Indonesian Breast Cancer Patients Research Articles

Higher peripheral blood mitochondrial DNA copy number and relative telomere length in under 48 years Indonesian breast cancer patients

ObjectiveBreast cancer is the leading cause of cancer incidence and mortality among Indonesian women. A comprehensive investigation is required to enhance the early detection of this disease. Mitochondrial DNA copy number (mtDNA-CN) and relative telomere length (RTL) have been proposed as potential biomarkers for several cancer risks, as they are linked through oxidative stress mechanisms. We conducted a case–control study to examine peripheral blood mtDNA-CN and RTL patterns in Indonesian breast cancer patients (n = 175) and healthy individuals (n = 181). The relative ratios of mtDNA-CN and RTL were determined using quantitative real-time PCR (qPCR).ResultsMedian values of mtDNA-CN and RTL were 1.62 and 0.70 in healthy subjects and 1.79 and 0.73 in breast cancer patients, respectively. We found a positive association between peripheral blood mtDNA-CN and RTL (p < 0.001). In under 48 years old breast cancer patients, higher peripheral blood mtDNA-CN (mtDNA-CN ≥ 1.73 (median), p = 0.009) and RTL (continuous variable, p = 0.010) were observed, compared to the corresponding healthy subjects. We also found a significantly higher ‘High-High’ pattern of mtDNA-CN and RTL in breast cancer patients under 48 years old (p = 0.011). Our findings suggest that peripheral blood mtDNA-CN and RTL could serve as additional minimally invasive biomarkers for breast cancer risk evaluation.

432MO Barriers and facilitators of home-based exercise intervention participation in Indonesian breast cancer patients: A nested qualitative study using COM-B model

432MO Barriers and facilitators of home-based exercise intervention participation in Indonesian breast cancer patients: A nested qualitative study using COM-B model

Case Report: The Relationship of CCND1 RS614367 Polymorphism with Clinicopathological Features

Recent studies have shown that the CCND1 rs614367 polymorphism increases the risk of breast cancer and its invasive nature. However, studies evaluating the relationship of the CCND1 rs614367 polymorphism based on the clinicopathology of breast cancer patients in Indonesia were still limited. This study is aimed to determine the CCND1 rs614367 polymorphism in breast cancer and its relationship with the patient's clinicopathology. Methods: This study was a cross-sectional study on 45 samples of breast cancer patients. After collecting demographic and clinical data, PCR and sequencing will be performed on all blood samples to determine the CCND1 rs614367 polymorphism. All variables that have been collected will be analyzed using SPSS version 25.0 to determine the relationship between the CCND1 rs614367 polymorphism and the clinicopathology of breast cancer patients. The CCND1 rs614367 gene polymorphism in breast cancer subjects showed that 25 (55.5%) and 20 (44.5%) subjects had C and T alleles. Subjects aged ≥ 50 years old had a significant 4.45 risk of having the T allele type (p=0.037). In addition, subjects with metastases (M1) were also at a significant 4.89 times risk of having the T allele type (p=0.015). Subjects with histological grade III also had a significantly 4.77 times risk of having the T allele type (p=0.013). In conclusion, there was a significant relationship between CCND1 rs614367 polymorphism and breast cancer subjects' clinopathology features (age, metastasis, and grade). More than half of the subjects with this polymorphism had the C allele.

Predictors need for complementary interventions using mobile application technology in women with breast cancer

Background. Some women with breast cancer tend to have psycho-social stress, embarrassment from the disease’s treatment, and difficulty asking for help. Furthermore, several studies indicate limited use of complementary online intervention in mental and spiritual health care, particularly when using mobile-based technologies.&#x0D; Purpose. This study identifies the key factors that affect the need for mobile-app complementary interventions and the variables affecting them among Indonesian breast cancer patients.&#x0D; Methods. A cross-sectional survey study with a simple random sampling technique included 112 patients between May and July 2022. The research instrument used is The Quality of Life-Breast Cancer questionnaire, Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp), Palliative Performa Scale Version 2, and The Need for Complementary Interventions using mobile-app technology (NCIM) to measure Predictors of The Need for Complementary Interventions. Meanwhile, multiple linear stepwise regression was used, and the potential multicollinearity effects among NCIM predictive variables were assessed through the collinearity analysis of variable inflation factors.&#x0D; Results. The mean score of NCIM was 25.17 and ranged from 10 to 40, and multiple regression analysis showed that the psychological and social dimensions of quality of life, as well as Facit-Sp, significantly affected the NCIM. This explains 8.5% of the total variance in the need for Mobile-app Complementary Intervention.&#x0D; Conclusion. Women with breast cancer have a high need for complementary interventions based on mobile technology. This study can provide the development of complementary intervention using mobile application technology.&#x0D; &#x0D;

