CHARACTERISTICS OF THE 5 MOST COMMON CANCER IN HEMATOLOGY-

ONCOLOGY OUTPATIENT POLY PATIENTS GENERAL HOSPITAL DR CIPTO

MANGUNKUSUMO GENERAL HOSPITAL 2020 - 2022 PERIOD

Cosphiadi Irawan1 Andree Kurniawam1

1
Division of Haematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General

Hospital/Faculty of Medicine University of Indonesia, Jakarta, Indonesia.

Introduction:
Methods:
Results:
Conclusion:
Keywords:

Introduction
Background
Cancer is one of the non-communicable diseases with the highest mortality rate
worldwide. According to the World Health Organization (WHO) in 2019 cancer is a disease
number 1 to 2 in 112 out of 183 countries in populations under 70 years. 1 Data that has been
collected in GLOBOCAN shows that worldwide, an estimated 19.3 million new cancer cases
(18 .1 million excluding nonmelanoma skin cancer) and nearly 10.0 million cancer deaths
(9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has
overtaken lung cancer as the most frequently diagnosed cancer, with an estimated 2.3 million
new cases (11.7%), followed by lung (11.4%), colorectal (10.0%), prostate (7.3%), and
gastric (5.6%) cancers. %). Lung cancer remains the leading cause of cancer death, with an
estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach
(7.7%) cancer , and female breasts (6.9%).2
Especially in Indonesia, through data by GLOBOCAN, there were a number of cancer
patients in 2020. Most cancers were found in both sexes, namely breast cancer (16.6%),
cervical cancer (9.2%), lung cancer (8.8%), lung cancer (8.8%), and cervical cancer.
colorectal cancer (8.6%) and liver cancer (5.4%).2 Through a global meta-analysis study by
Kocarnik et al. an estimated 250 million years of life adjusted for disability caused by cancer
were assessed from 2010 to 2019, this shows an increase in -respectively social demographics
of 26.3%, 20.9%, and 16.0%. By looking at the increasing incidence and death rates from
cancer, an evaluation of the diagnosis and management of cancer patients is needed in the
form of a registry for cancer patients.
The first case registrations for cancer studies appeared in the early 1900s as individual
physicians or institutional projects in the United States or Europe. In 1956, the American
College of Surgeons (ACoS) officially adopted a policy to encourage, through their Consent
Program, the development of a hospital-based cancer registry. It is believed that by
periodically reviewing the results of cancer treatment regimens, hospitals and physicians can
uncover weaknesses in local treatment patterns and ultimately develop a better understanding
of the disease and its treatment. Cancer data may indicate high-risk environmental or
behavioral risk factors, so that preventive measures can be taken to reduce the number of
cancer cases and resulting deaths. Local, state, and national cancer agencies and cancer
control programs also use registry data from specific areas to make important public health
decisions that maximize the effectiveness of limited public health funds, such as
implementing screening programs.4
Lifetime follow-up is another important aspect of the cancer registry. Current patient
follow-up serves as a reminder for clinicians and patients to schedule routine clinical
examinations and provide accurate survival information. Overall, it is hoped that the cancer
data obtained can be used to make a policy and management system that can reduce the
burden of the disease. 5 Based on the description and explanation of the background, through
this study the authors want to make a data registry of the characteristics of the 5 most
common cancers in patients hematology - oncology outpatient polyclinic at Dr. Cipto
Mangunkusumo National Central General Hospital (RSUPN) for the period 2020 – 2022.

Materials and Methods

Research subjects
This study was a cross-sectional study. The study was conducted on all patients who had been
proven to have the 5 most common types of cancer in the hematology-oncology outpatient
polyclinic at RSUPN Dr. Cipto Mangunkusumo, Jakarta. Diagnosis of this type of cancer is
based on clinical, laboratory, histopathological and radiological data. Inclusion criteria for
this study were patients with the 5 most common cancers consisting of breast cancer, lung
cancer, colorectal cancer, head and neck cancer, cervical cancer and lymphoma cancer
diagnosed in the period 2020 – 2022 and patients who had complete supporting examination
data for the baseline diagnosis in the form of histopathological examination or other
supporting examinations, namely cytology, clinical examination by ultrasound, CT-SCAN or
MRI, only death certificates, and surgery or autopsy. Data retrieval of complete blood
laboratory results comes from secondary data listed in the medical record. Exclusion criteria
were patients who had previously been declared cured and had relapsed

Statistical Analysis
All data were tabulated and presented in tables and graph using Microsoft excel 2019

Ethics
Ethical approval for this study was granted by The Ethics Committee of The Faculty of
Medicine, Universitas Indonesia (ethical approval number:).

