ray's pendadaran.pptx

7/27/2019 Ray's Pendadaran.pptx

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Ray Robson Lu Ju Chen

07/251657/KU/12248


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Background Nasopharyngeal carcinoma (NPC) is an Epstein-Barr

virus-associated cancer

highly prevalent in Southeast Asia and especiallysouthern China - its occurrence can reach about a 100-fold higher compared with other populations not at

risk. (Li et al, 2007)


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In Indonesia, especially central Java, undifferentiated

NPC (WHO type III) is one of the most commoncancers.

For instance NPC is ranked 1 in males and 3 in femalesin the Yogyakarta province, with regional villagesrepresenting hot spots of NPC incidence.

(Fachiroh et al, 2006)


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Nasopharyngeal carcinoma has been treatedpreferably treated with chemotherapy andradiotherapy due to the anatomic limitation and itstumors high degree ofradiosensitivity andchemosensitivity.

(Lin et al, 2002)


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Problem Statement Patients that underwent cancer treatment usually suffer

from its side effects.

Weight loss is one of the most common toxicity faced bythe patients.

Weight loss could lead to reduced response totreatment, decrease quality of life, and the survival.


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The possible risk factors affecting weight loss that we

are concerned are:

Age Gender

Stomatitis

Nausea

Vomiting

Diarrhea


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Research QuestionWhat is the prevalence and risk factors of weight loss

in the NPC patients who received concurrentchemoradiotherapy?


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Objective To research the risk factors of weight loss and its

significance

To find out the prevalence of weight loss among NPCpatients based on their clinical characteristics


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Literature Review Nasopharyngeal carcinoma (NPC), a malignant tumor

arising in the epithelial lining of the nasopharynx

According to WHO:

Stage III: cancer has spread to the lymph nodes on oneor both side of neck and may have spread to the soft

tissues of throat or nearby bones. Stage IV, cancer has spread to either facial nerve, lower

portion of throat, bones of skull or to the lymph node ofthe neck.


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Literature Review Sign and symptoms of NPC:

A lump in your neck caused by a swollen lymph node

Bloody discharge from your nose Nasal congestion on one side of your nose

Hearing loss in one ear

Frequent ear infections

Headaches Double vision

Face and neck pain


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Literature Review Patients with NPC undergo pretreatment staging

evaluations: clinical examination for head and neck

computed tomography (CT) scan or magnetic resonanceimaging from the skull base to the whole neck

complete blood count with differential count, plateletcount, and biochemical profile and Epstein-Barr virus

serology

For pathologic diagnosis, patients will undergo biopsyto obtain specimen.


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Conceptual FrameworkRisk Factors of Weight Loss:AgeGenderStomatitisNausea

VomitingDiarrhea.

Weight LossRace / EthnicEducationOccupation / Income

Sample population


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Hypothesis There is a significant difference in weight loss in NPC

patient based on their different clinical characteristics andrisk factors


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Methodology Cross Sectional Study


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Population and Sample Target population is patients with NPC Stage III and

Stage IV in Yogyakarta

The population scope includes all NPC patientsreceiving concurrent chemoradiotherapy in TulipIntegrated Cancer Clinic, Dr. Sardjito Hospital


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Minimal Sample Size Sample size is calculated using :

=

1

+

+ 1 11

+2 12

(12) q1 = proportion of subjects in group 1

q2 = proportion of subjects in group 2

N

= minimal sample size P = q1 P1 + q2 P2

By inserting q1=0.5, q2=0.5, P1=0.8, P2=0.5, P=0.65

Minimal sample size, N = 80


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Operational Definition Concurrent chemoradiotherapy is a chemotherapy

that consisted of cisplatin at a dose of 40 mg/m2 onday 1 in each weeks, repeated for 7 cycles, and followedby the external beam radiotherapy (EBRT)Radiotherapy used is a cobalt-60 g-ray or linearaccelerator 6-8MV photo-irradiation. Theradiotherapy treatment was given in fractions, 5 times

per week with 2 Gy per fraction, for 7 weeks, with atotal of 70 Gy radiotherapy dosages.


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Operational Definition Stomatitis is the inflammation of the mucous

membrane of the mouth.

Nausea is the inclination to vomit.Vomiting is when matter is ejected out from stomach

through mouth.

Dysphagia is difficulty in swallowing.


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Operational DefinitionA weight loss more than 10%, which is Grade II weight

loss according to National Cancer Institute, CommonToxicity Criteria, is considered as significant weightloss.


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Research Subject Criteria for the sample to be included in the study:

NPC stage III and IV patients who are in between ages 18to 70 years old, in which distant metastasis was notdetected

NPC patient that received concurrent

chemoradiotherapy in Tulip Integrated Cancer Clinic

Required data is available in the medical record of thepatient


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Research Method Data for weight collected before the cancer treatment,

and after the treatment.

