RESUME JURNAL NASIONAL DAN INTERNASIONAL

Dosen Pengampu : Ns. Tri Wahyuni, M.Kep., Sp.Mat.

Nama : Nurul Angraini

NIM : 2111102411051
Mata Kuliah : Keperawatan Maternitas I

PROGRAM STUDI S1 KEPERAWATAN

FAKULTAS ILMU KEPERAWATAN
UNIVERSITAS MUHAMMADIYAH KALIMANTAN TIMUR
2023/2024
TELAAH JURNAL NASIONAL
Author/Year Country Aims of Study Design and Sample and Key Findings
Method Setting
Aesthetica Indonesia Tujuan penelitian Desain penelitian Sampel yang Berdasarkan
Islami, untuk mengetahui adalah cross- digunakan hasil penelitian
Farida (2019) faktor yang paling sectional study. dengan dan teori,
dominan Adapun populasi penelitian ini didaptkan
mempengaruhi dari penelitian adalah kesimpulan
siklus menstruasi adalah seluruh Hubungan bahwa terdapat
pada remaja putri mahasiswi Tingkat antara faktor- hubungan yang
tingkat III di III Program Studi faktor yang signifikan
STIKes Hutama S1 Keperawatan mempengaruhi antara tingkat
Abdi Husada STIKes Hutama siklus stres dengan
Tulungagung. Abdi Husada menstruasi siklus
Tulungagung. digambarkan menstruasi
Teknik sampel dengan analisis pada remaja
yang digunakan bivariat dan putri tingkat III
adalah total multivariat. di STIKes
sampling dengan Hasil Hutama Abdi
kriteria inklusi analisis bivariat Husada
adalah berusia ≤ 21 menunjukkan Tulungagung.P
tahun. Kriteria bahwa tingkat enelitian ini
eksklusi penelitian stres dan status sejalan dengan
yaitu mahasiswi gizi hasil penelitian
yang belum berhubungan yang dilakukan
menarche. dengan siklus oleh Sekar
Instrumen atau alat menstruasi. Pinasti (2012)
bantu penelitian bahwa terdapat
berupa alat ukur hubungan yang
timbangan, signifikan
medline, dan antara tingkat
kuesioner. stres dengan
siklus
menstruasi.
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FAKTOR-FAKTOR YANG MEMPENGARUHI SIKLUS MENSTRUASI PADA

REMAJA PUTRI TINGKAT III
Aesthetica Islamy1, Farida1
1
STIKes Hutama Abdi Husada Tulungagung
tika.aesthetica@gmail.com

ABSTRAK
Remaja putri sering mengalami gangguan menstruasi terutama pada tahun pertama setelah
menarche.Gangguan terbanyak berupa keterlambatan siklus menstruasi (80%).Faktor risiko gangguan
siklus menstruasi adalah hormonal, status gizi, Indeks Massa Tubuh (IMT), dan tingkat stres.Tujuan
penelitian untuk mengetahui faktor yang paling dominan mempengaruhi siklus menstruasi pada
remaja putri tingkat III di STIKes Hutama Abdi Husada Tulungagung.Desain penelitian berupa
analitik cross-sectional dengan jumlah sampel sebanyak 40 responden.Analisis data dengan uji
statistik Chi-square dan multivariate analysis. Hasil penelitian menunjukkan bahwa terhadapat
hubungan antara tingkat stres (RP=4,7 (95% CI 1,1 – 20,0); p=0,015) dan status gizi (RP=2,8 (95% CI
1,6 – 4,8); p=0,026) dengan siklus menstruasi. Analisis multivariat menunjukkan bahwa variabel yang
paling besar pengaruhnya dalam siklus menstruasi adalah status gizi dan tingkat stres.Kesimpulan dari
penelitian bahwa remaja putri yang mengalami stres dan memiliki status gizi tidak normal dapat
berdampak pada siklus menstruasi. Rekomendasi bagi dinas kesehatan dan puskesmas diharapkan
lebih meningkatkan pemberian informasi dalam peningkatan kesehatan reproduksi terutama pada
gangguan siklus menstruasi.

Kata kunci :cross-sectional, faktor risiko, menstruasi, status gizi, stres

FACTORS THAT INFLUENCE THEMENSTRUATION CYCLE IN YOUNG WOMEN

LEVEL III

ABSTRACT
Menstrual disorders was a common problem for teenagers. The menstrual cycle in adolescents was
often irregular in the first year after menarche. Approximately 80% of teenage girls who experience
delayed menstrual cycle and 7% who experienced menstruation faster. There were several factors that
can cause menstrual cycle disorders including hormonal disorders, nutritional status, IMT, and stress.
The aim of this research was to find out the most dominant factors which caused Menstruation Cycle
in Young women. The study design was in the form of cross-sectional analytic with a total sample of
40 respondents. Data analysis with Chi-square and multivariate analysis. The results showed that
there was a relationship between stress levels (RP = 4.7 (95% CI 1.1 - 20.0); p = 0.015) and
nutritional status (RP = 2.8 (95% CI 1.6 - 4 , 8); p = 0.026) with the menstrual cycle. Multivariate
analysis showed that the variables that had the greatest influence on the menstrual cycle were
nutritional status and stress levels. The conclusion of the study is that young women who experience
stress and have abnormal nutritional status can have an impact on the menstrual cycle.
Recommendations for health offices and health centers are expected to increase information provision
in improving reproductive health, especially in disorders of the menstrual cycle.

