Dharmais Cancer Hospital Research Articles

The Role of FLT3-ITD Mutation, PI3K/AKT Pathway, and Leukemia Stem Cells in D3A7 Induction therapy – the Outcomes of Adult Indonesian Patients with Acute Myeloid Leukemia

Objective. This cohort study aimed to examine the impact of the FLT3-ITD mutation on the downstream signaling pathway of PI3K/AKT pathway, the percentage of leukemia stem cells, and the survival of patients receiving D3A7 induction therapy. Method. Bone marrow mononuclear cells were collected from 20 adult AML patients who had completed D3A7 induction therapy at Cipto Mangunkusumo National General Hospital and Dharmais Cancer Hospital. FLT3-ITD gene mutation was examined by the PCR-sequencing method. Expression of phosphorylated PI3K and AKT was detected using the sandwich ELISA method. Flow cytometry was used for detecting the number of apoptosis and proliferation cells, and biomarkers of leukemia stem cells. Result. The expression levels of PI3K and AKT proteins were higher in FLT3-ITD, both in the mutant group compared to the non-mutation group, and in the patient group with treatment failure outcomes compared to the patient group with treatment response. The percentage of the leukemia stem cell population did not differ significantly between the FLT3-ITD mutation group and the wild type group, and between the treatment failure outcome group and the response outcome group. Conclusion. This study presents the important role of FLT3-ITD mutation via its downstream signaling (PI3K/AKT) in the outcome of D3A7 induction therapy. The FLT3-ITD mutation plays an important role in the 12-month survival of AML patients after D3A7 therapy. However, the outcome of D3A7 therapy and FLT3-ITD mutation were not associated with leukemia stem cells.

Exploring Genetic Variants and Platinum Chemotherapy Response in Indonesian Non-Small Cell Lung Cancer Patients: Insights from ERCC2 rs13181.

Individual responses to platinum-based treatment for Non-Small Cell Lung Cancer (NSCLC) are influenced by genetic polymorphisms, including Single Nucleotide Polymorphisms (SNPs). This study aimed to explore the role of ERCC2 in the Nucleotide Excision Repair (NER) pathway for platinum-based chemotherapy in NSCLC. While ERCC2 is widely studied, data for Southeast Asian populations are lacking. Addressing this gap could improve personalized treatment strategies for NSCLC in this demographic. This study recruited 82 NSCLC patients with wildtype mutations of EGFR at Dr. H.A. Rotinsulu Lung Hospital, Bandung, and Dharmais Cancer Hospital, Jakarta. Data were collected prospectively from whole blood samples and medical records, while the effectiveness of chemotherapy was assessed by evaluating the response using RECIST 1.1 criteria on fourth cycle of chemotherapy. The results of this study showed the presence of genotype variation among the subjects, with frequency distribution as follows: AA genotype (82.9%), AC genotype (15.9%), and CC genotype (1.2%). The analysis of the association between ERCC2 rs13181 CC + AC versus AA with RECIST 1.1 yielded an odds ratio (OR) of 1.042 (95% CI: 0.292-3.715; p=0.950). A multivariate analysis that included cancer stage and chemotherapy regimen as additional variables produced an adjusted odds ratio (aOR) of 0.970 (95% CI: 0.263-3.568; p=0.963). This study did not find statistically significant associations between ERCC2 rs13181 polymorphisms and chemotherapy responses. However, this research highlights the presence of genetic variation within the Indonesian population, with the AA genotype being the most prevalent, which may influence chemotherapy responses. The results provided preliminary data and lay the foundation for future comprehensive cohort observational investigations.

Identification of a novel mutation of the FLT3 gene located on the juxtamembrane domain from acute myeloid leukemia patients.

