indonesia cancer registry, current situation
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Indonesia Cancer Registry, Current Situation - Evlina Suzanna, MD - Coordinator Collecting and Data Analysis of Indonesia, National Cancer Registry. Department of HealthTRANSCRIPT
Indonesia Cancer Registry.Current Situation
Evlina Suzanna,MDCoordinator Collecting and Data Analysis of Indonesia National Cancer Registry. Department of Health
Number of Population and Province in Indonesia.(Sensus 2005)
33 Provinces 218.086.288 PopulationM : 109.613.519F : 108.472.769
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Aceh
West S
umate
raJa
mbi
Bengk
uluBab
el DKI
Centra
l Jav
a
East J
ava
Bali
East N
T
Sentra
l Kalm
East K
alm
Sentra
l Sul
South
East S
ul
West S
ul
North M
al
Papua
Provinces
Num
ber Male
Female
Distribution of Population in Indonesia
History of Cancer Registry In Indonesia2006 Hospital Based Cancer Registry in Jakarta as a model à Population Based Cancer Registry.
1987 Pathological based Cancer Registry, 13 Centers Diagnostic of Pathology in Indonesia
1970 Population based Cancer Registry in Semarang, Central Java.
Population Based Cancer Registry
Semarang, 1970
KLATEN,1998
The 10 Commonest Malignancy in Semarang, 1990 -1999.
2.052.67
3.013.26
4.64.83
5.166.26
14.8421.77
0 5 10 15 20 25
Thyroid
Lymphoma
Corpus Uteri
Unknown
Skin
Lung
Ovarium
Colorectal
Breast
Cervix
Topo
ASR
1.18
2.82
3.62
3.62
3.78
4.69
5.63
5.65
6.76
14.08
0 2 4 6 8 10 12 14 16
Thyroid
Unknown
Lymphoma
Skin
Nasopharyx
Vesica Urinary
Prostat
Liver
Colorectal
Lung
Topo
ASR
Female Male
Prof Sarjadi,MD.Pathologist.
1988 IAP Indonesia,13 Centers Diagnostic of Pathology
1. Medan.
2. Padang
3.Palembang
4. Jakarta
5. Bandung
13 Manado
8. Semarang9. Surabaya
10. Malang
7. Yogjakarta
6. Surakarta
11 Bali
12 Makassar
The 10 commonest cancer in Indonesia 13 Centers of Pathology 1990 – 1999.
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1990 1991 1992 1993 1994
Cervical cancerBreast cancerSkin cancerNPCOvarial cancerLymphoma malignumRectal carcinomaThyroid carcinomaSTSsColon carcinoma
The 10 Commonest Cancer in Indonesia 13 Centers of Pathology 1990 – 1999.
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1995 1996 1997 1998 1999
Cervical cancerBreast cancerSkin cancerNPCOvarial cancerLymphoma malignumRectal carcinomaThyroid carcinomaSTSsColon carcinomaLung cancer
THE TEN COMMONEST MALIGNANCY in "DHARMAIS" NATIONAL CANCER CENTER 1995 - 2004
0
50
100
150
200
250
300
350
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
YEARS
NUMB
ER
Cervical Cancer
Nodal Lymphoma
Breast Cancer
Skin Cancer
Colorectal Cancer
Ovarial Cancer
Nasopharynx
Leukemia
Bronchus and Lung
Soft Tissue Sarcoma
Bone Sar coma
Ca Corpus Uteri
Thyroid Gland
GLOBAL DEATHS BY CAUSE, ALL AGES 2005
***Sumber: WHO dan WorldBank 2005
CARDIO-VASCULARDISEASES
CANCER
CHRONICRESPIRATORY
DISEASE
DIABETES
17.528.000
7.586.000
4.057.000
1.125.000
MALARIATUBER-
CULOSIS
HIV/AIDS
883.0001.607.000
2.830.000
Trend of Pattern of diseases causing death in decade in Indonesia
SKRT 1992, 1995, 2001
0
5
10
15
20
25
30
35
Inf & Par Sirkulasi Pernapasan Sal. Cerna Neoplasma Kecelakaan Perinatal
1992 1995 2001
Percentage
Report of SKRT 2001: Morbidity & Disability study, Litbangkes 2002
DefinitionCancer registration may be defined as the
process of continuing, systematic collection of data on the occurrence and characteristics of reportable neoplasms
The cancer registry is in the office orinstitution which attempts to collect, store, analyze and interpret data on persons with cancer.