Keywords: cross-sectional, risk factor, menstruation, nutritional status, stress

PENDAHULUAN seorang remaja telah menginjak usia 17 – 18

Siklus menstruasi adalah tanda proses
kematangan organ reproduksi yang
dipengaruhi oleh hormon tubuh. Peranan siklus
menstruasi berhubungan dengan tingkat
kesuburan perempuan (Sinha et al., 2011).
Siklus ini secara teratur berlangsung jika
tahun (Patil et al, 2013) namun dapatjuga
terjadi setelah 3 – 5 tahun dari usia menarche
(Rigon et al.,2012). Pola menstruasi normal
berlangsung setiap 21 – 35 hari sekali, adapun
lama hari menstruasi dapat berlangsung selama
3 – 7 hari (Aryani, 2010).

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Gangguan siklus menstruasi terdiri dari 2
macam, yaitu polimenorea dan oligomenorea.
Polimenorea adalah siklus menstruasi dengan
jumlah rentang hari kurang dari 21 hari dan
atau volume darah sama atau lebih banyak dari
volume darahan menstruasi biasanya.
Gangguan ini mengindikasikan gangguan pada
proses ovulasi, yaitu fase luteal yang pendek.
Polimenorea menyebabkan unovulasi pada
wanita karena sel telur tidak dapat matang
sehingga pembuahan sulit terjadi.
Oligomenorea adalah siklus menstruasi dengan
durasi lebih dari 35 hari. Volume perdarahan
umumnya lebih sedikit dari volume perdarahan
menstruasi biasanya. Gangguan jenis ini
berakibat ketidaksuburan dalam jangka
panjang karena sel telur jarang diproduksi
sehingga tidak terjadi pembuahan.
Oligomenorea tidak berbahaya pada wanita,
namun dapat berpotensi sulit hamil karena
tidak terjadi ovulasi (Sarwono, 2010).
Gangguan hormonal, status gizi, tinggi
rendahnya IMT (Indeks Massa Tubuh), dan
tingkat stress adalah faktor-faktor yang
mengakibatkan timbulnya gangguan siklus
menstruasi (Gharravi, 2009). Terdapat
hubungan antara IMT dengan siklus
menstruasi. Penurunan IMT berakibat pada
peningkatan durasi siklus menstruasi (Sinha et
al., 2011). Seseorang dengan status gizi
overweight berisiko mengalami anovulatory
chronic (Karyadi, 2007). Wanita dengan
kondisi ini, cenderung memiliki sel – sel lemak
yang lebih banyak sehingga produksi hormon
estrogen juga menjadi berlebih. Adapun wanita
dengan status gizi underweight, cenderung
kekurangan sel lemak sehingga produksi
. Tabel 1.
Karakteristik Responden
Karakteristik Responden
Umur (tahun)
19
20
21
Tingkat Stres
Stres
Tidak Stres
Status Gizi
Normal
Tidak Normal
Siklus Menstruasi
Teratur
Tidak teratur
hormon estrogen berkurang. Hal ini
berdampak pada kejadian ketidakteraturan
siklus menstruasi (Evan., 2011). Tingkat stres
berhubungan dengan siklus menstruasi karena
stres berhubungan dengan tingkat emosi, alur
berpikir, dan kondisi batin seseorang. Faktor
stres dapat mempengaruhi produksi hormon
kortisol yang berpengaruh pada produksi
hormon estrogen wanita (Sherwood, 2007).
Hasil penelitian menyebutkan bahwa sekitar
22,1% wanita dengan gangguan psikologis,
mengalami siklus menstruasi tidak teratur
(Barron et al, 2008). Adapun tujuan penelitian
untuk mengetahui faktor yang paling dominan
mempengaruhi siklus menstruasi pada remaja
putri tingkat III di STIKes Hutama Abdi
Husada Tulungagung.
METODE
Desain penelitian adalah cross-sectional study.
Adapun populasi dari penelitian adalah seluruh
mahasiswi Tingkat III Program Studi S1
Keperawatan STIKes Hutama Abdi Husada
Tulungagung. Teknik sampel yang digunakan
adalah total sampling dengan kriteria inklusi
adalah berusia ≤ 21 tahun. Kriteria eksklusi
penelitian yaitu mahasiswi yang belum
menarche. Instrumen atau alat bantu penelitian
berupa alat ukur timbangan, medline, dan
kuesioner. Penelitian dilakukan tanggal 9 April
2018. Analisa data dilakukan dengan
menggunakan uji chi-square dan multi variate
analysis.
HASIL
Adapun karakteristik responden sebagai
berikut:
f %
3 7
18 45
19 48
23 57,5
17 42,5
22 55
18 45
31 77,5
9 22,5

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Hubungan antara faktor-faktor yang analisis bivariat menunjukkan bahwa tingkat

mempengaruhi siklus menstruasi digambarkan stres dan status gizi berhubungan dengan
dengan analisis bivariat dan multivariat. Hasil siklus menstruasi.

