Presentation on theme: "Cancer Registration Oncology Team Tulip Integrated Cancer Clinic"— Presentation transcript:
1Cancer Registration Oncology Team Tulip Integrated Cancer Clinic Dr Sardjito General Hospital
2TULIP integrated cancer clinic Funded by Dutch Cancer Foundation (KWF)Operated since 2001Service: adult oncology cases.Multi-disciplinary approach.One of the health service in Dr Sardjito Hospital is Tulip cancer clinic.Tulip was built after people realized that oncology divisions that were previously spreaded throughout many departments (surgery, radiotx, gynaecology, internal med) were not doing optimal service for the patients. Thus previously any cancer patient was treated in only certain department without having many chances to be treated by a solid oncology team. As you can imagine, one patient with stage 3B cervical cancer (cancer that affects cervical area but is already infiltrate to urology organ) for example will be treated in gynaecology depart with chemotherapy without considering how to treat the defect of organ in uro tract. The people from gynaecology department would contact medical oncology when the patients had decreased renal function. When it happened, usually the chance to have a curable intention was so limited. Teherefor, many walls allowed an unintegrated management to the patients.
3Number of cancer visits Here is a picture showing us patients visits/year from In 2011, the sum of patients has folded ten times since the first year of operation. Patients came from the whole area of Yogyakarta prov, some part of center Jave and west Java, and even from other islands.
4Top 5 visits in 2012 Breast cancer Colorectal cancer Non-Hodgkin’s lymphomaNasopharyngeal carcinomaCervical cancer
5Oncology management still spreads in separated units First visitTreatmentDiagnosticChemotherapyin general wards and one day care “Tulip”Cancer clinicRadiodiagnosticsLike in many other hospitals in Indonesia, cancer management in our local hospital, Dr Sardjito general hospital, involves several departments. Usually newly cancer patient come to ambulatory clinic, mostly in cancer clinic, or other clinicsLung cancer:The consequence is that data may be in some separated units.Other clinics(departs of surgery, gynaecology,ENT, pulmonology, etc)Dx Lab and supportsPathology,Molecular biology, immunology,clinical chemistry, cytogeneticsSurgeryRadiotherapy
6Tulip cancer clinic and radiotherapy have particular medical records
7Background Cancer registration has not been comprehensively done. Systematic collection of data for every cancer patient have not been registered well.Bottleneck includescommitment to persist the worklack dedicated person in doing documentationfinancial supportLack information to support policy in improving cancer management.A small registration has been started in Tulip.Systematic collection of data on complete summary of patient history, diagnosis, treatment, and status for every cancer patient have not been registered well.Lately, cancer team in integrated cancer clinic “Tulip” Dr Sardjito General Hospital has re-started the registration supported by very small funding.
8Tulip cancer registration It started in 2012.Research intention.Aim:cancer incidencesuccess of treatmentcomparison of available treatment to the standard, treatment modalitiesCase report form – based.Involves data from on 4 cancer types:Breast cancer - Colorectal cancer (CRC)Nasopharyngeal cancer (NPC) - Multiple myeloma (MM)Principle: starts small and grows. Other types of cancer will be registered as well.Type of cancer was chosen not because they are in top rank list but because we have special interest to this type of malignancy.Data of other cancer types will also be registered (barrier: funding and human resources) resembles Srikandi registration tools.