Positive p53 Expression Is Associated with Primary Endocrine Therapy Resistance in Locally Advanced Stage Luminal B HER2-Negative Breast Cancer Patients: A Cross-Sectional Study in Indonesia.

Luminal B HER2-negative breast cancer (BC) is the most common type in Indonesian BC patients, and frequently manifests with locally advanced staging. Recurrence often occurs within two years of the endocrine therapy course (primary endocrine therapy (ET) resistance). p53 mutation often exists in luminal B HER2-negative BC, but its application as an ET resistance predictor in those populations is still limited. The primary purpose of this research is to evaluate p53 expression and its association with primary ET resistance in luminal B HER2-negative BC. This cross-sectional study compiled 67 luminal B HER2-negative patients' clinical data during their pre-treatment period until they completed a two-year course of endocrine therapy. They were divided into two groups: 29 patients with primary ET resistance and 38 without primary ET resistance. Pre-treatment paraffin blocks from each patient were retrieved, and the p53 expression difference between the two groups was analyzed. Positive p53 expression was significantly higher in patients with primary ET resistance [odds ratio (OR) of 11.78 (95% CI: 3.72-37.37, p-value < 0.0001)]. We conclude that p53 expression could be a beneficial marker for primary ET resistance in locally advanced luminal B HER2-negative BC.

Cross-cultural adaptation and psychometric properties of the Indonesian version for quality of life among breast cancer patients.

Breast cancer is one of the most important health problems worldwide. Quality of life (QoL) is an important indicator to evaluate symptoms in cancer patients, including those with breast cancer. Culturally suitable, valid, reliable, and appropriate instruments to measure the QoL of breast cancer patients are needed, which is still rare in Indonesia. This study aimed to translate the EORTC QLQ-BR45 instrument into Indonesian and evaluate its psychometrics. A cross-sectional study was performed on 635 patients conveniently selected from the oncology department in referral hospital. The first phase of this study involved translation of the existing EORTC QLQ-BR45 into Indonesian, and in the second phase, we evaluated its psychometric properties. Construct validity was evaluated using confirmatory factor analysis (CFA). Criterion validity was examined according to the association between disease stage and Karnofsky Performance Scale (KPS). A total of 635 (99.00%) completed the EORTC QLQ-BR45 successfully. The instrument indicated good readability and high content validity. All Cronbach's alpha coefficients were satisfactory (overall value, 0.87). For construct validity, patients with KPS ≥80% did better than those with KPS ≤70% as did two multi-item scales in functional scales (body image and breast satisfaction) and five multi-item scales in symptom scales (systemic therapy side effects, endocrine therapy, and arm, breast, and endocrine sexual symptoms). Body image score of late-stage patients was significantly higher. CFA indicated that the nine-factor structure of the Indonesian EORTC QLQ-BR45 was a good fit for the data. The Indonesian EORTC QLQ-BR45 questionnaire is reliable and valid with good psychometric properties, thus can be used for breast cancer patients in Indonesia.

Facing problems in radiotherapy for breast cancer patients in Yogyakarta, Indonesia: A cohort retrospective study.