Tabel 2.
Hasil analisis bivariate faktor-faktor yang berpengaruh pada siklus menstruasi (n=40)
Variabel Kriteria Siklus Menstruasi RP (95% CI) p value
Teratur Tidak Teratur
f % f %
Umur (tahun)
19 3 9,7 0 0 0,386
20 14 45,2 4 44,4
21 14 45,2 5 55,6
Tingkat Stres
Tidak Stres 10 32,3 7 77,8 1
Stres 21 67,7 2 22,2 4,7 (1,1 – 20,0) 0,015*
Status Gizi
Normal 21 67,7 1 11,1 1 0,026*
Tidak Normal 10 32,3 8 88,9 2,8 (1,6 – 4,8)
*bermakna secara statistik
Analisis mutivariat dilakukan untuk mengetahui variabel-variabel yang paling
mengetahui hubungan antara variabel dominan dalam mendeskripsikan hubungan
dependen dan independen secara sebab dan akibat.Hasil analisis multivariat
bersamaan.Analisis ini dilakukan untuk ditunjukkan dalam tabel 3 berikut.

Tabel 3.
Hasil Analisis Multivariate Faktor-Faktor yang Mempengaruhi Siklus Menstruasi
Nama Variabel Odds Ratio
(95% CI)
p value
Model (1) Model (2)∆ Model (3)

Status Gizi 27,96* 37,12 * 18.95*

(2,23 – 350,85) (2,38 – 354,64) (1.84 – 153.30)
0,010 0,008 0,012
Tingkat Stres 14,15 15.03
(1,57 – 127,49) (1.61– 117.26)
0,018 0,017
Umur 0,997
p value 0,0017 0,0002 0,002
Pseudo R2 (%) 40,4 40,2 22,9
AIC 35,3 31,5 36.9
* bermakna secara statistik
∆ goodfit model
Berdasarkan hasil analisis regresi logistik PEMBAHASAN
menunjukkan bahwa model terbaik adalah Tingkat stres menimbulkan ketidakteraturan
model ke-2.Variabel status gizi dan tingkat siklus menstruasi.Stres merupakan respon
stres merupakan variabel yang paling besar tubuh yang tidak dapat dijelaskan secara
pengaruhnya dalam siklus menstruasi. Kedua spesifik. Respon tersebut muncul akibat
variabel tersebut dapat menggambarkan siklus adanya stressor atau rangsangan terhadap
menstruasi sebesar 40,2% sedangkan sisanya, faktor-faktor yang mengancam sistem
yaitu sebesar 50,8% disebabkan oleh faktor pertahanan homeostatis (Sherwood., 2012).
risiko lain yang tidak diteliti dalam penelitian Stres berakibat timbulnya perubahan sistemik
ini. tubuh, terutama sistem saraf dalam
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hipotalamus. Adanya stres akan mempengaruhi
produksi hormon prolaktin yang secara
langsung berhubungan dengan aktivitas elevasi
kortisol basal dan menimbulkan penurunan
hormon LH. Selanjutnya hal ini berefek pada
timbulnya gangguan siklus menstruasi
(Kusmiran, 2014).
Berdasarkan hasil penelitian dan teori,
didaptkan kesimpulan bahwa terdapat
hubungan yang signifikan antara tingkat stres
dengan siklus menstruasi pada remaja putri
tingkat III di STIKes Hutama Abdi Husada
Tulungagung.Penelitian ini sejalan dengan
hasil penelitian yang dilakukan oleh Sekar
Pinasti (2012) bahwa terdapat hubungan yang
signifikan antara tingkat stres dengan siklus
menstruasi.Menurut peneliti hal ini
membuktikan bahwa tingkat stres seseorang
dapat mempengaruhi siklus menstruasi setiap
bulannya.Hal tersebut sesuai dengan data yang
diperoleh bahwa ada dari beberapa remaja
putri ada yang mengalami stres dan juga
memiliki siklus menstruasi tidak
teratur.Namun kebanyakan remaja putri tingkat
III tidak mengalami stres dan memiliki siklus
menstruasi teratur.
Ketidakteraturan siklus menstruasi tersebut
harus segera ditangani agar tidak terjadi
berkepanjangan. Pada seseorang yang
mengalami stres disarankan untuk mengurangi
faktor yang dapat menyebabkan stres dengan
cara mengontrol emosi. Dengan mengontrol
emosi dapat mempengaruhi produksi hormon
kortisol menjadi normal. Dengan begitu
seseorang tidak akan mengalami stres dan akan
mempengaruhi siklus menstruasinya menjadi
teratur.
Siklus menstruasi dipengaruhi oleh
hormonal.Terutama hormon estrogen dan
progesteron, kedua hormon tersebut
dikeluarkan secara siklik oleh ovarium pada
masa reproduksi.Status gizi juga bersinergi
dengan siklus menstruasi. Siklus ovulasi
supaya dapat berlangsung normal dan teratur,
tubuh memerlukan 22% lemak dan IMT lebih
dari 19kg/m2. Sel – sel lemak berfungsi untuk
membantu memproduksi estrogen yang
diperlukan bagi proses ovulasi dan berjalannya
siklus menstruasi (Coad., 2007).
Polimenorea dan oligomenorea
mengindikasikan adanya ketidaknormalan