FLT3 gene mutations are genetic abnormality that caused leukemogenesis. Furthermore, presence of FLT3 mutations is associated with poor prognosis in AML. This study aimed to identify FLT3 gene mutations so that it can be used as a genetic reference for the AML patients in Indonesian population. This cross-sectional study recruited 63 AML de novo patients between August 2021 and July 2023 at Cipto Mangukusumo General Hospital and Dharmais Cancer Hospital. We collected peripheral blood from the patients for DNA isolation. FLT3 gene mutation was detected using PCR method, then followed by the Sanger sequencing. Novel mutation in exon-14 continued to in silico study using SWISS MODEL server for modelling protein and PyMOL2 software for visualizing the protein model. Frequency FLT3-ITD mutation was 22% and 6 (10%) patients had a novel mutation on juxtamembrane domain. The number of FLT3-ITD insertions was 24bp to 111bp, with a median of 72bp. Novel mutation indicated a change in the protein sequence at amino acid number 572 from Tyrosine to Valine and formed a stop codon (UGA) at amino acid position ins572G573. In-silico study from novel mutation showed the receptor FLT3 protein was a loss of most of the juxtamembrane domain and the entire kinase domain. A novel FLT3 gene mutation was found in this study in the juxtamembrane domain. Based on the sequencing analysis and in silico studies, this mutation is likely to affect the activity of the FLT3 receptor. Therefore, further studies on this novel mutation are needed.

Unraveling Copy Number Alterations in Pediatric B-Cell Acute Lymphoblastic Leukemia: Correlation with Induction Phase Remission Using MLPA.

Acute Lymphoblastic Leukemia (ALL) is the most common malignancy occurring in children. Copy number alterations (CNA) like PAX5, CDKN2A/2B, PAR1 Region, ETV6, IKZF1, BTG1, and RB1 gene deletion are important genetic events that define and prognosticate B-cell ALL. Thus, this study aimed to evaluate associations of CNA with induction phase remission status in childhood B-cell ALL. This study was observational with a cross-sectional design at the Dharmais Cancer Hospital, Harapan Kita Mother and Children Hospital, and Tangerang Regional Public Hospital. We evaluated 74 pediatric B-cell ALL cases with 1-18-year-olds. Genomic DNA was analyzed by Multiplex Ligation Dependent Probe Amplification Assay (MLPA). This study used the P335 ALL-IKZF1 panel kit, which contains several ALL-related genes. The patient's clinical and laboratory characteristics were collected from medical records from January to December 2019. We observed gene copy number alteration in children with B-Cell ALL. PAX5 was the most commonly observed gene deletion, followed by CDKN21/2B, ETV6, IKZF1, BTG1, RB1, and PAR1 Region. Based on gene mutations, only the PAX5 had a significant association with the remission status of pediatric B-cell ALL (p-value <0.05; OR = 3.91). It showed that patients with PAX5 gene mutations have 3.9 times the risk of no remission and/or relapse compared to those without PAX5 gene mutations. Patients with mutations in the PAX5 gene have a higher chance of not achieving remission and/or experiencing relapse than those without such mutations. The MLPA method can be utilized for examining copy number alterations, which is valuable for achieving more precise stratification in diagnosis.. Further research is needed to expand upon this finding.

Profiles of Cancer Patients at Surgical Oncology Outpatient Clinic at Dharmais Cancer Hospital as National Referral Hospital in Indonesia from 2017 to 2021

Profiles of Cancer Patients at Surgical Oncology Outpatient Clinic at Dharmais Cancer Hospital as National Referral Hospital in Indonesia from 2017 to 2021

Cost and Duration Optimization at Building C of Dharmais Cancer Hospital Jakarta with TCTO Method Using Primavera P6 Analysis

Cost and Duration Optimization at Building C of Dharmais Cancer Hospital Jakarta with TCTO Method Using Primavera P6 Analysis

HEALTH-RELATED QUALITY OF LIFE IN POSTMENOPAUSAL WOMEN WITH ADVANCED BREAST CANCER RECEIVING ADJUVANT HORMONE THERAPY (RIBOCICLIB AND LETROZOLE)

