Hubungan respons terapi dengan kualitas hidup penderita karsinoma nasofaring WHO tipe III setelah terapi

Abstract

Latar belakang: Hasil terapi penderita kanker umumnya dinilai dari angka kelangsungan hidup dan angka kontrol penyakit secara lokal/regional. Penilaian ini dilakukan oleh dokter dan tidak menunjukkan bagaimana kepuasan penderita terhadap hasil terapi. Di Indonesia, karsinoma nasofaring (KNF) menempati peringkat keempat keganasan tertinggi, dengan tipe terbanyak adalah KNF WHO tipe III. Penilaian kualitas hidup penting dilakukan karena penyakit dan terapi KNF dapat mempengaruhi beberapa fungsi penting kehidupan (makan, komunikasi, dan hubungan sosial). Belum pernah dilaporkan penelitian mengenai kualitas hidup penderita KNF setelah terapi di Indonesia. Tujuan: Mengetahui hubungan antara respons terapi dengan kualitas hidup penderita KNF WHO tipe III setelah radioterapi atau kemoradioterapi. Metode: Penelitian observasional analitik dengan pendekatan cross-sectional. Dinilai respons terapi dan kualitas hidup 8 subyek dari kelompok radioterapi, dan 8 subyek dari kelompok kemoradioterapi, dengan waktu evaluasi minimal 3 bulan setelah terapi. Penilaian respons terapi berdasarkan hasil pemeriksaan terakhir: biopsi nasofaring, foto Rontgen toraks, ultrasonografi abdomen,biopsi aspirasi jarum halus kelenjar getah bening leher (jika ada indikasi), dan foto Rontgen torakolumbal (jika ada indikasi). Penilaian kualitas hidup menggunakan kuesioner EORTC QLQ-C30 dan EORTC QLQ-H&N35. Hasil: Tidak didapati perbedaan respons terapi antara kelompok radioterapi dan kemoradioterapi. Seluruh subyek memiliki respons terapi positif (tidak didapati tumor menetap, kambuh secara lokal dan regional, dan metastasis jauh). Penderita dengan respons terapi positif memiliki kualitas hidup tinggi. Uji perbedaan kualitas hidup menunjukkan perbedaan bermakna hanya dalam hal fungsi emosi (p=0,031). Kesimpulan: Penderita KNF WHO tipe III dengan respons terapi positif memiliki kualitas hidup tinggi. Tidak didapati perbedaan respons terapi antara kelompok radioterapi dengan kemoradioterapi. Penderita yang mendapatkan kemoradioterapi memiliki kualitas hidup lebih tinggi dalam hal fungsi emosi.

Kata kunci: Karsinoma nasofaring, radioterapi, kemoradioterapi, respons terapi, kualitas hidup

ABSTRACT

Introduction: The endpoint of medical care for cancer patients usually focused on the survival rate and locoregional control rate. These endpoints were assessed by doctor and not the patient’s satisfaction rate to treatment outcome. In Indonesia, nasopharyngeal carcinoma (NPC) is the fourth most common cancer, especially NPC type III WHO. Assessment of quality of life is important because both the disease and the therapy of NPC could affect several important functions in life (eating, communication, and social relationships). There was no study reported about quality of life of NPC patients after therapy in Indonesia. Purpose: To assess the relationship between treatment response and quality of life of NPC WHO type III patients after radiotherapy or chemoradiotherapy. Method: Analytic observational study with cross-sectional design assessed treatment response and quality of life in 8 subjects of radiotherapy group and 8 subjects of chemoradiotherapy group with minimal evaluation time 3 months after therapy. Treatment response was assessed by the latest examination result of nasopharyngeal biopsy, thorax plain photo, abdomen ultrasonography, fine needle aspiration biopsy of neck mass (if indicated), and thoracolumbal plain photo (if indicated). Quality of life was assessed by EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaire. Result: There was no treatment response difference between radiotherapy and chemoradiotherapy group. All subjects had positive treatment response (no cancer remained, no locoregional recurrence, and no distant metastasis). Subjects with positive treatment response had high quality of life. Statistical analysis on the quality of life only showed a marked difference in emotional function (p=0.031). Conclusion: NPC WHO type III patients with positive treatment response had high quality of life. There was no treatment response difference between radiotherapy and chemoradiotherapy subjects. Patients treated with chemoradiotherapy had a better quality of life in emotional function.

Keywords: Nasopharyngeal carcinoma, radiotherapy, chemoradiotherapy, treatment response, quality of life