dalam sistem metabolisme tubuh. Efek jangka
panjangnya adalah susah untuk hamil. Jika
terjadi siklus pendek, berisiko terjadi unovulasi
sedangkan jika terjadi siklus panjang,
mengindikasikan sel telur jarang diproduksi.
Keduanya mengindikasikan gangguan
kesuburan pada wanita (Atikah dan Misaroh.,
2009).Berdasarkan hasil penelitian dan teori,
menunjukkan terdapat kaitan signifikan antara
status gizi dengan dengan siklus menstruasi
pada remaja putri tingkat III di STIKes
Hutama Abdi Husada Tulungagung. Penelitian
ini sejalan dengan hasil penelitian yang
dilakukan oleh Harahap (2013) bahwa ada
hubungan yang signifikan antara indeks massa
tubuh dengan keteraturan maupun ketidak
teraturan siklus menstruasi.
Sebagian besar responden penelitian ini
memiliki status gizi normal dan mengalami
siklus menstruasi yang teratur.Namun ada pula
responden dengan status gizi tidak normal dan
mengalami siklus tidak teratur.Dari
ketidakteraturan siklus menstruasi tersebut
harus segera diantisipasi agar tidak terjadi
berkepanjangan.Pada saat seseorang
mengalami ketidaknormalan status gizi
dianjurkan segera menstabilkan status
gizinya.Karena dapat memperbaiki fungsi
reproduksi, termasuk perubahan hormon dan
sel lemak. Menurut peneliti hal ini
membuktikan bahwa status gizi seseorang
dapat mempengaruhi siklus menstruasi setiap
bulannya. Berarti dengan seseorang memiliki
status gizi normal akan mempengaruhi siklus
menstruasinya menjadi teratur.
SIMPULAN DAN SARAN
Simpulan
Analisis bivariate antara stres dan siklus
menstruasi pada mahasiswi tingkat IIIi STIKes
Hutama Abdi Husada Tulungagung tahun
2018, menunjukkan bahwa mahasiswi yang
mengalami stres berisiko 4,7 kali untuk
mengalami siklus menstruasi tidak teratur
(95% CI: 1,1 – 20,0). Analisis bivariate antara
status gizi dan siklus menstruasi pada
mahasiswi tingkat III STIKes Hutama Abdi
Husada Tulungagung tahun
2018,menunjukkan bahwa mahasiswi yang
memiliki status gizi tidak normal
(overweight/underweight) berisiko 2,8 kali
untuk mengalami siklus menstruasi tidak
teratur (95% CI: 1,6 – 4,8). Analisis
multivariate menunjukkan bahwa status gizi
16
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dan stres merupakan faktor yang paling
dominan mempengaruhi siklus menstruasi
dengan nilai Pseudo R2=40,2%.
Saran
Rekomendasi bagi dinas kesehatan dan
puskesmas diharapkan lebih meningkatkan
pemberian informasi dalam peningkatan
kesehatan reproduksi terutama pada gangguan
siklus menstruasi.
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TELAAH JURNAL INTERNASIONAL
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Method Setting
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databases of articles, and assessment
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and analyzed and health
Cengange using instruments or
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words methods with
gynecologic a randomized
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intervention study design.
and found 5 All samples
articles from were
EBSCO, 13 gynecologic
articles from cancer
PubMed, 169 patients.
articles from There were
ProQuest several
and 5 articles interventions
in the
from
treatment of
Cengange
gynecologic
with the cancer
following patients
inclusion associated
criteria: 1) with the
full text, 2) quality of life
published in of patients,
the period namely:
2008-2018, 3)
quantitative
design, 4)
main content
regarding
nursing
interventions
of quality of
life on
gynecologic
cancer
patients.
International Conference on SMART CITY Innovation 2018 IOP Publishing
IOP Conf. Series: Earth and Environmental Science 248 (2019) 012047 doi:10.1088/1755-1315/248/1/012047

Nursing Intervention of Quality of Life on Patient with

Gynaecologic Cancer

I Maryati1, A Setyawaty1, N Fithriyah2, Darmayanti2 and A Ardiyanti2, A

Setyawaty1
1
Lecturer of Nursing Faculty of Padjadjaran University, Jl. Raya Bandung-Sumedang KM. 21,
Hegarmanah, Jatinangor, Sumedang Regency, West Java 45363, Indonesia
2
Master student of Nursing Faculty of Padjadjaran University, Jl. Raya Bandung-Sumedang
KM. 21, Hegarmanah, Jatinangor, Sumedang Regency, West Java 45363, Indonesia

ida.maryati@unpad.ac.id

Abstract. Most women with gynecological cancer have low of quality of life. This is due to the
perception of the community that identifies cancer with death thus creates a feeling of being
useless for life and introvert more. To overcome, a nursing intervention is needed that can
improve the quality of life of patients with gynecological cancer. Methods: The literature search
was conducted using EBSCO, PubMed, ProQuest and Cengange with the key words
gynecological cancer, quality of life, nursing intervention. Furthermore, 188 articles (EBSCO 5,
PubMed 13, ProQuest 169 and Cengange 1) were retrieved, of which 11 (EBSCO 2, PubMed 6,
and ProQuest 3). The findings are made in table form and narrated. Results: Findings showed
that certain nursing interventions can be done to improve the quality of life on gynecologic
cancer survivors through physical activity, palliative care, Anma therapy, homecare, Leadership
and Coaching for Health (LEACH) programs, Non-sporting qigong (NSQG), Qigong sports
(SQG), and Our Fear of Recurrence Therapy (FORT). Conclusions and Recommendations:
Providing comprehensive physical and psychological nursing interventions through both
hospital and home care services can improve the quality of life on gynecologic cancer survivors.