Breast cancer is a type of cancer that affects many women in Indonesia. Adjuvant hormone therapies, such as letrozole and ribociclib, have succeeded in improving the patient's quality of life. This study aimed to assess the quality of life of postmenopausal women with advanced breast cancer who received adjuvant hormone therapy with ribociclib and letrozole. A cross-sectional study was conducted using retrospective data from postmenopausal female breast cancer patients at Dharmais Cancer Hospital between 2020 and 2023 who met the inclusion criteria. To determine the impact of sociodemographics on patient quality of life, data were examined using the quality of life score (EQ5D5L) and Spearman test. There were 29 patients, with a mean age of 54.9 years (SD = 8.65); the highest education level was high school (34.5%); The majority of occupations are housewives (69%), and the majority are stage IV (34.5%). The mean utility and VAS values of Ribociclib were 0.885 and 81.66, respectively, whereas those for letrozole were 0.725 and 78.46, respectively. Analysis of the relationship between quality of life and patient characteristics showed that the quality of life of patients with breast cancer treated with adjuvant ribociclib and letrozole therapy was influenced by the stage of breast cancer (p = 0.008). These findings indicate that patients receiving ribociclib and letrozole therapy have a good quality of life, which quality of life quality of life is influenced by the stage of malignancy. Keywords: breast cancer, quality of life, letrozole, ribociclib, post menopause

Protein Programmed Death-Ligand 1 Expression in Non-Small Cell Lung Cancer (NSCLC) and Its Correlation to Smoking Status in North Sumatera Population

Tobacco smoking is associated to the increase risk of lung cancer, and smoking could also trigger the tumour proportion score from programmed death ligand (PD-L1). This study aims to identify the correlation of non-small cell lung cancer (NSCLC) with the PD-L1 expression and smoking profile on the North Sumatra Population. Lung cancer is a significant health issue worldwide, where it is the leading cause of death in men. In Indonesia, lung cancer ranks second in terms of incidence overall and first in men. The 5-year prevalence of lung cancer in Indonesia is 10.85 per 100,000 population. The case fatality rate (CFR) for lung cancer in Indonesia is 86.91%. This research implemented a descriptive study with cross-sectional design. 100 of patients with lung cancer were recruited, however; only 52 patients were diagnosed with NSCLC based on histopathological results. Subsequently, 35 samples were included in accordance to inclusion criteria. Staining on Ventana 22C3 platform was performed in Dharmais Cancer Hospital, and tumour proportion score was assessed by two experts of Pathologist. This study was carried out from August 2019 to September 2020. Results: Characteristics of patients with NSCLC to the PD-L1 expression were found more in male patients with percentage of 88.6%, whereas the most common type of cancer is adenocarcinoma, accounting for 97.14% of cases with mild degree smoking index for 45.7% (Brinkman index) and IV-stage of clinical status for 68.6%. The tumour proportion score with 1-49% was 51.4% with high expression of PD-L1 (positive) for 74.28%, while lower expression of PD-L1 accounted for 45%. There is a correlation between PD-L1 expression and smoking status in NSCLC patients, with p-value of 0.037 (&lt;0.05).

Upper Arm Exercises on Pain Intensity Among Patient with Breast Cancer Dharmais Cancer Hospital, Indonesia

Upper Arm Exercises on Pain Intensity Among Patient with Breast Cancer Dharmais Cancer Hospital, Indonesia

User Centered Design in Analysis and Design of UI UX in the Simpeg Application of Dharmais Cancer Hospital

Dharmais Cancer Hospital as a health service facility that is experienced in its field, of course, has human resources which are important, so to support employee performance in terms of employee rights such as employee leave, media is needed that really supports employee needs. Through the employee support system, namely the Employee Information System (SIMPEG) application, several problems were found in terms of appearance and the proposal process as well as the leave recapitulation process which did not exist in the previous SIMPEG application. From the problems found in the Personnel Information System (SIMPEG), a User Centered Design (UCD) method is offered which places the Personnel Information System (SIMPEG) users as the main consideration for building a new system. In the design process there are three steps that are carried out starting from the initial stage, the development stage and the final stage, where at the initial stage testing is carried out using a questionnaire, the average result is 53 which means OK but still low or not good, after the development of the system is carried out and the distribution of questionnaires was carried out again, the results were 71, which means Good. With the design of a Personnel Information System (SIMPEG) using the User Centered Design (UCD) method, it produces a new User Interface (UI) and User Experience (UX) design for the Personnel Information System (SIMPEG), which consists of a forgot password menu feature, leave recap and display easier to use for employees.