Medical record is used to gain the requiredretrospective data regarding the NPC patients

Age, gender, stomatitis, nausea, vomiting, dysphagia

from year 2006 to 2010


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Statistical Analysis Data collected using Microsoft Excel 2010

Analysis using Stata

Two sets of nominal data is analyzed using:

Contingency Table

Pearson Chi-Square test


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Study Results Table 1: Patient characteristics

Variables n %Sex Male

Female34

2063.0

37.0Age 18-30

31-40

41-50

51-60

61-70

4

13

21

12

4

7.4

24.1

38.9

22.2

7.4


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Study Results In the 54 subjects involved:-

26 (48.1%) had stomatitis

25 (46.3%) had nausea

16 (29.6%) had vomiting

39 (72.2%) had dysphagia

31 patients (57.4%) had Grade II weight loss

23 patients((42.6%) had < Grade II weight loss

p < 0.05 is regarded as statistically significant


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Study Results

Age Grade II Weight Loss < Grade II Weight Loss Total

18-30 3 1 4

31-40 7 6 13

41-50 15 6 21

51-60 5 7 12

61-70 1 3 4

Total 31 23 54

Chi-square, Pr = 0.268

Table for age and weight loss


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Table for gender and weight lossStudy Results

Gender Grade II Weight Loss < Grade II Weight Loss Total

Male 19 15 34

Female 12 8 20

Total 31 23 54

Chi-square, Pr = 0.768Relative Prevalence = 0.931


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Study Results Table for stomatitis, nausea, vomiting and dysphagia

Variable n Grade II Weight Loss P-value* Relative Prevalence

Stomatitis 26 13 (50.0%) 0.289 0.778

Nausea 25 16 (64.0%) 0.363 1.237

Vomiting 16 11 (68.8%) 0.274 1.306

Dysphagia 39 25 (64.0%) 0.109 1.603

* - from Chi-Square calculation


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Table for risk factors (stomatitis, nausea, vomiting and dysphagia)Study Results

Variable Grade II Weight Loss < Grade II Weight Loss Total

With risk factor(s) 30 19 49

Without any risk factor 1 4 5

Total 31 23 54

Chi-square, Pr = 0.076Relative Prevalence = 3.061


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Study Results

Variable Grade II Weight Loss < Grade II Weight Loss Total

With 2 or more risk

factors 23 12 35

Without any risk

factor 1 4 5

Total 24 16 40

Table for 2 or more risk factors (stomatitis, nausea, vomiting anddysphagia)

From Chi-square, Pr = 0.051Relative Prevalence = 3.288


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Discussion The study results did not support the hypothesis

The data did not prove significant association between therisk factors and weight loss

However, there is a trend that weight loss might be causedby the increase of more risk factors

Results maybe more significant if more subjects is involvedin the study; minimal sample size not achieved.


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DiscussionA weight loss of as little as 5% of body weight can

cause reduced response to treatment (Andreyev et al,1998).

In addition, weight loss is associated with poor qualityof life and reduced survival (Davidson et al, 2004).

Therefore, risk factors in these patients that may causeweight loss must be well-managed.


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Result of other Studies Demizu et al, 2006; studying efficacy and feasibility of

cisplatin-based concurrent chemoradiotherapy fornasopharyngeal carcinoma

Clinically significant:

mucositis ( grade 2, 88%)

dysphagia ( grade 2, 88%) nausea/vomiting ( grade 2, 63%).


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Result of other Studies Lin et al, 2003; 284 patient study of concurrent

chemoradiotherapy versus radiotherapy alone for advancednasopharyngeal carcinoma

Weight loss Grade I II : 90.8% Grade III IV : 3.5%

Mucositis

Grade I II : 53.2% Grade III IV : 45.4%

Vomiting Grade I II : 49.6%

Grade III IV : 4.3%


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Result of other StudiesWeight loss has always been seen as one of the non-

hematological toxicity in treatment of cancer, and hasnot been analyzed with other risk factors

There was no previous study that focuses on weightloss and relate it directly to other risk factors


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Conclusion Risk factors of age, gender, stomatitis, nausea,

vomiting and dysphagia did not show significantassociation with weight loss in NPC patients

undergoing concurrent chemotherapy.

However, there is a trend that weight loss might becaused by increasing combination of more risk factors


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Limitations The lack of subjects in this study due to temporary

dysfunction of radiotherapy equipment since June,causing decrease of expected CCRT patients.

Some required data was not available in certainmedical record, thus lessening the subject count

Weakness of retrospective research


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Suggestions This research can be improved by investigating more

risk factors, e.g. loss of appetite,

The grade of the risk factors involved should also bespecified.

Prospective design In the future, questionnaires can be used to help doctors

in follow-up patients condition


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Thank you !

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