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Cancer Registration Oncology Team Tulip Integrated Cancer Clinic

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Presentation on theme: "Cancer Registration Oncology Team Tulip Integrated Cancer Clinic"— Presentation transcript:

1 Cancer Registration Oncology Team Tulip Integrated Cancer Clinic
Dr Sardjito General Hospital

2 TULIP integrated cancer clinic
Funded by Dutch Cancer Foundation (KWF) Operated since 2001 Service: 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.

3 Number 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.

4 Top 5 visits in 2012 Breast cancer Colorectal cancer
Non-Hodgkin’s lymphoma Nasopharyngeal carcinoma Cervical cancer

5 Oncology management still spreads in separated units
First visit Treatment Diagnostic Chemotherapy in general wards and one day care “Tulip” Cancer clinic Radiodiagnostics Like 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 clinics Lung cancer: The consequence is that data may be in some separated units. Other clinics (departs of surgery, gynaecology, ENT, pulmonology, etc) Dx Lab and supports Pathology, Molecular biology, immunology, clinical chemistry, cytogenetics Surgery Radiotherapy

6 Tulip cancer clinic and radiotherapy have particular medical records

7 Background Cancer registration has not been comprehensively done.
Systematic collection of data for every cancer patient have not been registered well. Bottleneck includes commitment to persist the work lack dedicated person in doing documentation financial support Lack 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.

8 Tulip cancer registration
It started in 2012. Research intention. Aim: cancer incidence success of treatment comparison of available treatment to the standard, treatment modalities Case 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 oncology Head of Tulip cancer clinic Data 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 manager Data manager - CRC Research assistant Data manager – NPC Research assistant Data manager – Breast Research assistant Data manager – MM Research assistant

10 Items 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 Therapies Follow-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

11 Flow of data collection
Medical Record (Tulip Integrated Cancer Clinic) Data verification and exclusion Case Report Form Medical Record (RSUP Dr. Sardjito) Data completion and verification Excell database SPSS Analysis

12 Interim results This work is still far from finish. All data should be confirmed with data from central source

13 Number of cases of the 4 cancer types
387 88 70 59 57 57 65 42 38 17 18 20 9 8

14 Age distribution (breast ca)

15 Age distribution (CRC)

16 Age distribution (NPC)

17 Age distribution (MM)

18 Sex distribution

19 Histology grading (breast cancer)
NPC data is not convincing

20 Histology grading (CRC)
NPC data is not convincing

21 Histology grading (NPC)
NPC data is not convincing

22 Treatment modality (Breast cancer)

23 Treatment modality (CRC)

24 Treatment modality (NPC)

25 Treatment modality (MM)

26 Overall survival (CRC)

27 Overall survival (NPC)

28 Data of CRC on SRiKanDi (n= 173)
Because our CRF that is done prospectively resembled registration tool in Srikandi we made a try on performing Srikandi cancer registration for our CRC panel.

29 CRC on SRiKanDi (topography)

30 Data of CRC on SRiKanDi (morphology)

31 Challenges MR searching
Often takes days to find and get them ready for data entry Incomplete information (either in Tulip or central MR) Data discordance Loss to follow up  needs mail and call checking. Registration technical trainings Multiple data sources Funding and organization Demography Pathology assessment Post treatment analysis (CR, PR, SD, PD, relapse) Toxicity grade

32 Can we set up such organization?
RSKN Dharmais (1996-now)

33 Further steps Consolidation with other departments (Indonesian society of oncologist, Yogyakarta branch) Surgeon (oncology surgeon) Radiology (diagnostic and radio-oncology) Pathology Pediatric Etc Study on data collection and administration in order to perform hospital-based cancer registration (Guardian YS, MD, MHealthinfo) Trainings Set up organization Learn from other centers (Dharmais, overseas) Fund raising (self-funded  grant attract)

34 Acknowledgement Project leader Steering committee
Teguh Aryandono, MD, PhD, Prof. (oncology surgeon) Kartika Widayati, MD – Head of Tulip clinic (hematologist-medical oncologist) Ibnu Purwanto, MD Kunta Setiaji, MD – Chief of cancer committee (oncology surgeon) Project leader Johan Kurnianda, MD (hematologist-medical oncologist) Multidisciplinary oncology team for cancer registry Artanto, 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, PhD Etcs. Data coordinator Susanna H. Hutajulu, MD, PhD (Internist) Mardiah Suci H, MD, PhD (Internist) Femiko Mora, MD (Internist) Suryo A Taroeno, MD (Internist) Data manager Wahyu Wulaningsih, MD, MRes. Naomi Yoshuantari, MD Zulrahman, MD Sri Wahyuni, Public health

35 Data of CRC on SRiKanDi (ICD 10)

36 Overall survival (Breast cancer)

37 Overall survival (MM)

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