A prospective study: current problems in radiotherapy for nasopharyngeal carcinoma in yogyakarta, indonesia.
BACKGROUND
Nasopharyngeal carcinoma (NPC) has a high incidence in Indonesia. Previous study in Yogyakarta revealed a complete response of 29% and a median overall survival of less than 2 years. These poor treatment outcome are influenced by the long diagnose-to-treatment interval to radiotherapy (DTI) and the extended overall treatment time of radiotherapy (OTT). This study reveals insight why the OTT and DTI are prolonged.


METHODS
All patients treated with curative intent radiotherapy for NPC between July 2011 until October 2012 were included. During radiotherapy a daily diary was kept, containing information on DTI, missed radiotherapy days, the reason for missing and length of OTT.


RESULTS
Sixty-eight patients were included. The median DTI was 106 days (95% CI: 98-170). Fifty-nine patients (87%) finished the treatment. The median OTT for radiotherapy was 57 days (95% CI: 57-65). The main reason for missing days was an inoperative radiotherapy machine (36%). Other reasons were patient's poor condition (21%), public holidays (14%), adjustment of the radiation field (7%), power blackout (3%), inoperative treatment planning system (2%) and patient related reasons (9%). Patient's insurance type was correlated to DTI in disadvantage for poor people.


CONCLUSIONS
Yogyakarta has a lack of sufficient radiotherapy units which causes a delay of 3-4 months, besides the OTT is extended by 10-12 days. This influences treatment outcome to a great extend. The best solution would be creating sufficient radiotherapy units and better management in health care for poor patients. The growing economy in Indonesia will expectantly in time enable these solutions, but in the meantime solutions are needed. Solutions can consist of radiation outside office hours, better maintenance of the facilities and more effort from patient, doctor and nurse to finish treatment in time. These results are valuable when improving cancer care in low and middle income countries.
Department of head and neck oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Sharon D
SD
Stoker
Department of head and neck oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands ; Department of otorhinolaryngology, Academic Medical Centre, Amsterdam, the Netherlands.
Maarten A
MA
Wildeman
Department of head and neck oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Renske
R
Fles
Department of otorhinolaryngology, Dr Sardjito General Hospital/Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia.
Sagung R
SR
Indrasari
Department of otorhinolaryngology, Dr Sardjito General Hospital/Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia.
Camelia
C
Herdini
ValueCare BV, Utrecht, The Netherlands.
Pieter L
PL
Wildeman
Department of radiation and oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Judi N A
JN
van Diessen
Department of radiotherapy, Dr Sardjito General Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Maesadji
M
Tjokronagoro
Department of head and neck oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands ; Department of otorhinolaryngology, Academic Medical Centre, Amsterdam, the Netherlands ; Department of oral and maxillofacial surgery, Academic Medical Centre, Amsterdam, the Netherlands.
I Bing
IB
Tan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma; D002648:Child; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D028761:Withholding Treatment; D055815:Young Adult