The aim of this study is to explore problems in radiotherapy for breast cancer patients in Yogyakarta, Indonesia, focusing on overall treatment time (OTT) and completion rate. A retrospective cohort study was conducted based on data from the Insurance Unit at a tertiary hospital in Yogyakarta, Indonesia. The study included all female outpatients with breast cancer who were treated with radiotherapy from January to December 2017 and met the inclusion criteria. The primary outcomes were OTT and completion rate. The secondary outcomes included the number of radiotherapy fractions, radiotherapy doses, number of radiotherapy interruption days, and reasons for radiotherapy interruption. The chi-squared and Mann-Whitney U tests were used to assess the differences in outcomes between two insurance schemes (JKN-PBI (Beneficiaries of Health Insurance Contribution Assistance) and JKN-NON-PBI (Non-Beneficiaries of Health Insurance Contribution Assistance)). The sample included 285 breast cancer patients (mean age: 53 years). The median OTT was 38 days (IQR: 17-48 days), with 123 (43.2%) patients having prolonged OTT. The completion rate was 57.9%. No significant differences in OTT (44.4% vs. 35.7%, p= 0.445) and completion rate (57.2% vs. 61.9%, p= 0.569) were found between the JKN-NON-PBI and JKN-PBI groups, respectively. In all, the data reported 3,022 interrupted days of radiotherapy across a total of 227 patients. The most common reason for radiotherapy interruption was unknown. There are problems in timely delivery and low completion rate of radiotherapy among breast cancer patients in Indonesia. There are no significant differences in OTT and completion rate between the insurance schemes.

Overall Survival for Stage III Breast Cancer Patients at DR. Mohammad Hoesin General Hospital Palembang and the Influencing Factors

Background: There is still a limited number of studies related to overall survival in breast cancer patients in Indonesia. This study determines the overall survival and the factor which can affect the survival of stage III breast cancer patients.Methods: This study was a retrospective study. Patients first diagnosed with stage III breast cancer from January 1 to August 31, 2018, at DR. Mohammad Hoesin General Hospital Palembang had been studied. The primary outcome of this study was overall survival. The sociodemographic, clinicopathology, and treatment factors were analyzed to identify the independent variables associated with overall survival using Kaplan-Meier and Cox proportional hazard regression.Results: In this study, 78 samples were included. The 3-year overall survival for stage III breast cancer was 71%. In the bivariate analysis, several factors including older age (&gt; 40) (HR = 2.795, 95% CI 1.223–6.387), higher stages for IIIB (HR = 7.155, 95% CI 0.960–53.334), and IIIC (HR = (HR = 33.450, 95% CI 3.013-371.354), history of not undergoing surgical intervention (HR = 3.999, 95% CI 1.684–9.495), and adjuvant chemotherapy (HR = 2.768, 95% CI 1.211–6.327) have been associated significantly to lower overall survival. Multivariate analysis showed IIIC breast cancer stage as an independent factor and had a significantly increased probability of mortality (HR = 14.677, 95% CI 1.268–169.948).Conclusions: The stage at diagnosis was the only significant predictor for the survival outcome, indicating that early diagnosis may need more attention.

Deriving Breast Cancer’s Primary Cultures from Patients' Tumor Biopsies in Indonesia Using Explant and Enzymatic Methods

Breast cancer is the most common cause of death in women globally with high rates of heterogeneity. The development of breast cancer treatment is still constrained because of the different responses to its therapy. The use of primary breast cancer culture is invaluable because it provides the same properties as breast cancer itself. Primary culture is used as a tool to determine the proliferative ability of breast cancer cells. However, the use of optimum methods in cultivating primary culture must be evaluated because of the unstable nature of primary culture. In this study, we investigate the optimum method for culturing cells derived from the tumor biopsies of breast cancer patients in Indonesia by comparing explant and enzymatic methods. Breast cancer tissues were obtained from five breast cancer patients, who underwent surgery and incision biopsies. Tissues were further cultured by explant and enzymatic methods. The cell cultures were observed daily using a microscope for up to 30 days. The results showed that the cells cultured using the enzymatic method for more than 16 h were susceptible to microbiome contamination in the following days after enzymatic digestion, while those cultured using the explant method grew well for 30 days. The findings of this research suggested that the explant method gave better results compared with the enzymatic method. The findings of this study provide insight into the optimum conditions for the primary culture of breast cancer cells.

Does Trastuzumab Offer Good Value for Money for Breast Cancer Patients with Metastasis in Indonesia?