Analysis of Presentation Delay in Patients with Advanced Breast Cancer Visiting Dharmais National Cancer Hospital

Background: Breast cancer is still one of the significant causes of the increasing mortality rate due to cancer. Treatment of breast cancer patients was delayed by 66.34%. The majority of patients arrive at stages IIIB and IV and are therefore treated at an advanced stage. This study aimed to analyze the factors causing the arrival delay of breast cancer patients to Dharmais Cancer Hospital with advanced stages. Methods: A descriptive study with a qualitative approach was used as the research design. Indepth interviews and document reviews were used to collect data. In-depth interviews were conducted with 12 advanced-stage breast cancer patients. Thematic data analysis was performed by tracing and identifying the main topics of the entire interview process. The triangulation method was used to validate the data by conducting interviews with 4 patient families and 2 oncology surgeons, as well as document review. Results: The presentation delay of advanced breast cancer patients was analyzed based on the interpretation and recognition of symptoms. There was an attitude of ignoring when there were symptoms and not seeking treatment. On psychological factors, there was a feeling of fear after being diagnosed and a sense of worry in the treatment process. On socioeconomic factors, there was no early detection, lack of information on early detection, waiting time constraints, and the selection of alternative treatments. Conclusions: Late-stage breast cancer patients were drawn to Dharmais Cancer Hospital due to issues with the interpretation and experience of symptoms, psychological issues patients reported, and socioeconomic difficulties during treatment. As a result, patients must be given additional care to deal with late arrivals, especially in cases of advanced breast cancer.

Analysis of Hospital-Based Cancer Registration Training Readiness Using Blended Learning Method in the National Cancer Center Indonesia, Dharmais Cancer Hospital

Background: Cancer registration produces statistical information on cancer that complies with international standards so that it can be used as a baseline for taking cancer policy directions. The quality of the data can be affected by the officers who carry it out. Hospital-Based Cancer Registration Training in Indonesia has been held since 2016 to increase the capacity of cancer registration implementation. Since the pandemic, online methods have been increasingly used in the world, not only in education but also in health sector . In addition, the blended learning method has becomebecome an option because it is more effective for delivering material that requires interaction with the instructor. Cancer registrars have an important role in the process of cancer registration activities in providing valid and accurate information so that to support performance, training is needed to increase the capacity of cancer registrars. Dharmais Cancer Hospital has had a Hospital-Based Cancer Registration Training program with the aim of achieving the competencies needed in cancer registration. This study aims to analyze the readiness of the blended learning method of hospital-based cancer registration training by the National Cancer Center Indonesia, Dharmais Cancer Hospital. Methods: The research design was carried out in the form of quantitative descriptive where data collection was in the form of questionnaires to the research subjects according to the inclusion criteria. The inclusion criteria for research subjects were training instructors, training organizers, cancer registration implementers, and leaders who were responsible for cancer registration. The research was conducted at the National Cancer Center Indonesia, Dharmais Cancer Hospital from April to November 2022. Data will be analyzed using SPSS. Results: We analysed the 35 respondents with the results were mostly female (80%), bachelor degree (51.4%), 30-39 years old (40%), never been cancer registration trainer (71.4%), and ever heard about about cancer registration training (82,9%). There were three variable that had mean higher than overall mean which technology (3.95), self development (3.86), and training curriculum (3.98). However the innovation (3.61) and training organizer (3.17) were less then overall mean. Conclusion: Dharmais Cancer Hospital has been ready but need improvements to have cancer registration training using blended learning. Innovation factor and training organizer should be improved.