The main objective of the cancer registry
• To collect and classify information on all cancer cases in other to produce statistics on the occurrence of cancer in a defined population and
• To provide a framework for assessing and controlling the impact of cancer on the community
Source of DataSource of Data
CLINICS
HOSPITAL
LABORATORIES
VITAL STATISTICSDEATH CERTIFICATES
Hospital 6HB6
Hospital 1HB1
Hospital 2HB2
Hospital 3HB3Hospital 5
HB5
Hospital n..Hb n...
Hospital 4HB4
PB
case 6
PB= population-based HB= hospital-based
case 1
case 5
Case 3
case 2
case 4
Case n..
Case 61
Case51
Case 31
PB = case 1-6, n..HB3= case 3, 31
Cancer Incidence in IndonesiaNew cases of cancerAsAbsolute numbersProportion (percent) of totalRate per (100.000) population at risk, per (year)
??
?? ?
?
Measuring the Burden of cancerin Indonesia
• Incidence• Mortality• Person-years of life lost (PYLL)• Quality adjusted life years (Lost) (QALYs).• Disability adjusted life years (Lost) (DALYs)• Survival• Prevalence
MOH of RI Organization Structure, 2006
DG of Disease Control & EH
Directorate VBDC
Directorate of NCDC
Directorate of EH
Directorate of SESPIM
Secretary of DG of DC & EH
Subdit Cardiovas
Subdit. DM & Other Metabolic
SubDit Cancer
Subdit. Chronis &
degenerative
Subdit. Violence &
Injury
Directorate of DCDC
Ministry of Health
DG of Public Health
Inspectorate General
DG of Medical Services
Secretary General
DG of Pharmacies & med-supp
Revitalization ofJakarta Cancer Statement
By WHO SEARO, UI, UICC and Presiden Soeharto
in 1995 à Action Plan.
On 10th-11th there will be the launching of Indonesia NCCPs by DNCC and MOH, together with all Health Professional, NGOs to unify theActivities in Cancer Control Programmes. All the parties concern will make action plan for the coming years.
• Undang-Undang RI No : 29 th 2004 ttg Praktek Kedokteran (Psl 46) àwajib membuat Rekam Medis.
• Kepmenkes RI No.604/Menkes/SK/IX/1989 ttg Pokok-pokok penanggulangan penyakit kanker di Indonesia à Registrasi kanker
• Kepmenkes RI No: 1575/Menkes/Per/XI/ ttg Organisasi dan Tata kerja Depkes RI àDirektorat PPTM (Subdit kanker).
Legal Aspect
STRUKTUR ORGANISASI RUMAH SAKIT KANKER DHARMAIS JAKARTA
DIREKTURUTAMA
DIREKTUR MEDIK DAN KEPERAWATAN
DIREKTURSUMBER DAYA MANUSIA
DAN PENDIDIKAN DIREKTUR
UMUM DAN OPERASIONAL
DEWAN PENGAWAS
LAMPIRAN PERATURAN MENTERI KESEHATAN R.I.NOMOR : 1684/Menkes/Per/XII/2005.TANGGAL: 27 Desember 2005
MENTERI KESEHATAN,
Dr. dr. Siti Fadilah Supari, Sp.JP (K)
BIDANGMEDIK
BIDANGKEPERAWATAN
BIDANGREKAM MEDIK
SEKSIPELAYANAN -MED
SEKSI RAWAT JALAN
SEKSICATATAN MEDIK
SEKSIPENUNJANG
MEDIK
SEKSIRAWAT INAP
SEKSIADMISI
SEKSIPENING & PENGEN
DALIAN MUTU YAN.MED.SEKSI
RAWAT KHUSUS
BAGIANUMUM
BAGIANPROGRAM DAN
SIM RS
BAGIANPELAY PELANGGAN
SUBBAGIANTATA USAHA
SUBBAGIANPENGEMBANGAN
SIM RSSUBBAGIAN
PROMOSI
SUBBAGIANRUMAH TANGGA &
HUMAS
SUBBAGIANPENYUSUNAN
PROGRAM
SUBBAGIANPENGEMBANGAN
USAHA
BAGIANS D M
BAGIANPENDIDIKAN DAN
PELATIHAN
BAGIANPENELITIAN DANPENGEMBANGAN
SUB BAGIANADM.INISTRASIKEPEGAWAIAN
SUB BAGIANPENGELOLAAN
DIKLATSUB BAGIANPENELITIAN
SUB BAGIANPENGEMBANGAN
SDM
SUB BAGIANPENGELOLAANSARANA DIKLAT
SUB BAGIANPENGEMBANGAN
SARANA PENELITIAN
SUB BAGIANPERPUSTAKAAN
DAN DOKUMENTASI
INSTALASIINSTALASIINSTALASI
INSTALASIINSTALASIINSTALASI
INSTALASIINSTALASIINSTALASI
SUBBAGIANDATA DANLAPORAN
INSTALASIINSTALASISTAF MEDIK
FUNGSIONAL
SEKSIPENGKODEAN DAN
PENYIMPANAN
SUB BAGIANPERENCANAAN
SDM
SUB BAGIANREGIS TRASI
KANKER
SUBBAGIANPERLENGKAPAN
SUBBAGIANPEMASARAN
KOMITEMEDIK
KOMITEETIK DANHUKUM
SATUANPEMERIKSA
INTERN