1. Introduction
Cancer is one of the leading causes of death worldwide. American Cancer Society 2018 explain in 2012,
cancer caused the death of 8.2 million people, of which 20% came from gynecological cancer.
Gynecological cancer is uncontrolled growth and spread of abnormal cells in the female reproductive
organs, including the cervix, ovary, uterus, fallopian tubes, vagina and vulva. Every woman is at risk of
gynecological cancer, in the Southeast Asian country about 1.2 million deaths from cancer with the
highest prevalence in women is breast and cervical cancer [1]. Cancer patients experience various
symptoms that affect their quality of life.
In Theofilou (2013) and Diener et al (1999) explain the concept of quality of life includes how one
measures 'good' from various aspects of their lives. This evaluation includes a person's emotional
reaction to the occurrence of life, disposition, a sense of satisfaction and life satisfaction, and work and
personal relationships satisfaction. Intervention aims to develop effective symptom care and

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International Conference on SMART CITY Innovation 2018 IOP Publishing
IOP Conf. Series: Earth and Environmental Science 248 (2019) 012047 doi:10.1088/1755-1315/248/1/012047

management needs so the gynecologic patients have the ability to control the impact of their illness and
the treatment they undergo [2], [3]. The gynecologic patient cancer through several studies has poor
quality of life related to health. The high rate of cancer morbidity and mortality can lead to feelings of
being useless for life and more self-closing so there is a need for interventions to improve the quality of
life of cancer patients. The ultimate goal of intervention is to improve the quality of life [4].
The researchers are interested in analyzing nursing interventions to improve the quality of life of
gynecologic cancer patients by conducting a review literature. The purpose of this paper is to find out
various interventions that can improve the quality of life of in gynecologic cancer patients.

2. Methods
Literature review was conducted by searching several journal through electronic databases of EBSCO,
PubMed, ProQuest and Cengange with the key words gynecologic cancer, quality of life, nursing
intervention and found 5 articles from EBSCO, 13 articles from PubMed, 169 articles from ProQuest
and 5 articles from Cengange with the following inclusion criteria: 1) full text, 2) published in the period
2008-2018, 3) quantitative design, 4) main content regarding nursing interventions of quality of life on
gynecologic cancer patients.

3. Results and Discussion

Seven articles were obtained based on the selection of inclusion criteria (EBSCO 2 articles, PubMed 2
articles, and ProQuest 3 articles). Articles analyzed using quantitative methods with a randomized
controlled trial (RCT) and quasi-experimental study design. All samples were gynecologic cancer
patients. There were several interventions in the treatment of gynecologic cancer patients associated
with the quality of life of patients, namely:

3.1. Palliative Therapy

Zimmermann et al (2014) conducted RCT design with number of samples 461 samples (intervention
228, control 233) with inclusion criteria aged ≥ 18 years, stage III and IV cancers with poor clinical
progonosis, life expectancy 6-24 months (assessed by experts oncology) obtained results for secondary
quality of life and symptoms of distress at 3 months, there were significant differences between groups
in the change in score for QUAL-E, the ESAS score showed no significant difference between groups
in the last 4 months, while there were differences significant for FACIT-Sp, QUAL-E, and ESAS [5].
The conclusion is that there are differences in quality of life in the intervention and the control group
but not significant. Palliative care can be used as a treatment for patients with advanced cancer diagnosis.
The strength of this study is not only to focus on the quality of life of cancer patients but to pay attention
to support systems and involve interdisciplinary disciplines. In line with the research of Temel et al
(2010) and Greer et al (2011) suggesting that early palliative care can improve quality of life and prolong
survival on lung cancer patients [6], [7].
Palliative care focuses on improving the quality of life of patients and families in the face of life-
threatening problems, through prevention, recovery by identifying early treatment of physical,
psychosocial and spiritual [1]. The principle of palliative care services including: relieving pain and
physical symptoms; respect life and assume the process of death is a normal process; does not aim to
accelerate and delay death; integrating psychological, social and spiritual aspects; provide support so
that patients can live as actively as possible; provide support to the family until the time of sorrow; use
a team approach to address the needs of patients and their families and avoid futile actions [8].

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IOP Conf. Series: Earth and Environmental Science 248 (2019) 012047 doi:10.1088/1755-1315/248/1/012047

3.2. Anma Massage Therapy (AMT)

Anma therapy (Japanese massage) is an intervention to improve the quality of life of gynecologic cancer
patients [9]. Design of RCT studies in 40 samples with inclusion criteria: have a history of uterus cancer,
endometrium cancer, ovary cancer, fallopian tube cancer, or peritoneal cancer; for 3 years there was no
recurrence of cancer, aged 20 years and when confirmed fulfilled the requirements for the trial by a
gynecologist. The results were QLQ-C30 Global Health Status and quality of life showed a significant
increase at 8 weeks (P = 0.042) in the Anma Massage Therapy (AMT) group compared to the non-AMT
group, and estimates of mean difference achieved important clinical differences of at least 10 points
(10.4 points, 95% CI = 1.2 to 19.6). Scores on fatigue and insomnia showed a significant increase in the
AMT group compared with the non-AMT group (P = 0.047 and 0.003, respectively). There were no
significant improvements between groups in the anxiety and depression scale of HADS; however, the
anger-hatred assessed by POMS showed a significant increase in AMT group compared with the no-
AMT group (p = 0.028). In conclusion AMT is able to improve the quality of life, especially in the
health of gynecological cancer patients. Other benefits Anma therapy can affect a person's immune
system [10], reduce pain intensity, reduce shoulder and neck muscle tension [11], and reduce symptoms
of Parkinson's disease [12].