Evaluation of Completeness of Cancer Data Variables on Data Quality in Hospital-Based Cancer Registration Activities at Dharmais Cancer Hospital

Background: Cancer is a major burden of disease worldwide, including in Indonesia. As an effort to control the burden of cancer, WHO established National Cancer Control Programs (NCCP) where cancer registration is one of the key points. Dharmais Cancer Center Hospital, appointed as the national cancer center, has the responsibility to conduct a cancer registry in Indonesia. The good quality data of cancer registry according to international standards is beneficial to describe the cancer burden in the country. In Dharmais Cancer Center Hospital, microscopic verification is one of the variables that has not been qualified. Therefore, it is important to evaluate the completeness of cancer data variables toward data cancer quality on hospital-based cancer registry of Dharmais Cancer Center Hospital. To assess the quality of cancer data based on microscopic verification, to evaluate the completeness of hospital-based cancer registry variables and the quality of data based on microscopic verification between complete and incomplete variable groups. Materials and Methods: This quantitative research is an observational study (non-experimental) with cross- sectional study design. It utilizes secondary data from hospital-based cancer registry of Dharmais Cancer Center Hospital for incidence year 2013-2017. Results: Data quality of microscopic verification that assessed on a complete data group is 87,8% and for overall cancer cases is 62%. Among social variables, identity numbers are the most incomplete variable, which is 39%. While among tumor data variables, stage is also the most incomplete variable with 82% data. There are differences between the quality of data based on microscopic verification with the completeness of data, especially among social data variables and tumor data variables. Conclusion: The quality data based on microscopic verification that is assessed on a complete variable group is better than microscopic verification on overall cancer cases. The incomplete variables among social variables are identity number, date of birth, address, and district/province. Whereas on tumor variables, the incomplete variables are stage, treatment, metastasis, and laterality. The completeness of cancer data has an important role on data quality based on microscopic verification mainly on social and tumor variables. Improvement and strengthening particularly on management and technical aspects of cancer registration are indispensable.

Gender role conflicts experienced by Indonesian women with gynecological cancer: A phenomenological study.

Gynecological cancer and its treatments can lead to sexual problems, potentially disrupting the gender role performance of women. Sexuality and gender roles are context-specific, yet these issues remain unexplored in the Indonesian context. This study aimed to explore the gender role conflicts experienced by Indonesian women having gynecological cancer. A qualitative design with a phenomenology approach was utilized in this study. Data were collected through individualized, face-to-face, in-depth interviews conducted from 1 April to 30 December 2022 with 22 women diagnosed with gynecological cancer who had undergone treatments at the Dharmais Cancer Hospital, Jakarta, Indonesia. Data were analyzed using thematic analysis. Three themes were developed: 1) challenges in fulfilling female gender roles after having cancer diagnosis and therapies, 2) emotional struggles related to gender role conflicts, and 3) efforts to cope with gender role conflicts. The study sheds light on how sexual complications due to gynecological cancer and its treatments extend beyond physical issues. A deeper layer of problems around sexual dysfunctions among gynecological cancer survivors is often rooted in traditional gender-role expectations. Nurses should have a comprehensive and contextual understanding of the unique experiences of women living with gynecological cancer to facilitate a positive adaptation to their cancer journey.

Genomic features of lung cancer patients in Indonesia’s national cancer center

IntroductionAdvances in molecular biology bring advantages to lung cancer management. Moreover, high-throughput molecular tests are currently useful for revealing genetic variations among lung cancer patients. We investigated the genomics profile of the lung cancer patients at the National Cancer Centre of Indonesia.MethodsA retrospective study enrolled 627 tissue biopsy samples using real time polymerase chain reaction (RT-PCR) and 80 circulating tumour DNA (ctDNA) liquid biopsy samples using next-generation sequencing (NGS) from lung cancer patients admitted to the Dharmais Cancer Hospital from January 2018 to December 2022. Data were obtained from medical records. Data statistically analysed with p < 0.05 is considered significant.ResultThe EGFR test results revealed by RT-PCR were wild type (51.5%), single variant (38.8%), double variant (8.3%), and triple variant (1.4%), with 18.66% L85R, 18.22% Ex19del, and 11.08% L861Q variant. Liquid biopsy ctDNA using NGS showed only 2.5% EGFR wild type, 62.5% single variant and 35% co-variant, with EGFR/TP53 and EGFR/PIK3CA as the highest.ConclusionEGFR variants are the most found in our centre. Liquid biopsy with ctDNA using NGS examination could detect broad variants and co-variants that will influence the treatment planning.