Breast cancer is the most common cancer in Indonesia, with Indonesia's breast cancer mortality rate being the highest among Southeast Asian countries. This study aims to evaluate the cost-effectiveness and budget impacts of adding trastuzumab to chemotherapy versus chemotherapy alone for HER2-positive breast cancer patients in Indonesia. We performed a Markov model-based economic evaluation to assess cost-effectiveness, cost-utility, and budget impact. Utility data, direct medical costs, and indirect costs were obtained primarily from interviewing patients. Clinical effectiveness data, on the other hand, were obtained from systematic reviews and real-world data and represented through progression free survival, overall survival, and quality-adjusted life years (QALYs). From a healthcare provider's perspective, the total costs for the combined group were USD 14,516, while chemotherapy alone cost USD 7,489. While the cost-effectiveness analysis showed that the combination group had a higher total cost by USD 7,027, PFS was longer in the chemotherapy alone group, with a difference of 2.2 months. The ICER was USD 17,307 for every QALY gained. The total cost of adding trastuzumab over a 5-year period was USD 589 million. In conclusion, this economic evaluation suggests that the addition of trastuzumab to standard chemotherapy is not cost-effective in terms of PFS and OS compared with chemotherapy alone.<br />.

Breast Cancer in Indonesia in 2022: 30 Years of Marching in Place

Breast Cancer in Indonesia in 2022: 30 Years of Marching in Place

Cost-Effectiveness Analysis of Two Chemotherapy Regiments FAC vs. Taxane for Operable Breast Cancer Patients in Indonesia.

Background:Breast cancer is the deadliest cancer among women worldwide including Indonesia. Both FAC and Taxane-based chemotherapies are often used for patients with early node-positive breast cancer. However, the study regarding the cost-effectiveness of those regiments is still rare. This study aims to analyze the cost-effectiveness of Taxane versus FAC in the Indonesia setting. Methods:Twenty-four patients with stage I-IIIA breast cancer who had received surgery, FAC or Taxane-based adjuvant chemotherapy, and radiation were included in this study. Health-related quality of life was assessed using INA-BCHRQoL. INA-BCHRQoL was mapped to the EuroQoL 5D (EQ-5D) index calculator to get the utility score. All direct cost was retrieved from electronic medical records and hospital information system. Whereas, a questionnaire was designed to collect information about society cost from patients. ICER was counted to summarize the cost-effectiveness of two chemotherapy regiments (Taxane versus FAC). A sensitivity analysis was done to assess the uncertainty result. Results:The results showed there was no significant difference between the score of quality of life and utility in respondents who received FAC chemotherapy and Taxane-based chemotherapy. However, in terms of cost, Taxane was 6.5 times higher than the FAC group per patient for chemotherapy drugs only. Moreover, the total cost of treatments in Taxane-based chemotherapy was approximately 3.7 times more costly than the counterpart in the FAC arm (p=0.000). Taxane-based chemotherapy dominated with ICER IDR 765.213.092 per QALY gained. Overall, FAC was found more cost-effective compared to the Taxane regiment. Conclusion:FAC represents the value of money compared to Taxane-based for breast cancer patients with stage I-IIIA in Indonesia.

Breast Cancer Awareness among Bandung Adolescents

Most breast cancer patients in Indonesia experienced a delay in their diagnosis due to a lack of awareness and other factors. Female adolescents are the key population for an educational intervention to raise breast cancer awareness. This study assessed knowledge of breast cancer risk factors, signs, and symptoms, attitudes toward breast cancer prevention, barriers in breast cancer screening, and behavior regarding breast cancer awareness among female adolescents in Bandung using the Breast Cancer Awareness Scale – Indonesia (BCAS-I) instrument. Among 371 female high school and undergraduate students, 53.1% of them had limited knowledge about breast cancer risk factors, and 99.2% of these respondents had negative behaviors. However, most of them understood the early breast cancer signs and symptoms (89.8%) and had positive attitudes toward seeking health support (98.7%). Preference of health information sources and educational level are the significant factors for breast cancer awareness. Our initial assessment may provide the basis for further research and surveys on a larger scale to develop breast cancer prevention educational materials appropriate for young female populations.

The Relation of Haplotype ATP-binding Cassette B1 and Glutathione S-transferase P1 A313G Genes with Hematological Toxicity in Indonesian Breast Cancer Patients Receiving Chemotherapy.