DIREKTURKEUANGAN
BAGIANPENYUSUNAN &
EVALUASI ANGGARAN
BAGIANPERBENDAHARAAN& MOBILISASI DANA
BAGIANVERIFIKASI &AKUNTANSI
SUBBAGIANPENYUSUNAN
ANGGARAN
SUBBAGIANPERBENDAHARAAN
SUBBAGIANAKUNTANSI KEUANGAN
SUBBAGIANEVALUASI
ANGGARAN
SUBBAGIANMOBILISASI DANA
SUBBAGIANVERIFIKASI &AKUNTANSIMANAJEMEN
Working Programmes 2007-2008
Training/Socialization 28 Hospts à40 Hospts DKI Jaya
Hospital based àPopulation based : 2005 2006 2007 à 2008
Software CanReg4 – SRiKandI (32variables)Hardware Computers, Server, Networking device.Brainware Registrar, Pathologist, Oncologist,
Specialist, GP, Statistician, etc
Office space/archives With special permit/restricted room.
Funding National/Province budged/ Hospital/ WHO, Others
Capital city of Indonesia : Jakarta
Indonesia (2005) 218.086.288 Population
1,408,711 75- 1,462,776
1,470,205 70- 1,570,199
1,990,762 65- 2,192,385
2,800,974 60- 2,918,499
3,813,793 55- 3,563,361
5,266,079 50- 4,851,176
6,418,712 45- 6,190,218
7,401,933 40- 7,347,511
8,344,025 35- 8,428,967
8,709,370 30- 9,054,955
9,271,546 25- 9,821,617
9,754,543 20- 10,150,607
10,370,890 15- 9,958,783
11,238,221 10- 10,614,026
11,370,615 5- 10,739,089
9,983,140 0- 9,608,600
109,613,519 TOTAL 108,472,769
Male (%) Female (%)
0 2,000,000 4,000,000 6,000,000 8,000,000 10,000,000
12,000,000
-12,000,000
-10,000,000
-8,000,000
-6,000,000
-4,000,000
-2,000,000
0 12 10 8 6 4 2 0 0 2 4 6 8 10 12
Indonesia, Jakarta (2005)
21,090 75- 24,843
33,549 70- 41,589
59,524 65- 57,523
88,452 60- 77,440
132,016 55- 130,224
201,932 50- 186,628
244,639 45- 230,399
307,293 40- 307,977
416,885 35- 356,711
451,377 30- 445,717
505,945 25- 536,794
485,929 20- 549,923
358,987 15- 426,285
353,062 10- 375,802
366,009 5- 350,138
364,057 0- 350,508
4,390,746 TOTAL 4,448,501
Male (%) Female (%)
0 100,000 200,000 300,000 400,000 500,000 600,000-600,000
-500,000
-400,000
-300,000
-200,000
-100,000 0 600 500 400 300 200 100 0 0 100 200 300 400 500 600
Distribution of Jakarta Population
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
Number
Jakarta Centrl East West North South
Region
Male
FemaleTotal
Mortality in Jakarta in 2006
Cancer Mortality Among Total Death in Jakarta in 2006 ( 4 Hospitals)
40 Hospitals in Jakarta Cancer Registry as a ModelNational Cancer Registry PM.01.02/V/530/07
RSUPN Cipto MangunkusumoRSAL MitoharjoRSPAD Gatot Subroto( Reg of Central)RSIslam JakartaRS Tria DipaRS CarolusRS Keramat 128RS HusadaRSB Budi KemuliaanRS PGI CikiniRSK Dharmais (NCCPs), (Reg of West)RSK RS CengkarengRS TarakanRSAB HarKit (Childhood Cancer Reg)RS PluitRS Sumber warasRS Pelni PetamburanRS Koja (Regional of North)RS Pantai Indah KapukRS Mitra Klp Gading
RS ATMAJAYARS Gading PluitRS Fatmawati (Regional of South)RS MMCRS MedistraRS Pondok IndahRS TebetRS JakartaRS Pusat PertaminaRS Persahabatan (Regional of East)RS POLRI PusatRS Budi ASIHRS UKIRS Mitra InternationalRS Haji JakartaRS Dharma NugrahaRS Omni Medical centerRS Islam Jakarta TimurRS Pasar ReboRS Sumber Waras
Cancer Registry Activities in Cancer Registry Activities in 40 40 Hospitals Hospitals in Jakartain Jakarta
RSUPN Cipto MangunkusumoRSUPN Cipto MangunkusumoRS Fatmawati (South Regional )RS Fatmawati (South Regional )
RS Sumber WarasRS Sumber Waras RS MMCRS MMC
RS POLRI Pusat RSAB Harapan Kita (Childhood Cancer Reg)
RSPAD Gatot Subroto( Central Regional )
Cancer Registry Activities in Cancer Registry Activities in 40 40 Hospitals Hospitals in Jakartain Jakarta
RS Pasar Rebo
28 Hospitals in Jakarta
