Terapi Terapi

Suportif Paliatif

Terapi Suportif dan Paliatif pada

Pasien Kanker
Djumhana Atmakusuma
Divisi Hematologi – Oncologi Medik
Departemen Ilmu Penyakit Dalam
Universitas Indonesia
 Manajemen Kanker

• Tujuan • Bentuk
Manajemen Pengobatan
Kanker Kanker
 Tujuan Manajemen
Kanker
• Prevensi kanker : • Pengobatan kanker :
= prevensi primer - Kuratif/penyembuhan
= prevensi sekunder - Paliatif (terapi keluhan
akibat komplikasi
• Deteksi awal kanker kanker)
(prevensi tersier) - “End of life” or
“hospice” care (prediksi
bertahan hidup < 6
bulan)
 Bentuk Pengobatan Kanker
Modalitas Utama Terapi Suportif
• Untuk mendukung
keberhasilan modalitas
- Pembedahan utama pengobatan:
- Radiasi - yg bertujuan kuratif
- Kemoterapi  Terapi - yg bertujuan paliatif
sistemik kanker dgn obat - yg bertujuan “end of life” /
anti kanker “hospice” care
 Terapi Suportif pd Manajemen Kanker
Kemoterapi paliatif,
Modalitas Utama: Radiasi paliatif
• Pembedahan Pembedahan paliatif
• Radiasi Tujuan pengobatan
• Terapi Sistemik kanker tercapai:
Terapi • kuratif: sembuh /
SUPORTIF disease free survival >
• paliatif: keluhan
komplikasi kanker (-)/
<<<<
• “end of life” or
hospice management
(prediksi bertahan
PALLIATIVE
PALLIATIVECARE
CARE!!!
!!! 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 Pengobatan Kanker
Bedah

Modalitas Utama Terapi Suportif

Pembedahan

Radiasi Kemoterapi
Sitotostatika
Terapi Target
Terapi Sistemik
Terapi Hormon
Onkologi
Radiasi Terapi Biologik
Onkologi
Medik Lain lain
 WHO common toxicity criteria of
cytotoxic chemotherapy
• Grade 1 (slight • Common acute
toxicyties) toxicities:
to Leukopenia  Febrile - myelosuppression
grade 4neutropenia
(life  Sepsis (leukopenia,
threatening)  septic shock
thrombocytopenia,
anemia)
• Relatively common: - gastrointestinal
acute effects (nausea,
or vomiting, etc)
delayedNausea vomiting
- mucous membrane
 dehydration
toxicities ulceration
 Renal failure
- alopecia
 Localized Breast Cancer

Surgery Radiation + Adjuvant

Radiosensitizer Chemotherapy

ENT &Main = Cisplatin e.g. FAC

modality of = Docetaxel + regimeny
treatment HN O

Terapi Suportif
Terapi Suportif pada
Kanker
Myelosupresi

Leukopenia >>>
Trombopenia
Anemia
 Recommendation for grading of toxicity
(WHO Criteria)
Grade 0 Grade 1 Grade 2 Grade 3 Grade 4
(life thre
atening)
Hb (g %) ≥ 11.0 >9.5 - 10.9 8.0 - 9.4 6.5 - 7.9 < 6.5

Leukocyte ≥ 4 3.0 – 3.9 2.0 – 2.9 1.0 – 1.9 < 1.0

(x1000/mm3)

Granulocyte ≥ 2 1.5 – 1.9 1.0 – 1.4 0.5 – 0.9 < 0.5

(x1000/mm3)
Platelet ≥ 100 75 – 99 50 – 74 25 – 49 < 25
(x1000/mm3)
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 mlld moderate severe

• Vomiting mild moderate severe very severe

1x 2–5x 10 x > 10 x
 Malnutrisi

Nutrisi <<<  Kaheksia  Protein

<<  Infeksi >>>

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Nyeri 1111
 Cancer Pain !!!

• Specific procedure to
relief cancer pain ??
• Surgery ?
• Radiation ?
• Cytotoxic
OR
Pain killer ?
chemotherapy ?
• Targeted threapy ?
WORLD HEALTH ORGANISATION
NOCICEPTIVE STEP CARE APPROACH

If pain is not relieved well, Step 3

next ladder should be used
Oxycodone
Pain is treated right away Morphine
Step 2
Fentanyl
Codeine
Tramadol Acetaminophen
Step 1 NSAIDs / COX2
Acetaminophen Tramadol
Acetaminophen NSAIDs / COX2
NSAIDs / COX2 Tramadol

Light pain Moderate pain Severe pain

± CO-ANALGESICS

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