Results
There were 400 patients across 6 different types of cancer. Baseline subjects’ characteristics
can be seen in Table 1.

Table 1. Study Subject's Characteristics

Variables All Patients

(N=401)

Age (y), mean (SD) 50,01

Sex
Male (N [%]) 154 [38,4%]
Female (N [%]) 247 [61,4%]

Type of Cancer
Breast Cancer (N[%]) 58 [14,46%]
Cervical Cancer (N[%]) 97 [24,19%]
Lung Cancer (N[%]) 42 [10,47%]
Head & Neck Cancer (N[%]) 91 [22,69%]
Colorectal Cancer (N[%]) 34 [8,48%]
Lymphoma (N[%]) 79 [19,70%]
Comorbidity
Hypertension 42
Asthma 2
Obesity 22
Diabetes Mellitus 22
Others 65
Table 2. Clinical-Pathological Characteristics for Breast Cancer

Variables

Age 49,98
Laterality
Left 26 [44,83%]
Right 25 [43,10%]
Bilateral 6 [12,07%]
Clinical Extension
Localized
6 [10,9%]
Direct Extension
4 [7,3%]
Regional LN Involvement
16 [29,1%]
Direct Extension + Regional LN
7 [12,7%]
Involvement
22 [40,0%]
Distant Metastasized
Grade
Well Diff
5 [8,8%]
Poor Diff 1 [1,8%]
51 [89,4%]
TT
Morphology
Ductal/NST
45 [77,6%]
Carcinoma
8 [13,8%]
Others 5 [8,6%]
Immunohistochemistry
Stage
2 [3,6%]
I
13 [23,6%]
II
16 [29,1%]
III
24 [43,6%]
IV
Distant Metastasizes
19 [67,8%]
1 site
9 [32,2%]
2 or more
ECOG
0 42 [73,7%]
1 8 [14,0%]
2 3 [5,3%]
3 4 [7,0%]

Table 3. Type of treatment and response therapy follow up for Breast Cancer

Variables First Cycle Third Cycle Sixth Cycle

 Type of treatment
Surgery 35 [60,34%]
Chemotherapy 51 [87,93%]
Radiotherapy 17 [29,31%]
Chemoradiation 8 [13,79%]
Hormone Therapy 3 [5,17%]

Response Criteria 1 [2,27%] 0 [0%]

Complete Response
22 [50,00%] 18 [45,00%]
Partial Response
10 [22,73%] 9 [22,50%]
Stable Disease
11 [25,00%] 13 [32,50%]
Progressive Disease
ECOG
38 [73,08%] 30 [78,95%] 22 [73,33%]
0
8 [15,38%] 4 [10,53%] 4 [13,33%]
1
3 [5,77%] 3 [7,89%] 1 [3,33%]
2
3 [5,77%] 1 [2,63%] 2 [6,67%]
3
Adverse Events CTCAE Grade
Hematologic
Hb Grade ≥2 18 [34,6%] 13 [34,2%] 14 [45,2%]
WBC Grade ≥2 11 [21,2%] 12 [31,6%] 8 [25,8%]
Neutrophil Count Grade≥2 10 [19,2%] 11 [28,9%] 6 [19,4%]
Thrombocyte≥2 1 [1,9%] 4 [10,5%] 1 [3,2%]
Gastrointestinal
Diarrhea 1 [1,9%] 2 [5,3%] 0 [0%]
Nausea 10 [19,2%] 8 [21,0%] 8 [25,8%]
Vomiting 4 [7,7%] 3 [7,9%] 3 [9,7%]
Constipated 1 [1,9%] 1 [3,6%] 0 [0%]
Abdominal Pain 5 [9,6%] 3 [7,9%] 1 [3,2%]