ObjectivesHematological toxicity induced by chemotherapy is known to be caused by multiple factors, including genetic factors such as polymorphisms. The polymorphisms may occur in drug efflux transporter proteins and enzymes involved in drug metabolism. We investigate the incidence of hematological toxicities and their relation to the haplotype ATP-binding cassette B1 (ABCB1) which were polymorphisms of C1236T, C3435T, G2677T, and glutathione S-transferase P1 (GSTP1) A313G genes in Indonesian breast cancer patients who received anthracycline during chemotherapy.MethodsThis retrospective cohort study was conducted on 138 breast cancer patients who underwent three cycles of chemotherapy in H. Adam Malik Hospital, Medan, Indonesia, who satisfied the inclusion criteria. The DNA of these patients was extracted from the peripheral leukocytes. Single nucleotide polymorphism (SNP) ABCB1 and GSTP1 were examined by the polymerase chain reaction-restriction fragment length polymorphism method. Data on patient characteristics and the incidence of hematological toxicity after each of the three cycles of chemotherapy were obtained from the medical records. The variations in absolute neutrophil count (ANC) and anemia were analyzed using the Friedmann test and the Wilcoxon signed-rank test. The Kruskal-Wallis test was used to investigate the association of ABCB1 and GSTP1 polymorphisms with anemia and neutropenia. The frequency distributions of genotypes and alleles were determined using the Hardy-Weinberg Equilibrium (HWE).ResultsPost the chemotherapy cycles, there was decrease in ANC (Mean±SD: 5 644.4±2 962.5 mm3 vs. 3 034.8±2 049.6 mm3) and increase in anemia (12.1±1.5 g/dL vs. 11.2± 1.3 g/dL) (p < 0.050 for each). No relation was observed between ABCB1 polymorphism, either in each SNP or in the form of haplotype (the combination of more than one SNP), and the incidence of anemia and neutropenia (p > 0.050). There was also no correlation between GSTP1 polymorphisms, anemia and neutropenia incidence (p > 0.050). The ABCB1 and GSTP1 genotypes and alleles frequency distribution showed no deviation from HWE (p > 0.050).ConclusionsIndonesia breast cancer patients who underwent three cycles of chemotherapy demonstrated susceptibility to hematological toxicity by developing side effects such as anemia and neutropenia. However, no relationship was found between hematological toxicity and ABCB1 and GSTP1 polymorphisms.

Changes in Ki67 expression and clinical response to neoadjuvant chemotherapy in locally advanced breast cancer (LABC)

Background: Locally Advanced Breast Cancer (LABC) is still the most common stage found in breast cancer patients in Indonesia. Neoadjuvant Chemotherapy (NAC) is the initial therapy and the main pillar of LABC treatment. NAC could provide less extensive surgery and improve patient’s overall survival to those who achieve a complete pathological response. Ki67 expression is a tumor biomarker representing tumor cell proliferation and has been extensively investigated as a promising predictive and prognostic factor in breast cancer. This study aims to examine the association between Ki67 expression with clinical response of NAC.Methods: The study was designed as a case-control study in breast cancer patients who received standard anthracycline-based NAC. Clinical and immunohistochemical characteristics before and after NAC were obtained retrospectively. Changes in Ki67 and NAC responses were analyzed. Data were analyzed using SPSS version 23 for WindowsResults: A total of 66 subjects were analyzed. About 33 subjects were in good clinical response and 33 subjects were in poor clinical response. Chi-square analysis showed that no significant differences were found in the pre-treatment Ki67 expression between good and poor clinical response group, whereas a low post-treatment Ki67 expression (Ki67 &lt;20%) was correlated with a good clinical response to NAC (p=0.027). Further analysis also showed that a decrease of Ki67 expression greater than 12.5% after treatment was significantly correlated with good clinical response (p=0.007; OR=4.67; 95%CI=1.45-15.08). In multivariate analysis, a decrease in Ki67 was significantly correlated to response in NAC (p=0.037).Conclusion: Decreased in Ki67 greater than 12.5% was correlated with good clinical response of Anthracycline-based NAC in LABC.

Breast cancer patients therapeutic adherence during the COVID-19 pandemic in Indonesia: Knowledge level analytical study.

