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
Modalitas Utama:
Kanker Kemoterapi paliatif,
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
Onkolog Pengobatan Kanker
i Bedah

Modalitas Utama Terapi Suportif

Pembedahan

Radiasi Kemoterapi
Sitotostatika
Terapi Target
Terapi Sistemik
Terapi Hormon
Onkolog
i Radiasi Terapi Biologik
Onkolog
i 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
Step 1
Tramadol Acetaminophen
NSAIDs / COX2
Acetaminophen Tramadol
Acetaminophen NSAIDs / COX2
NSAIDs / COX2 Tramadol

Light pain Moderate pain Severe pain

± CO-ANALGESICS

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