Table 2. Clinical-Pathological Characteristics for Lung Cancer

Variables
 Age 58,69
Laterality
Left 6 [14,2%]
Right 3 [7,1%]
Bilateral 6 [14,2%]
Multiple 17 [40,5%]
Clinical Extension
Localized
6 [14.3%]
Distant Metastasized
36 [85,7%]
Grade
Well Diff
1 [2.4%]
Mod Diff
1 [2.4%]
Poor Diff
4 [9,5%]
TT
36 [85,7%]
Morphology
Adenocarcinoma 32 [76,2%]
Small Cell Carcinoma 2 [4,8%]
Squamous Cell Carcinoma 4 [9,5%]
Others 5 [11.9%]
PLD1 27 [64,3%]
EGFR 6 [14,2%]
Stage
I 0 [0%]
II 2 [4,8%]
III 33 [7,1%]
IV 34 [81,0%]
NA 3 [7,1%]
Distant Metastasizes
1 site 18 [42,9%]
2 or more 16 [38,1%]
TT 2 [4.8%]
ECOG
0 21 [50.00%]
1 15 [35.71%]
2 3 [7.14%]
3 3 [7.14%]

Table 3. Type of treatment and response therapy follow up for Lung Cancer

Variables First Cycle Third Cycle Sixth Cycle

Type of treatment
Surgery 9 [15,52%]
Chemotherapy 30 [51,72%]
Radiotherapy 17 [29,31%]
Chemoradiation 1 [1,72%]
Targeted Therapy 10 [17,24%]
Immunotherapy 1 [1,72%]
 Response Criteria
Complete Response 0 [0,00%] 2 [8,33%]
Partial Response 17 [58,62%] 11 [45,83%]
Stable Disease 6 [20,69%] 6 [25,00%]
Progressive Disease 6 [20,69%] 5 [20,83%]
ECOG
14 [46,67%] 10 [43,48%] 9 [39,13%]
0
12 [40,00%] 10 [43,48%] 10 [43,48%]
1
2 [6,67%] 3 [13,04%] 0 [0%]
2
1 [3,33%] 0 [0%] 0 [0%]
3
1 [3,33%] 0 [0%] 0 [0%]
4
Adverse Events CTCAE Grade
N=30 N=23 N=19
Hematologic
Hb Grade ≥2 6 [20,00%] 3 [13,04%] 3 [15,79%]
WBC Grade ≥2 1 [3,33%] 4 [17,39%] 3 [15,79%]
Neutrophil Count Grade≥2 1 [3,33%] 3 [13,04%] 1 [5,26%]
Thrombocyte≥2 0 [0%] 1 [4,35%] 0 [0%]
Gastrointestinal
Diarrhea 2 [6,66%] 1 [4,35%] 0 [0%]
Nausea 8 [26,66%] 10 [43,47%] 5 [26,31%]
Vomiting 2 [6,66%] 7 [30,43%] 3 [15,79%]
Constipated 0 [0%] 0 [0%] 0 [0%]
Abdominal Pain 4 [13,33%] 0 [0%] 0 [0%]

Table 2. Clinical-Pathological Characteristics for Cervical Cancer

Variables
 Age 49,79
Clinical Extension
In Situ 4 [4,1%]
Localized 23 [23,7%]
Direct Extension 16 [16,5%]
Regional LN Involvement 17 [17,5%]
Direct Extension + Regional LN 21 [21,6%]
Involvement
Distant Metastasized 16 [16,5%]
Grade
Well Diff 14 [14,4%]
Mod Diff 38 [39,2%]
Poor Diff 21 [21,6%]
Undiff 1 [1,0%]
NA 23 [23,7%]
Morphology
Squamous Cell Ca 69 [71,1%]
Adenocarcinoma 11 [11,3%]
Neuroendocrine Ca 4 [4,1%]
Others 10 [10,3%]
TT 3 [3,1%]
Stage
I 4 [4,1%]
II 12 [12,4%]
III 60 [61,9%]
IV 21 [21,6%]
Distant Metastasizes
12 [12,4%]
1 site
7 [7,21%]
2 or more
ECOG
89 [91.75%]
0
3 [3.09%]
1
0 [0.00%]
2
3 [3.09%]
3
2 [2.06%]
4

