Pengobatan kanker

Terapi
Suportif
Terapi
Paliatif
Terapi Suportif dan Paliatif pada
Pasien Kanker
Djumhana Atmakusuma
Divisi Hematologi – Oncologi Medik
Departemen Ilmu Penyakit Dalam
Universitas Indonesia
Manajemen Kanker
• Tujuan
Manajemen
Kanker
• Bentuk
Pengobatan
Kanker
Tujuan Manajemen
Kanker
• Prevensi kanker :
= prevensi primer
= prevensi sekunder
• Deteksi awal kanker
(prevensi tersier)
• Pengobatan kanker :
- Kuratif/penyembuhan
- Paliatif (terapi keluhan
akibat komplikasi
kanker)
- “End of life” or
“hospice” care (prediksi
bertahan hidup < 6
bulan)
Bentuk Pengobatan Kanker
Modalitas Utama
- Pembedahan
- Radiasi
- Kemoterapi  Terapi
sistemik kanker dgn obat
anti kanker
Terapi Suportif
• Untuk mendukung
keberhasilan modalitas
utama pengobatan:
- yg bertujuan kuratif
- yg bertujuan paliatif
- yg bertujuan “end of life” /
“hospice” care
Terapi Suportif pd Manajemen Kanker
Modalitas Utama:
• Pembedahan
• Radiasi
• Terapi Sistemik
Terapi
SUPORTIF
PALLIATIVE
PALLIATIVECARE
CARE!!!
!!!
Kemoterapi paliatif,
Radiasi paliatif
Pembedahan paliatif
Tujuan pengobatan
kanker tercapai:
• kuratif: sembuh /
disease free survival >
• paliatif: keluhan
komplikasi kanker (-)/
<<<<
• “end of life” or
hospice management
(prediksi bertahan
hidup < 6 months)
Nyeri dan simptom
lain yang mengganggu
Antisipasi, prevensi & mengurangi penderitaan, dan mensuport quality
of life (QOL) pasien dan keluarga , tanpa memandang stadium kanker
dan kebutuhan pengobatan lainnya untuk kanker
SUPPORTIVE TREATMENT
• Infections: Prevention and treatment
(bacterial, fungal, viral infections)
• Febrile neutropenia
• Fatigue due to Anemia
• Bleeding and coagulation problems
• Nausea and vomiting
• Mucositis
• Diarrhea
• Anorexia and Cachexia
• Pain
• Bone metastasis
• Neurological complications
• Dermatological complications
SUPPORTIVE TREATMENT
• Obstructive syndromes (Gastrointestinal tract,
urinary tract, respiratory obstruction, neurological
obstruction, etc)
• Psychiatric / Psychological Problems
• Sexual Health and Functioning after Cancer
• Malignant effusion
• Oncology emergencies
Onkologi
Bedah
Pengobatan Kanker
Modalitas Utama
Terapi Suportif
Pembedahan
Radiasi
Terapi Sistemik
Onkologi
Radiasi
Onkologi
Medik
Kemoterapi
Sitotostatika
Terapi Target
Terapi Hormon
Terapi Biologik
Lain lain
WHO common toxicity criteria of
cytotoxic chemotherapy
• Grade 1 (slight
• Common acute
toxicyties)
toxicities:
Leukopenia  Febrile - myelosuppression
to
 Sepsis
grade 4neutropenia
(life
(leukopenia,
 septic shock
threatening)
thrombocytopenia,
anemia)
• Relatively common:
- gastrointestinal
acute
effects (nausea,
or
vomiting, etc)
Nausea vomiting
delayed
- mucous membrane
 dehydration
toxicities
ulceration
 Renal failure
- alopecia
Localized Breast Cancer
Surgery
ENT &Main
modality of
treatment HN O
Radiation +
Radiosensitizer
Adjuvant
Chemotherapy
= Cisplatin
= Docetaxel +
e.g. FAC
regimeny
Terapi Suportif
Terapi Suportif pada
Kanker
Myelosupresi
Leukopenia >>>
Trombopenia
Anemia
Recommendation for grading of toxicity
(WHO Criteria)
Hb (g %)
Grade 0 Grade 1 Grade 2 Grade 3 Grade 4
(life thre
atening)
≥ 11.0 >9.5 - 10.9 8.0 - 9.4 6.5 - 7.9 < 6.5
Leukocyte ≥ 4
(x1000/mm3)
3.0 – 3.9 2.0 – 2.9 1.0 – 1.9 < 1.0
Granulocyte ≥ 2
(x1000/mm3)
Platelet
≥ 100
(x1000/mm3)
1.5 – 1.9
75 – 99
1.0 – 1.4 0.5 – 0.9 < 0.5
50 – 74
25 – 49 < 25
Leukopenia  Infeksi Bakteri 
Sepsis  Septic shock 
bisa FATAL
• Bakteri aerob
• Bakteri anaerob
•Jamur
•Virus
Mual dan Muntah:
ESO anti kanker yang sering
ditemukan, di samping leukopenia
Muntah muntah hebat  dehidarsi
 gagal ginjal akut  bisa fatal
WHO TOXICITY GRADING
• Grade
0
1
2
3
4
(life threatening)
• Nausea
• Vomiting
mlld
moderate severe
mild
moderate severe
1x
2–5x
10 x
very severe
> 10 x
Malnutrisi
Nutrisi <<<  Kaheksia  Protein
<<  Infeksi >>>
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Nyeri 1111
Cancer Pain !!!
• Specific procedure to
relief cancer pain ??
• Surgery ?
• Radiation ?
OR
• Cytotoxic
chemotherapy ?
• Targeted threapy ?
Pain killer ?
WORLD HEALTH ORGANISATION
NOCICEPTIVE STEP CARE APPROACH
If pain is not relieved well,
next ladder should be used
Pain is treated right away
Step 2
Step 1
Codeine
Tramadol
NSAIDs / COX2
Acetaminophen
NSAIDs / COX2
Tramadol
Light pain
Moderate pain
Acetaminophen
Step 3
Oxycodone
Morphine
Fentanyl
Acetaminophen
NSAIDs / COX2
Tramadol
Severe pain
± CO-ANALGESICS
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