BRAF V600E Mutation Test in Fine Needle Aspiration (FNA) Specimens of Thyroid Nodules by Competitive Allele-Specific TaqMan PCR (castPCR)

Background: BRAF V600E mutation has been confirmed as a significant molecular indicator for the diagnosis and prognosis of papillary thyroid carcinoma (PTC). Sanger sequencing is the recognized approach for BRAF V600E mutation analysis, yet it is not proficient at detecting mutations that occur at low frequencies, especially in thyroid fine needle aspiration (FNA) specimens. This study aimed to evaluate the diagnostic value of Competitive Allele-Specific TaqMan PCR (castPCR) as a new reliable method for BRAF V600E mutation test in thyroid FNA specimens compared to Sanger sequencing. Methods: Thirty patients with thyroid nodules were enrolled prospectively at Dharmais Cancer Hospital Jakarta from 2013–2014. The BRAF V600E mutation was analyzed from FNA specimens using castPCR and Sanger Sequencing methods. The sensitivity and specificity of those methods were compared with routine diagnostic histopathological examination as a gold standard for PTC assessment.Results: A total of 66.6% (20/30) cases were confirmed as PTC by postsurgical histopathological examination. Among these, the BRAF V600E mutation was found in 60.0% (12/20) by castPCR and 40.0% (8/20) by Sanger sequencing. Neither castPCR nor Sanger sequencing detected BRAF V600E mutation in other nodular thyroid diseases. The sensitivity and specificity of castPCR were 60.0% and 100.0%, while Sanger sequencing was 40.0% and 100.0%, respectively. Conclusions: This study indicated that castPCR has a higher sensitivity for the BRAF V600E mutation test than Sanger Sequencing, especially in samples with a low abundance of mutant alleles. A sensitive, rapid, and easy castPCR method is reliable for evaluating BRAF V600E mutation and can improve PTC preoperative diagnosis in clinical settings.

IDENTIFIKASI KAWASAN HUNIAN DI SEKITAR RUMAH SAKIT HARAPAN KITA DAN RUMAH SAKIT KANKERDHARMAIS, JAKARTA BARAT, INDONESIA

Harapan Kita Heart Hospital and Dharmais Cancer Hospital are national scale hospitals in Indonesia, are central hospitals with the most complete service facilities for heart disease and cancer. these two hospitals are referral centers for patients from various provinces and cities throughout Indonesia. There are various levels of care needed, patients must be accompanied by family or relatives at the time of treatment. For this reason, patients need a place to live around these two hospitals. The purpose of this study is to identify residential areas around Harapan Kita Heart Hospital and Dharmais Cancer Hospital, as well as identify land use suitability with the DKI Jakarta RDTR 2022. The study location is RT01 and RT 08, RW 06 and RW 09, South Bamboo City Village, Palmerah District, West Jakarta City, which is directly adjacent to the two hospitals. Descriptive analysis was used to determine the changes that occurred based on in-depth interviews with 30 study respondents who were boarding house owners or guards. The results showed a change in residential form by 80% from a onestory house to a 2.3-storey building, with the Basic Building Coefficient and Building Floor Coefficient not in accordance with the DKI Jakarta RDTR 2022.

