title: Knowledge of general practitioners about nasopharyngeal cancer at the Puskesmas in Yogyakarta, Indonesia.
abstract: BACKGROUND
  Nasopharyngeal carcinoma (NPC) is one of the leading causes of cancer death in Indonesia. At initial diagnosis, 80% of the patients present with advanced stage disease. In Indonesia, primary medical care is generally provided by the health care centres; named Puskesmas. The lack of knowledge of various aspects of NPC of the General practitioners (GPs) working in these centers might contribute to the diagnostic delay. The aim of this study was to assess the knowledge of these GPs on different aspects of NPC including symptoms, risk factors and incidence.
  
  
  METHODS
  One hundred six GPs in the Puskesmas in the Yogyakarta province were subjected to a questionnaire on different aspects of NPC based on literature and interviews with Head and Neck Surgeons.
  
  
  RESULTS
  All GPs approached participated and in total 106 questionnaires were filled in. All participants were aware of NPC as a disease and 89% confirmed that it is a serious problem in Indonesia. However, 50% of the participants believed NPC has a low incidence in their region. The question on early symptoms gave a mean 4.2 answers of which 50% were incorrect.The GPs provided a total of 318 answers when asked for the risk factors of NPC, 75% of which were incorrect. Fifty seven GPs (54%) stated that they did not receive sufficient education on NPC at the university and insufficient knowledge was gained during daily practice. Ninety-two percent of the GPs were interested in additional education, preferably in form of lectures, meetings or folders.
  
  
  CONCLUSIONS
  This study revealed that GPs in the Puskesmas in Yogyakarta lack knowledge on all aspects of NPC. This is an important finding as NPC is endemic in Indonesia and the Puskesmas are the institutions which provide primary medical health care in the country. Further education of the GPs in these endemic areas could be a first step to increase the rate of early detection. Therefore, we suggest 1) to conduct a medical awareness campaign for GPs on the most important subjects concerning NPC, and 2) as soon as NPC awareness among GPs has risen, provide further education on the risk factors, the early symptoms and the incidence, education to the community. We propose to extend this study to other areas in Indonesia (i.e. Jakarta, Surabaya, Central Java), using models that have been developed in Yogyakarta.
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121 1066 CX, Amsterdam, The Netherlands.
authors.forename: Renske
authors.initials: R
authors.lastname: Fles
authors.forename: Maarten A
authors.initials: MA
authors.lastname: Wildeman
authors.forename: Beni
authors.initials: B
authors.lastname: Sulistiono
authors.forename: Sofia Mubarika
authors.initials: SM
authors.lastname: Haryana
authors.forename: I Bing
authors.initials: IB
authors.lastname: Tan
mesh_terms: D002983:Clinical Competence; D003151:Community Health Centers; D003430:Cross-Sectional Studies; D003906:Developing Countries; D042241:Early Diagnosis; D004502:Education, Medical, Continuing; D058006:General Practice / Q000193:education*; D006801:Humans; D015994:Incidence; D007214:Indonesia; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D011795:Surveys and Questionnaires