89 Background: Corona virus diseases 2019 (COVID-19) pandemic is a new challenge for Indonesia's cancer patient’s treatment. Patients face problems in undergoing therapy during the pandemic due to government lockdown regulations. Cancer patients, especially breast cancer, still do not understand how to deal with this problem. This study aims to determine COVID-19 knowledge’s effect on therapeutic adherence in breast cancer patients in Indonesia. Methods: This study was a cross-sectional study conducted from February to April 2021. This study involved breast cancer patients from various regions in Indonesia. The research instrument employed the UNS-CASKQ14 questionnaire (Universitas Sebelas Maret-Cancer Altitude Satisfaction Knowledge Questionnaire) to determine COVID-19 knowledge and therapeutic adherence levels in breast cancer patients. The data were then tested the Spearman Rho correlation utilizing SPSS 25. Results: There were 812 respondents in this study, with the most respondents in the age range of 50-59 years (31.8%). As many as 222 (27.3%) respondents had a low knowledge level about COVID-19, 511 (62.9%) respondents had a sufficient knowledge level, and 79 (9.8%) respondents had a good knowledge level. As many as 369 (45.4%) respondents had a low therapeutic adherence level, and 443 (54.6%) respondents had a good adherence level during the COVID-19 pandemic. Based on the Spearman Rho correlation test between COVID-19 knowledge and therapeutic adherence levels, the results obtained were p = 0.51 (p &gt; 0.05), with the Spearman Rho coefficient value = 0.026. Conclusions: There was no significant effect between COVID-19 knowledge and therapeutic adherence levels in breast cancer patients during the COVID-19 pandemic in Indonesia.

Relationship between adjusted skeletal muscle index and the proportion of macronutrients intake in breast cancer patients in indonesia

Rationale: Chemotherapy treatment received by the cancer patients was inevitably accompanied by the depreciation in muscle mass which played an important key to determine the quality of life of the patients after treatment. This condition could be minimized by adequate amounts of each macronutrients. In Indonesia, the depreciation of muscle mass was rarely noticed in breast cancer patients, which is the most prevalence cancer in Indonesian women.Therefore, there was little to none data reported about the relationship between the skeletal muscle index (SMI) and the proportion of macronutrients intake in breast cancer patients in Indonesia. Thus, the aim of this study is to analyze the relationship between them.

22P Correlation of muscle strength and quality of life in Indonesian breast cancer patients who underwent chemotherapy

22P Correlation of muscle strength and quality of life in Indonesian breast cancer patients who underwent chemotherapy

Survey data of COVID-19 awareness, knowledge, preparedness and related behaviors among breast cancer patients in Indonesia.

This dataset presents a survey data describing COVID-19 awareness, knowledge, preparedness and related behaviors among breast cancer patients in Indonesia. The data were collected from breast cancer patients through a survey distributed by an online questionnaire, assesing social-demographic characteristics (6 items), COVID-19 awareness (5 items), knowledge (2 items), preparedness (2 items) and related behaviors (2 items), from 20th June until 14th July 2020. The samples were gathered 500 breast cancer patients in Indonesia who were willing to fill an online questionnaire. SPSS version 23.0 was used to analyzed the data by descriptive and inferential statistics and SmartPLS 3 to created the partial least square path modeling. The data will help in preventing the transmission of COVID-19 among breast cancer patients and can support for health education and promotion interventions.

Breast cancer stigma among Indonesian women: a case study of breast cancer patients

BackgroundThe stigma experienced by cancer patients stems from the association of cancer with death, as cancer is the most feared disease worldwide, especially among cancer patients and their families. The stigma regarding breast cancer screening behaviour has not been critically evaluated and is poorly understood; therefore, we aimed to analyse the stigmatization of breast cancer patients in Indonesia to reduce the morbidity and mortality of breast cancer.MethodsA qualitative study using a focus group discussion (FGD) and in-depth interviews with thematic analysis was conducted.ResultsOne informant experienced breast pain and kept the referral letter, in which the medical doctor advised medical treatment, to herself for 3 months due to her embarrassment. A traditional healing practice known as ‘kerokan’, which involves scraping of the skin, and consumption of a traditional drink were used by most informants to decrease their breast pain. Finally, most informants were diagnosed with an advanced stage of cancer when they returned to the health care facility. In addition, financial difficulties were noted as barriers to breast cancer screening in Indonesia.ConclusionsFeelings of fear and shame when diagnosed with breast cancer were reported by the informants in this study. Alternative treatment known as ‘kerokan’ was the first treatment sought for breast cancer symptoms due to financial difficulties among breast cancer patients. Informants were diagnosed with an advanced stage of cancer after they returned to the health care facility. A better understanding of early breast cancer symptoms could motivate women to seek out breast cancer treatment.