3.3. Sporting Qigong (SQG)

Huang et al (2016) conducted a study on 95 samples (controls: 31, NSQG (non-sporting Qigong): 33,
and SQG (Sporting qigong): 31) in adult women with breast cancer who would start chemotherapy
(without stroke, musculoskeletal diseases, and other diseases known to affect physical activity) [13].
Respondents get Qigong sporting intervention three times a week (30 minutes per session). Data were
collected in face-to-face interviews before chemotherapy and at 1 and 3 months after chemotherapy.
The results obtained in months 1 and 3 after practicing Qigong, patients in the SQG group had lower
weakness scores than in the control group. At the 3rd month after intervention, patients in the NSQG
group also had lower weakness scores and higher mental component scores for quality of life than the
control group. Patients with higher weakness scores have worse physical and mental component scores
for quality of life than those with lower brittle scores. The Sobel test shows that fragile scores mediate
SQG and physical component scores for QOL. In conclusion, SQG and NSQG beneficial increasing
weakness and quality of life among breast cancer patients who receive chemotherapy. The strength of
the research conducted was that the measurements were carried out three times.
Sporting Qigong can be used to improve the quality of life on breast cancer patients. In accordance
with the research of Chen et al (2013) qigong has a therapeutic effect in the quality of life management
on women with breast cancer undergoing radiotherapy [14]. Other studies conducted by Van Vu et al
(2017) and Chen and Yeung (2002) show that Qigong therapy can improve the quality of life of cancer
patients and can inhibit qi emissions in cancer growth, and reduce tumor growth and improve patient
survival for longer[15], [16].
The Qigong theory consists of psychoneuroimmunology, namely the science of behavioral, neural
and endocrine interactions, and the immunological adaptation process [17], [18]. Qigong is divided into:
external Qigong includes the transfer of therapeutic energy from competent practitioners and internal
Qigong is done by individuals by means of meditation, rhythmic movements involving breathing
regulation, meditation and self-massage [19]. The Qigong mechanism is a therapeutic action in a disease
through positive vegetative pathways that can be activated in functional dysfunctional patterns. Then a
positive vegetative pattern arises during a critical stress phase, qigong training is an ancient vegetative
biofeedback exercise that encourages positive vegetative functions that will be passed on to individual
reactive repertoires [20].

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IOP Conf. Series: Earth and Environmental Science 248 (2019) 012047 doi:10.1088/1755-1315/248/1/012047

3.4. Comprehensive care

Hwang et al (2014) stated that comprehensive care consists of health management education, self- group
support, exercise and relaxation therapy related to the quality of life on patients in physical,
social/family, emotional, and health aspects [21]. Social support is identified as a strong predictor of
positive prognosis. Social support provides physical and psychological comfort obtained through the
knowledge that cancer sufferers are loved, cared for, valued by others and also a member of a group
based on common interests [22].
In addition, Hwang et al used physical activity as a part of comprehensive care. Hananingrum (2017)
stated that cancer patients who have low activity, the majority have a low quality of life. Many cancer
sufferers face psychosocial and physical problems during and after cancer treatment, such as fatigue,
increased risk of distress and reduce physical activity and physical function [23]. This can affect the
patient's quality of life. Physical activity can increase feelings of happiness, quality of life and survival
of cancer patients [24].
Another study conducted by Ruth et al (2009) used RCT design in 123 samples of patients with
primary suspected ovarian cancer who were given nursing interventions such as maintaining ADL,
symptom management for side effects of chemotherapy, counseling and support. The results of this
study indicate a decrease in distress symptoms and better mental and physical quality of life over time
after being given physical activity intervention. This study concludes that nursing interventions that
involve more than one aspect more effectively improve the quality of life of patients [25].
Li Jue et al. (2015) conducted a study on 226 hospital patient, found that the Home-Based Program
program, Nurse-Led Health Promotion (NLHP-HB) can improve quality of life, sexual function and
family function on patients with early stage cervical cancer [26]. The NLHP-HB program is a nursing
intervention in the form of a health promotion program to help cervical cancer patients. This program
provides comprehensive services through health promotion that starts from the beginning of treatment
during care and preparation for going home, and continued with home care. This program involves all
support systems to facilitate patient needs. This is in line with the role of nurses as: care griver, educator,
facilitator, collaborator, advocate and coordinator [27]. The role of educator in this study was carried
out through health promotion that significantly improved the quality of life of cervical cancer patients.
Health promotion programs also have been shown to improve symptoms in chronic patients. Mohamed
(2014) studied of hemodialysis patients given significant educational interventions was able to reduce
fatigue whereas fatigue on hemodialysis patients was one of the causes of decreased quality of life [28].
Demet Aktas and Fusun Terzioglu (2012) provided 60 to 90 minutes of home care services including:
wound care, medicine and pain management, physical settlement, psychological and social problems,
nutrition, drug management, etc [29]. The results showed that the intervention group had a high quality
of life (average: 6.01 ± 0.64), while the control group had relatively lower quality (mean: 4.35 ± 0.79)
in a 12-week period after treatment (p <0.05). It was concluded that home care services efficiently
improved the quality of life on gynecologic cancer patients