14 Private HospitalsBoard Committee 77%Pathologist 77%Surg Onc 77%Medical Onc 77%Registrar 55,56%Staf MR 77%Staf morbid 66,67%Ahli Epid 33,3%Ahli statistik 44%Entry data/IT 66,67%
14 Govern Hospitals85,71%78%50%35%42%100%85%14%28%78%
28 Hospitals in Jakarta
14 Private HospitalsOffice/Room 11%Hardware 44,%Software 0Internet system 1%Cabinet 33%Hosp Policy 33%Dana 11%
14 Govern Hospitals57%64%42%57%57%35%7%
Network System in National Cancer Registry : 40 Hospitals in Jakarta as a Model
HCR : Hosp. Cancer Reg. NCR : National Cancer Reg.
DRC : Disaster Recovery Center RCR : Regional Cancer Reg.
Dharmais NCC
RSPAD -GS
RS Fatmawati
RS Persahabatan
RS KojaRSKD
REG
REG
REG REG
REG
Regional Cancer CentreRegional Cancer CentreRegional Cancer CentreRegional Cancer Centre
Establishment of National Cancer Registry in Indonesia
National Cancer CentreNational Cancer CentreNational Cancer CentreNational Cancer Centre
South Sulawesi
Cancer Registry System in South Sulawesi
HCR : Hosp. Cancer Reg.
DRC : Disaster Recovery Center
RCR : Regional Cancer Reg.
Wahidin Hospital
RS Pare-Pare
RS Bone
RS Palopo
RS Bulu Kumba
RS Makassar
REG
REG
REG REG
REG
Establishing National Cancer RegistryAction Plan.
Planning(2007)
Hand book /Regulation (SK-SK) SOFTWARE
Meeting and TrainingPlanning
SOS &ADV Central to Hospt, PROP,KAB/KEC
Monitoring Evaluation
(2008- 2010)Monitoring and Facilitate
Dissemination of Information
Activity(2008)
Sos & Adv Central, Hospt, DINKES PROP/KABMeeting and Training in MOH
REGIONAL.Data Verification and Validation
Job DescriptionNational Cancer Registry
“Dharmais”NCC
Central National Cancer DataData Collecting and Analysis
Verify and Validate
Regional Hospitals
Regional Cancer DataData collecting and verify
from Municipal govern and Private hospt
Municipal Hospitas
ENTRY DATASending data to Regional Hospital
DINKES PROP/Municipals
KADINKES, SUBDIN P2PL& YANKESManagement support
Resources
Facilitate Room office/HARDWARE/ SOFTWARE
EQUIPMENT Networking/Abstract,/tools etc
Funding National/Regional BudgetWHO
HR/Brain ware
Hospital Management Pathologist/Oncologist/Stastiticion/
GP/REGISTRAR
Cancer Registry Software
International Association of Cancer Registries (IACR)
International Agency for Research on Cancer (IARC)
Indonesia Cancer Registry SoftwareSistem Registrasi Kanker di Indonesia
International Classification of Diseases for Oncology v.3
Outline of Registration Procedure
Cancer notification forms
Request information clarification
Form complete and correct
Check patient index
New cancer patient
Check previous notification
New primary
Update record
Pathology & other reports
Hospital discharges
Mention of cancer
Check patient index
New cancer patient
Request notification or information from related persons
From complete & correct
REGISTER CASE New reg. number
Computer file
Death certificates
Ignore
New primary
Update record
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
% Histological verified, DCO
2005
2006
2007
2008
Quality of dataJakarta Cancer Registry as a Model
Quality
• Coverage• Completeness• Reliability:
cancer/non-cancer• Follow up: last date,
status• Staging
• Histology verified• Cause of death• DOB, ID• Death certificate
notification• Treatment (Hosp-
based)
0
5
10
15
20
25
30
35
40
45
Cntrl Jkt West Jkt East Jkt South Jkt Nort h Jkt TotalHospt
Area
Num
ber
Hospital
Cancer Team Work
Brainware
Hardware
Softw are
Room/off ice
Management support in Hospital based cancer registry activities in 40 Hospitals in Jakarta
Result in 12 Months
From 40 Hospital – only 31 Hospitals sent the data, only (86,53% data) can be analysis.