Table 3. Type of treatment and response therapy follow up for Cervical Cancer

Variables First Cycle Third Cycle Sixth Cycle

Type of treatment
Surgery 10 [9,52%]
Chemotherapy 0 [0,00%]
Radiotherapy 7 [6,67%]
Chemoradiation 87 [82,86%]
Targeted Therapy 1 [0,95%]
 Response Criteria
Complete Response 51 [83,61%] 27 [72,97%]
Partial Response 1 [1,64%] 3 [8,11%]
Stable Disease 4 [6,56%] 0 [0,00%]
Progressive Disease 5 [8,20%] 7 [18,92%]
ECOG
0 74 [89,16%] 52 [88,14%] 3 [85,00%]
1 4 [4,82%] 6 [10,17%] 4 [10,00%]
2 0 [0,00%] 1 [1,69 %] 0 [0,00%]
3 3 [3,61%] 0 [0,00%] 1 [2,50%]
4 0 [0%] 0 [0%] 0 [0,00%]
5 0 [0%] 0 [0%] 1 [2,50%]
Adverse Events CTCAE Grade
N=83 N=59
Hematologic N=40
Hb Grade ≥2
50 [60,24%] 30 [50,84%] 23 [57,50%]
WBC Grade ≥2
1 [1,20%] 3 [5,08%] 1 [2,50%]
Neutrophil Count Grade≥2
1 [1,20%] 0 [0%] 2 [5,00%]
Thrombocyte≥2
0 [0%] 1 [1,69%] 1 [2,5%]
Gastrointestinal
Diarrhea
3 [3,61%] 6 [10,17%] 3 [7,50%]
Nausea
17 [20,48%] 13 [22,03%] 4 [10,00%]
Vomiting
6 [7,22%] 7 [11,84%] 3 [7,50%]
Constipated
0 [0%] 2 [3,39%] 0 [0%]
Abdominal Pain
6 [7,22%] 6 [10,17%] 2 [5,00%]

Table 2. Clinical-Pathological Characteristics for Head & Neck Cancer

Variables
 Age
Clinical Extension
Localized
Direct Extension
Regional LN Involvement
Direct Extension + Regional LN
Involvement
Distant Metastasized
Grade
Morphology
Stage
I
II
III
IV
Distant Metastasizes
1 site
2 or more
ECOG
0
1
2
3

Table 3. Type of treatment and response therapy follow up for Head & Neck Cancer

Variables First Month Third Month Sixth Month

 Type of treatment
Surgery
Chemotherapy
Radiotherapy
Chemoradiation
Response Criteria
Complete Response
Partial response
Stable Disease
Progressive Disease
ECOG
0
1
2
3
Adverse Events CTCAE Grade
Hematologic
Hb Grade >2
WBC Grade >2
Neutrophil Count Grade >2
Thrombocyte >2
Gastrointestinal
Diarrhea
Nausea
Vomiting
Constipated
Abdominal Pain

Table 2. Clinical-Pathological Characteristics for Lymphoma

Variables
 Age
Laterality
Left
Right
Bilateral
Clinical Extension
Localized
Direct Extension
Regional LN Involvement
Direct Extension + Regional LN
Involvement
Distant Metastasized
Grade

Morphology
Ductal/NST
Lobulated
Others
Immunohistochemistry
Stage
I
II
III
IV
Distant Metastasizes
1 site
2 or more
ECOG
0
1
2
3

Table 3. Type of treatment and response therapy follow up for Lymphoma

Variables First Cycle Third Cycle Sixth Cycle

 Type of treatment
Surgery
Chemotherapy
Radiotherapy
Chemoradiation
Response Criteria
Complete Response
Partial response
Stable Disease
Progressive Disease
ECOG
0
1
2
3
Adverse Events CTCAE Grade
Hematologic
Hb Grade >2
WBC Grade >2
Neutrophil Count Grade >2
Thrombocyte >2
Gastrointestinal
Diarrhea
Nausea
Vomiting
Constipated
Abdominal Pain

Table 2. Clinical-Pathological Characteristics for Sarcoma

Variables
 Age
Laterality
Left
Right
Bilateral
Clinical Extension
Localized
Direct Extension
Regional LN Involvement
Direct Extension + Regional LN
Involvement
Distant Metastasized
Grade

Morphology
Ductal/NST
Lobulated
Others
Immunohistochemistry
Stage
I
II
III
IV
Distant Metastasizes
1 site
2 or more
ECOG
0
1
2
3

Table 3. Type of treatment and response therapy follow up for Sarcoma

Variables First Cycle Third Cycle Sixth Cycle

 Type of treatment
Surgery
Chemotherapy
Radiotherapy
Chemoradiation
Response Criteria
Localized
Direct Extension
Regional LN Involvement
Direct Extension + Regional LN
Involvement
Distant Metastasized
ECOG
0
1
2
3
Adverse Events CTCAE Grade
Hematologic
Hb Grade >2
WBC Grade >2
Neutrophil Count Grade >2
Thrombocyte >2
Gastrointestinal
Diarrhea
Nausea
Vomiting
Constipated
Abdominal Pain

Discussion

Conclusion

Disclosure
The authors report no conflicrs of interest in this work.

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