4. References
[1] World Health Organization 2016 WHO Definition of Palliative Care. Retrieved from
http://www.who.int/cancer/palliative/definition/en/
[2] Theofilou P 2013 Theoretical Contributions Quality of Life: Definition and Measurement Eur. J.
Psyc 9 150–62
[3] Diener E, Suh E M, Lucas R E and Smith H L 1999 Subjective Well-Being: Three Decades of
Progress Psychological Bulletin 125 276–302
[4] Nayak M G, George A, Vidyasagar M S, Mathew S, Nayak S, Nayak B S, Shashidhara Y N and
Kamath A 2017 Quality of Life among Cancer Patient Indian J. Palliative Care 23 445–50
[5] Zimmermann C et al 2014 Early Palliative Care for Patients with Advanced Cancer: A Cluster-
Randomised Controlled Trial The Lancet 383 1721–30

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IOP Conf. Series: Earth and Environmental Science 248 (2019) 012047 doi:10.1088/1755-1315/248/1/012047

[6] Temel J S et al 2010. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung
Cancer New Eng. J. Med. 363 733–42
[7] Greer J A, Pirl W F, Jackson V A, Muzikansky A, Lennes I T, Heist R S, Gallagher E R and Temel
J S 2011 Effect of Early Palliative Care on Chemotherapy Use and End-of-Life Care in Patients
with Metastatic Non–Small-Cell Lung Cancer J. Clin. Onco. 30 394–400
[8] Ministry of Health R I 2013 Technical Guidelines for Cancer Palliative Services Minister of
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[9] Donoyama N, Satoh T, Hamano T, Ohkoshi N and Onuki M 2018 Effects of Anma therapy
(Japanese Massage) on Health-Related quality of Life in Gynecologic Cancer Survivors: A
Randomized Controlled Trial PloS One 13 e0196638
[10] Donoyama N and Ohkoshi N 2011 Effects of Traditional Japanese Massage Therapy on Gene
Expression: Preliminary Study The J. Alter. Comp. Med. 17 553–55
[11] Donoyama N, Munakata T and Shibasaki M 2010 Effects of Anma Therapy (Traditional Japanese
Massage) on Body and Mind J. Bodywork and Movement Therapies 14 55–64
[12] Donoyama N and Ohkoshi N 2012 Effects of Traditional Japanese Massage Therapy on Various
Symptoms in Patients with Parkinson's Disease: A Case-Series Study The J. Alter. Comp. Med.
18 294–99
[13] Huang S M, Tseng L M, Chien L Y, Tai C J, Chen P H, Hung C T and Hsiung Y 2016 Effects of
Non-Sporting and Sporting Qigong on Frailty and Quality of Life Among Breast Cancer
Patients Receiving Chemotherapy Eur. J. Onco. Nurs. 21 257–65
[14] Chen Z et al 2013 Qigong Improves Quality of Life in Women Undergoing Radiotherapy for
Breast Cancer: Results of A Randomized Controlled Trial Cancer 119 1690–98.
[15] Van Vu D, Molassiotis A, Ching S S Y and Le T T 2017 Effects of Qigong on Symptom
Management in Cancer Patients: A Systematic Review Comp. Ther. in Clin. Prac. 29 111–21
[16] Chen K and Yeung R 2002 Exploratory Studies of Qigong Therapy for Cancer in China
Integrative Cancer Therapies 1 345–70
[17] Picard G 2009 Heal Yourself with Qigong (Canada: Spiral Graphics Inc.) p. 47
[18] Jwing-Ming Y 1997 The Essence of Taiji Qigong, 2nd Ed. (Boston: YMAA Publication Center)
ISBN 1-886969-63-9
[19] Chodzko-Zajko W, Jahnke R and Working Group. 2005. National Expert Meeting on Qigong and
Tai Chi: Consensus Report. University of Illinois at Urbana-Champaign: Urbana, IL, USA.
[20] Matos L C, Sousa C M, Gonçalves M, Gabriel J, Machado J and Greten H J 2015 Qigong as a
Traditional Vegetative Biofeedback Therapy: Long-Term Conditioning of Physiological
Mind-Body Effects BioMed. Res. Int 2015 1–6
[21] Hwang K-H, Cho O-H and Yoo Y-S 2014 The Effect of Comprehensive Care Program for Ovarian
Cancer Survivors Clinical Nursing Research 25 1–17
[22] Marni A and Yuniawati R 2015 The Relationship Between Social Support and Self-Acceptance
on The Elderly in The Werdha Budhi Dharma Home in Yogyakarta Journal of the Faculty of
Psychology 3 2–3
[23] Hananingrum R W 2017 Relationship of Physical Activity with Quality of Life on Cervical
Cancer Patients Undergoing Chemotherapy at Dr Moewardi Hospital Surakarta Thesis Faculty
of Health Sciences, Muhammadiyah University of Surakarta
[24] Sloan J A, Cheville A L and Liu H 2016 Impact of Self-Reported Physical Activity and Health
Promotion Behaviors on Lung Cancer Survivorship Int. J. Env. Res. Pub. Health 14 45–56.
[25] Ruth et al 2009 Effects of a Nursing Intervention on Quality of Life Outcomes in Post-Surgical
Women with Gynecological Cancers Psycho-Oncology 18 62–70
[26] Li J, Huang J, Zhang J and Li Y 2016 A Home-Based, Nurse-Led Health Program for
Postoperative Patients with Early-Stage Cervical Cancer: A Randomized Controlled Trial Eur.
J. Oncol. Nurs. 21 174–80
[27] Kozier 2010 Buku Ajar Praktik Keperawatan Klinis 5th Ed. (Jakarta: EGC)