9(Non-official) organization Head of subdepart of hematology and medical oncologyHead of Tulipcancer clinicData coordinator - CRC(subspecialty fellow)Data coordinator - NPC(subspecialty fellow)Data coordinator – breast ca(subspecialty fellow)Data coordinator - MM(subspecialty fellow)Task of data coordinator and data managerData manager - CRCResearch assistantData manager – NPCResearch assistantData manager – BreastResearch assistantData manager – MMResearch assistant
10Items on Case Report Form Demography (Patient’s Initial, Patient’s Code, Tulip/RSUP Dr. Sardjito MR, Date of Birth, Age, Address, Contact Number, Address Type, Sex, Occupation, Education Level, Funding, Risk Factors, Past History)Diagnosis (Visit Type, Chief-complaint, Early Sign, First Party Treating Chief-complaint, Chief-complaint to Medical-attention Period, Early-detection to Surgery Period, Surgery to Chemotherapy Period, Early-detection, Additional Tests, Performance Status, Clinical Diagnosis, Pathological Diagnosis)Therapy (Surgery, Chemotherapy, Radiotherapy, Additional Tests, Toxicity)Post-therapy Monitor (Treatment Response, Event)Second-line therapy* (Indication, Type, Regimen, Start Date, End Date, Duration, Cycle, Additional Tests, Toxicity)Post-Second Line Therapy Monitor (Treatment Response)Consecutive TherapiesFollow-up (Latest Follow-up Date, Final Status, Overall Survival, Disease Free Survival, Progression Free Survival)Other Analysis (Metastasis, Biomarkers, Comorbidity)CRF was designed ....Every cancer type their own data character
11Flow of data collection Medical Record(Tulip Integrated Cancer Clinic)Data verification and exclusionCase Report FormMedical Record(RSUP Dr. Sardjito)Data completion and verificationExcell databaseSPSSAnalysis
12Interim resultsThis work is still far from finish. All data should be confirmed with data from central source
13Number of cases of the 4 cancer types 387887059575765423817182098
31Challenges MR searching Often takes days to find and get them ready for data entryIncomplete information (either in Tulip or central MR)Data discordanceLoss to follow up needs mail and call checking.Registration technical trainingsMultiple data sourcesFunding and organizationDemographyPathology assessmentPost treatment analysis (CR, PR, SD, PD, relapse)Toxicity grade
32Can we set up such organization? RSKN Dharmais (1996-now)
33Further stepsConsolidation with other departments (Indonesian society of oncologist, Yogyakarta branch)Surgeon (oncology surgeon)Radiology (diagnostic and radio-oncology)PathologyPediatricEtcStudy on data collection and administration in order to perform hospital-based cancer registration (Guardian YS, MD, MHealthinfo)TrainingsSet up organizationLearn from other centers (Dharmais, overseas)Fund raising (self-funded grant attract)
34Acknowledgement Project leader Steering committee Teguh Aryandono, MD, PhD, Prof.(oncology surgeon)Kartika Widayati, MD – Head of Tulip clinic(hematologist-medical oncologist)Ibnu Purwanto, MDKunta Setiaji, MD – Chief of cancer committee (oncology surgeon)Project leaderJohan Kurnianda, MD (hematologist-medical oncologist)Multidisciplinary oncology team for cancer registryArtanto, MD (oncology surgeon)Wigati D, MD (radio-oncologist)Retno Dwi D, MD, (radio-oncologist)Henry Kusumo, MD (radiologist)Lina Choridah , MD (radiologist)Ediati, MD (pathologist)Ghozali, MD (pathologist)Eddy Supriyadi, MD, PhD (pediatrician, oncologist)Nungki Anggorowati, MD, PhD (pathologist)Bambang Hariwiyanto, MD, PhD (ENT oncologist)Sagung Rai Indrasari, MD (ENT oncologist)Camelia Herdini, MD (ENT oncologist)Burham W., MD (gynaecology oncologist)Lutfan Lazuardi, MD, PhD (health informatics)Guardian Y S, MD, MHealthinfo (health informatics)Fatwasari Tetra Dewi, MD, PhDEtcs.Data coordinatorSusanna H. Hutajulu, MD, PhD (Internist)Mardiah Suci H, MD, PhD (Internist)Femiko Mora, MD (Internist)Suryo A Taroeno, MD (Internist)Data managerWahyu Wulaningsih, MD, MRes.Naomi Yoshuantari, MDZulrahman, MDSri Wahyuni, Public health