Total Data Analysis, 2005 (40 Hospitals)
3400
3600
3800
4000
4200
4400
4600
Verify1 Verify2 Verify3 Verify4
Activities
Num
ber
% Histology Verification, 2005
010
2030
4050
6070
80
ClinOnly
Rad Surg Lab Cyt HistMetas
MV Autop Unk
Basic Diagnosis
Perc
ent
The Ten Commonest Malignancy in Female in 31 Hospitals in Jakarta, 2005
0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00
Liver Ca
Skin Ca
Lung Ca
Nasopharynx Ca
Thyroid Ca
Colorectal Ca
Leukaemia
Ca Ovarium
Cervix Ca
Breast Ca
TOPO
Percent
The Ten Commonest Malignancy in Male in 31 Hospitals in Jakarta, 2005
2.00
2.60
2.90
4.70
6.00
6.90
10.80
11.10
11.50
12.00
0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00
Gaster Ca
Brain Ca
Skin Ca
Liver Ca
Prostate Ca
Lymphoma
Colorectal Ca
Leukemia
Lung Ca
Nasopharynx Ca
TOPO
Percent
Result in 6 Months• From 40 Hospital – only 30 Hospitals sent the
data, only from 24 Hospitals data can be analysis(87% data)
• Consult data analysis to IACR – to get Cancer Distribution in Jakarta
• Follow-up the Problems : Hardware - Software –Brainware and Funding.
• National Policy for Cancer Registry model in Jakarta
• In 2008 Establish NCCPs based on data 40 hospts as a Pilot Project.
Total Data Analysis, 2006 (40 Hospitals)
4000
4100
4200
4300
4400
4500
4600
4700
4800
4900
5000
Total Cases Enrty Data Verified Analysis
Data
Num
ber
The Ten Commonest Malignancy in Female in 24 Hospitals, 2006
2.14
2.14
2.26
2.6
3.02
3.39
5.11
5.99
16.13
34.48
0 5 10 15 20 25 30 35 40
Colorectal
Skin
Lung
Nasopharynx
Lymphoma
Thyroid
Ovarium
Leukemia
Cervix
Breast
Topo
Percent
The Ten Commonest Malignancy in Male in 24 Hospitals, 2006
2.8
3.12
3.28
3.28
5.28
5.36
5.92
11.67
12
13.91
0 2 4 6 8 10 12 14 16
Skin
Brain
Mediastinum
Prostate
Colorectal
Tongue
Lymphoma
Lung
Nasopharynx
Leukemia
Topo
Percent
Challenges and Obstacles
Commitment of the Department of Health• Policy Jakarta Cancer Registry as a Model • Issue on confidentiality (private physicians)/Private Hospital
• Lack of Budgeting/No special Budget from Government
Lack of Human Resources.• Training of newer registry assistants• Keeping the well-trained staff
Increasing awareness of the general public and concerned parties
• Professional Organization (POI, IAPI, PERABOI, PORI, PDSRI, HOGI, MABI) Management Hospital and Private Sector. Network system : Computerization
The Planning of NCCPs of Indonesia
2006
NCD
CD
Under DevelopedDeveloping
Intervention
2009 2010 2015 2019
Fundamental development Strengthening
Sustainability
1. Legal aspect2. Socialization and advocatie3. Programme development4. Humant invesment5. Networking6. Surveillance7. Logistic8. Monitoring and evaluation9. Budget development
2014
National Cancer Control Programmes
MORBIDITY MORTALITY
Ca Patients
Environment
Diet & food
Hormonal
Physical Activity
Behavior
Conductor Cancer
Program
Policy of NCCPs
Impact :Risk Factor
Occupation
Genetic/Screening
Tobacco Control
Colaborate with• Professional Organization• Indonesia Cancer Foundation• Board committee of NCCPs• University Society network • Others Foundation
Vaccination
WHO WHO 19821982, “Do not put years but life into years “, “Do not put years but life into years “THANK YOUTHANK YOU