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[28] Mohamed S 2014 The Effectiveness of an Educational Intervention on Fatigue in Hemodialysis

Patients: A Randomized Controlled Trial J. Nurs. Health Sci. 3 40–50
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Life in Patients with Gynecological Cancer Asian Pac. J. Cancer Prev. 16 4089–94

Acknowledgements
This article is presented at the International Conference on Smart City Innovation 2018 that supported
by the United States Agency for International Development (USAID) through the Sustainable Higher
Education Research Alliance (SHERA) Program for Universitas Indonesia’s Scientific Modeling,
Application, Research and Training for City-centered Innovation and Technology (SMART CITY)
Project, Grant #AID-497-A-1600004, Sub Grant #IIE-00000078-UI-1.

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IOP Conf. Series: Earth and Environmental Science 248 (2019) 012047 doi:10.1088/1755-1315/248/1/012047

Sample
No Author and year Design Result Comments
size
1 Kyung-Hye A quasi- (n=40) There are significant differences Researchers
Hwang, Ok-Hee experimental, between the two groups in heart measured
Cho, and Yang- non equivalent function, muscle strength, and several
Sook Yoo (2014) control group quality of life. But there was no functions of
pretest - difference in the immune the patient's
postest. response in the two groups. body that were
associated
with
comprehensiv
e care
2 Ruth Single-blind (n=123) APN interventions produced far The
McCorkle1,_, randomized less uncertainty than the instrument
Michael Dowd1, clinical trial attention of control used to
Elizabeth interventions 6 months after measure the
Ercolano1, Dena surgery. When the subgroups results is well
Schulman- that received APN plus the explained
Green1, Anna- PCLN intervention compared to
leila Williams1, the total attention control group,
Mary Lou the subgroup had far less
Siefert2, Jeanne uncertainty, reduced distress
Steiner2 and Peter symptoms, and better mental
Schwartz (2009) and physical QOL over time.
3 Camilla RCT (n=461) There were significant In this study
Zimmermann, differences in FACIT-Sp, pay attention
Nadia Swami, QUAL-E, and ESAS scores on both the
Monika secondary quality of life and the support
results of symptoms of distress systems and
Krzyzanowska,
in the 3 ESAS bulls showed no involve
Breffni Hannon, significant differences between interdisciplina
Natasha Leighl, groups. ry
Amit Oza,
Malcolm
Moore, Anne
Rydall,
Gary Rodin, Ian
Tannock, Allan
Donner,
Christopher Lo
(2014).
4 Nozomi RCT (n=40) QLQ-C30 Global Health Status Involving
Donoyamal, and Quality of Life showed a other
Toyomi Satoh, significant increase at 8 professions in
Tetsutaro Haman, week (P = 0.042) in the AMT determining
Norio Ohkoshi, group compared to the no-AMT diagnosis so as
Mamiko Onuki group, and estimates to prevent the
the average difference reaches subjectivity of
important clinical differences of researchers in
at least 10 points (10.4 points, determining
95% CI = 1.2 to 19.6). Scores the sample.
on fatigue and insomnia show a
significant increase
the AMT group was compared

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IOP Conf. Series: Earth and Environmental Science 248 (2019) 012047 doi:10.1088/1755-1315/248/1/012047

Sample
No Author and year Design Result Comments
size
with the no-AMT group (P =
0.047 and 0.003, respectively).
There
there were no significant
improvements between groups
in the anxiety and depression
scale of HADS;
however, the anger that POMS
assessed showed a significant
increase in AMT
group compared to the no-AMT
group (p = 0.028)
5 Jue Li, Jilinag Randomized (n= 226) 6-month NLHP-HB program Assessment
Huang, Jun kontrol trial improved quality of life After involves
Zhang, Yajie Li intervention, significant several aspects
(2015) improvement was found for
quality of life total score (t
¼7,650, p ¼ 0,000), sexual
function score (t ¼6,465, p ¼
0,000), Cohesion score (t
.48,417, p ¼ 0,001) and
adaptability score (t¼10,735, p
¼ 0,000) in the intervention
group.
6 Demet Aktas, Quasy (n=35) The results showed that the The sample is
Fusun Terzioglu, Eksperiment intervention group that received not
2012 with home care services had a high homogeneous,
Randomized quality of life (average: 6.01 ± it is still
Control Trial 0.64), while the control group common in
had relatively lower quality gynecologic
(average: 4.35 ± 0.79) in the cancers
period of 12 weeks after
treatment (p <0.05).
7 Sheng-Miauh Quasi- (n=95) In the 1st and 3rd months after Measurements
Huang, Ling- experimental practicing qigong, patients in are not only
Ming Tseng, Li- design the SQG group had lower done once but
Yin Chien, Chen- dengan weakness scores than those in up to three
Jei Tai, rancangan the control group. At the 3rd times.
Ping-Ho Chen, time series month after intervention,
Chia Tai Hung, (three-group, patients in the NSQG group also
Yvonne Hsiung pre-testepost- had lower weakness scores and
test) higher mental component scores
for quality of life than the
control group. Patients with
higher weakness scores have
worse physical and mental
component scores for quality of
life than those with lower brittle
scores. The Sobel test shows
that fragile scores mediate SQG
and physical component scores
for QOL