Analysis of The Utilization of The Automatic Exposure Control (AEC) Feature in The Use of Deep Learning Breast Image Technology in Women's Mammogram Screening Examinations at Dharmais Cancer Hospital

Deep learning technology is useful for radiology specialists as double reading to help increase the accuracy of image interpretation results. One of the preparations for maximizing the use of this technology is using good-quality images as the source. The Automatic Exposure Control (AEC) feature, which functions to determine exposure factors automatically, is expected to help produce images with good and consistent quality so that deep learning technology can work more effectively. This research aims to determine the quality results of mammogram images taken using the AEC feature and to analyze the use of deep learning technology in evaluating mammogram images. This research method is retrospective by collecting 800 mammogram images randomly and anonymously. Three hundred images were tested, 500 were evaluated, and 250 were analyzed for image quality based on references related to applying AEC and assessing the contrast-to-noise ratio (CNR). Deep learning technology was analyzed by comparing the results of mammogram image evaluation using deep learning and the evaluation results of a radiology specialist. Deep learning technology analysis shows that 98% of mammograms have the same results as the radiology doctor's evaluation, and 2% have different results from the radiology doctor's evaluation where the image has a dense breast type. The image quality results in this research showed that 97.6% of the 250 samples taken using the AEC feature had good image quality, and 2.4% had poor image quality due to inappropriate breast positioning during the examination.

CEA and Cyfra 21-1 linked to serial miRNA expressions of advanced-stage non-small cell lung cancer in Indonesia

Globally, lung cancer is one of the cancers leading to dead, dominated by non-small cell lung cancer (NSCLC). In a previous study has shown those serial miRNA expressions (miR-148, miR-34, miR-222, and miR-155) had prognostic value in advanced-stage NSCLC patients. Meanwhile, CEA and Cyfra 21-1, pulmonary tumor markers, are sometimes considered in the Department of Pulmonology, Dharmais Cancer Hospital, Jakarta, although they are not used in routine clinics for prognostication. Both miRNA and CEA-Cyfra 21-1 are valuable biomarkers in NSCLC. This study aimed to evaluate their correlation between CEA and/or Cyfra 21-1 with miRNA expressions in NSCLC patients. It was a cohort retrospective study using data from the previous study. The correlation between variables was analyzed by Spearman-rho. A positive correlation was observed between CEA and Cyfra 21-1 with miR-148, miR-222, and miR-155 [(CEA: p=0.00369, r=0.522; p=0.00242, r=0.542; p 0.00106, r=0.576) (Cyfra: 21-1= p 0.01252, r=0.378; p=0.00035, r=0.519; p=0.01532, r=0.368)]. In conclusion, CEA and Cyfra 21-1 correlate with miR-148, miR-222, and miR-155 expressions in advanced-stage NSCLC.

The Correlation between Sputum Retention and Oxygen Saturation in Nasopharyngeal Cancer Patients with Tracheostomy at The Emergency Department of Dharmais Cancer Hospital in 2022

The Global Burden of Cancer Study (Globocan) stated that nasopharyngeal cancer is the fifth most common cancer in Indonesia, with an incidence of 19,943 cases. One of the therapies for patients with nasopharyngeal cancer is a tracheostomy. Post-tracheostomy care is critical because blockage in the cannula due to accumulation of secretions impact decreasing oxygen saturation and result in death. This study analyzes the correlation between sputum retention and oxygen saturation in nasopharyngeal cancer patients with tracheostomy at the Emergency Department of Dharmais Cancer Hospital in 2022. It was correlational quantitative research with a cross-sectional approach. The study population was all nasopharyngeal cancer patients with tracheostomy at the Emergency Department, Dharmais Cancer Hospital, from August to November 2022, totaling 65 respondents. There were 65 respondents with a total sampling technique. The data collection used secondary data, namely the level of sputum retention and oxygen saturation in nasopharyngeal cancer patients with tracheostomy. Data analysis was univariate analysis and bivariate analysis through chi-square test. The result showed that most respondents experienced poor sputum retention (61.5%) and moderate hypoxemia (63.1%). The chi-square test obtained a p=0.000 (p&lt;0.05). Thus, there was a correlation between sputum retention and oxygen saturation in respondents. In conclusion, sputum retention correlates with oxygen saturation in nasopharyngeal cancer patients with tracheostomy at the Emergency Department of Dharmais Cancer Hospital. The hospital should continue improving the ability of nurses to manage airway blockage through regular training.