in health promotion activities would help the community and have a positive impact on their future careers. Conclusion: Pharmacy students gained positive knowledge, perceived role and self-efficacy towards a health promotion course. Strategies to ensure that positive attitudes translate into actual behaviours of engaging in health promotion activities are needed. Sustainability and the integration of health promotion activities into the curriculum of pharmacy schools nation-wide in Indonesia should be encouraged.

Readiness to Educate Patient: Indonesian Health Professionals’ Perspective

The aim of this study was to investigate Indonesian health professionals’ practice in educating patients and explore the perceived barriers. A self-administered questionnaire was given to the health professionals attending the Agent of Change (AoC) meeting in Yogyakarta Province, Indonesia. Data were explained by descriptive analysis. One hundred and twenty health professionals participated in this study. Majority participants were female (75.8%), the mean of age were 46.74 (SD 5.32), pharmacists (63.3%), work in primary health care (62.5%), working experience <5 years (54.2%), and had counseling experience (66.7%). Name of medicine and its active ingredients was the most medication information which counselled by participants (3.67±1.22). Limited time to communicate to the patients was the most barrier that perceived by health professionals (70.8%). Improve the work efficiency is the key strategies. Health professionals can be effectively trained in counseling skills and be encouraged by constant monitoring of the obtained skills.

Knowledge, Perception, and Acceptance of HPV Vaccination and Screening for Cervical Cancer among Women in Yogyakarta Province, Indonesia

Objective: To determine knowledge, perception, and acceptance related to cervical cancer, HPV vaccination and screening for cervical cancer among Indonesian women, particularly in Yogyakarta province. Methods: A convenience sample of 392 women consists of 192 young women, 100 mothers of girls aged 12 – 15 years, and 100 adult women in Yogyakarta province, Indonesia was participated in this study. A self-administered paper-based questionnaire was used to determine demographics characteristics of respondents, as well as their knowledge – perception – acceptance related to cervical cancer, HPV vaccination, and screening for cervical cancer. Data collection were conducted during December 2013 to March 2014. Descriptive statistics was used to analyze description of demographics characteristics, knowledge, perception, and acceptance; while crosstab analysis using Chi-Square was used to analyze the relationship between demographics characteristics versus knowledge, perception, and acceptance. Results: This study found that knowledge and perception regarding cervical cancer, HPV vaccination, and screening for cervical cancer among women in Indonesia, particularly in Yogyakarta Province were still insufficient, however the acceptance was good. Among female young women, 64% had good knowledge, 62% had positive perception of cervical cancer and HPV vaccination, and 92% tended to accept HPV vaccination. Among mothers of girls aged 12 – 15 years, 44% had good knowledge, 46% had positive perception of cervical cancer and HPV vaccination, and 91% tended to accept HPV vaccination for their daughters. Among adult women, 68% had good knowledge, 57% had positive perception of cervical cancer and screening for cervical cancer, and 90% tended to accept cervical cancer screening. In general, demographics characteristics of having experience and exposure to information had significant relationship with knowledge, perception, and acceptance of HPV vaccination and screening for cervical cancer. Conclusions: Either knowledge or perception of cervical cancer and strategies toward it among Indonesian women particularly in Yogyakarta province were still unsatisfied. Efforts should be improved for supporting cervical cancer prevention and control in Indonesia through such as education on cervical cancer disease and strategies toward it.

National Burden of Cancers Attributable to Secondhand Smoking in Indonesia

Background The high prevalence of smokers in Indonesia is also increase the number of people as secondhand smokers. Secondhand smoke causes many health problems, including cancer. Thus, Indonesia will bear large number cancer burden of disease, but research on cancer related to secondhand smoking in Indonesia still does not exist. Therefore, this study aimed to determine the number of secondhand smoke attributable fractions (SAFs) of six cancers (lung, bladder, colorectal, stomach, pancreas and larynx) and burden of cancer caused by secondhand smoking in Indonesia using Disability Adjusted Life Years (DALYs) indicator. Material and Methods This research was using descriptive epidemiological prevalence-based research design, with cancers prevalence data gained from Indonesian health assurance system database in 2016. The SAFs is calculated by combining both data of secondhand smoking prevalence and relative risk and the DALY indicator is calculated as the sum of years of life lost due to premature mortality (YLL) and the equivalent healthy years lost due to disability (YLD). Results Based on SAFs proportion, the highest SAFs among men were in pancreas cancer (80.20%), stomach cancer (79.54%) and laryngeal cancer (69.61%), whereas in women, pancreas cancer (78.95%), stomach cancer (78.26%) and bladder cancer (63.30%). Meanwhile, burden priorities for Indonesian men and woman were lung cancer (110,491), colorectal (68,131), and bladder cancer (39,140). Conclusions In total, DALYs 6 cancer diseases due to secondhand smoke analyzed in this study were 283,360 DALYs. Thus, the results of the research can be used as a basis for further policies making on national cigarette prevention and control in Indonesia.

Estimating the Burden of Cancer and Treatment Cost Related to Alcohol Consumption in Indonesia: a Descriptive Study

Background Alcohol consumption has become one of the most common cancer risk factors after smoking. Nowadays, estimation of the burden of disease attributable to alcohol has become standard in documenting the impact of health problems, but it has been rarely performed in Indonesia. The aim of this study was to estimate treatment cost of cancer related to alcohol consumption among the Indonesian population. Methods This research design was descriptive with a prevalence-based approach using secondary data. Proportions of cancers were calculated using an alcohol-attributable fractions (AAF) formula. Treatment costs for eight types of cancer were assessed according to average treatment cost per patient from the national universal health coverage database for 2016. Result The top three AAFs for males were cancers of the pharynx, esophagus and larynx (17.5%, 15.3% and 7.98%, respectively), while in females they were cancers of the esophagus, pharynx and stomach (2.15%; 1.39%; 0.83%). Among the eight types of cancer studied, the highest incidence in males was noted for liver cancer (132 cases) while colorectal cancer was the most common among females (31 cases). Treatment cost for cancers related to alcohol consumption were highest for colorectak cancer followed by laryngeal and liver cancer (116,083, 98,325 and 93,253 USD, respectively. Conclusion The expenditure for treatment of cancers related to alcohol consumption accounts for about 1.71% of total cancer treatment cost. Since cancers related to alcohol consumption can be considered having an economic impact in Indonesia, it becomes important for the government to control alcohol consumption so that related healthcare expenditure can be minimized.