The challenging journey of cervical cancer diagnosis and treatment at the second largest hospital in Indonesia

Objectives

Cervical cancer is a major health concern in developing countries. Access to preventive measures is limited in low- and middle-income countries, and cervical cancer is often identified at an advanced stage of the disease. In this study, we aimed to investigate when patients were first diagnosed and received treatment at a large hospital in Indonesia.

Methods

Data were collected using a questionnaire from outpatient visits and descriptively analyzed. Totally, 215 cervical cancer patients being treated at the Dr. Soetomo Academic Hospital's gynecological oncology outpatient clinic in Indonesia between August and October 2022 were included.

Results

Most patients were 51-60 years old (36.3 %), housewives (87 %), and had an elementary school education level (50 %). Most (88.4 %) admitted they were unaware about cervical cancer prevention, and 85.6 % never underwent screening. Most cervical biopsies were performed at primary hospitals (42.3 %). Fear of cancer treatment was the most frequent reason for patients arriving late at tertiary hospitals (50 %). Treatment delays occurred because patients had to visit two healthcare facilities before visiting a tertiary hospital (47.4 %). Most patients were diagnosed with stage III cancer (38.1 %), and chemotherapy was administered as the first-line therapy (96.3 %). Most patients (51.2 %) received their first therapy >12 months after initial symptom onset.

Conclusions

Most cervical cancer patients were diagnosed at a late stage owing to a lack of information regarding early symptoms and irregular screenings. Treatment was delayed owing to social barriers. Therefore, the government should have more strict policies to implement cervical cancer detection and prevention.

Explaining the increase of incidence and mortality from cardiovascular disease in Indonesia: A global burden of disease study analysis (2000-2019)

BACKGROUND

In the last two decades, there has been a discernible shift in the distribution of mortality attributed to cardiovascular disease (CVD) between developing and developed nations; in developed nations, the percentage of deaths caused by CVD decreased from 48% in 1990 to 43% in 2010, while in developing nations, they increased from 18% to 25%. In Indonesia, CVD death has increased substantially and remained elevated in the last ten years. Current behavioral and metabolic risk factors, including hyperglycemia, obesity, dyslipidemia, hypertension, and smoking, enhance the risk of CVD mortality, according to several studies.

AIMS

We undertook a study to determine whether the increase in mortality and incidence of CVD can be attributed to changes in the most common metabolic and behavioral risk factors from 2000 to 2019 across 34 Indonesian provinces.

MATERIALS AND METHODS

Data from 34 province for CVD incidence and mortality and data on changes in metabolic and behavioural risk factors between 2000 and 2019 in Indonesia were obtained from the Global Burden study (GBD) by The Institute of Health Metrics and Evaluation (IHME). A statistical model was applied to calculate the fatalities attributable to the risk factors change using Population attributable fractions (PAF) and baseline year death numbers. Furthermore, we ran multivariate regressions on Summary Exposure Value of risk factors associated with the increasing mortality, incidence rates in a lag year analysis. R software used to measure heteroscedasticity-consistent standard errors with coeftest and coefci. Covariates were added to adjusted models, including the Socio-demographic Index, Primary health care facilities coverage, and GDP per capita.

RESULTS

The age-standardized mortality rate for CVD from 2000 to 2019 in Indonesia, increased from 356.05 to 412.46 deaths per 100,000 population among men and decreased from 357.52 to 354.07 deaths per 100,000 population among women, resulting in an increase of 270.928 per 100,0000 inhabitants of CVD deaths. In the same period, there was an increase in exposure to risk factors such as obesity by +9%, smoking by +1%, dyslipidemia by +1.3%, hyperglycemia by +2%, and hypertension by +1.2%. During this time span, an additional 14,517 men and 17,917 women died from CVD, which was attributable to higher obesity exposure. We apply multivariate regression with province-fixed and year-fixed analysis and find strong correlation between hyperglycemia in women (6; 95%CI 0 to 12, death per 1-point increase in hyperglycemia exposure) with an increasing death rate in ischemic heart disease. We also performed a year lag analysis and discovered a robust association between high low density lipoprotein (LDL) levels in men and women and the growing incidence of ischemic heart disease. The association between a 10-year lag of high LDL and the incidence of ischemic heart disease was five times stronger than that observed for other risk factors, particularly in men (5; 95%CI 2 to 8, incidence per 1-point increase in high LDL exposure).

CONCLUSION

Hyperglycemia in women is an important risk factor associated with increasing mortality due to Ischemic Heart Disease (IHD) in Indonesia This study also revealed that the presence of high LDL in both men and women were associated with an increase incidence of IHD that manifested several years subsequent to exposure to the risk factor. Additionally, the highest cardiovascular death portion were attributed to obesity. These findings suggest that policymakers should control high LDL and hyperglycemia 10 years earlier prior to the occurrence of IHD and employ personalized therapy to regulate associated risks.