Current Status of Cancer Care for Young Patients with Nasopharyngeal Carcinoma in Jakarta, Indonesia

Abstract

BackgroundNasopharyngeal carcinoma (NPC) is endemic in Indonesia and 20% of the patients are diagnosed before the age of 31. This study evaluates presentation and treatment outcome of young patients in Jakarta, in a tertiary referral centre.MethodsForty-nine patients under the age of 31, diagnosed with NPC between July 2004 and January 2007, were evaluated. Baseline data included histological type, stage of disease and presenting symptoms. We intended to follow all patients after diagnosis to reveal treatment outcome and overall survival (OS).ResultsAll but two patients had advanced stage disease (94%), 7 (14%) had distant metastasis. The median interval between start of complaints and diagnosis was 9 months. Forty-two patients were planned for curative intent treatment. Eleven patients (26%) never started treatment, 2 patients did not complete treatment and 3 patients did not return after finishing treatment. Four patients died before radiation could start. Three patients died within 4 months after treatment. Nine patients (21%) had a complete response. Due to the high number of patients who were lost to follow-up (LFU), OS was analyzed as follows: a best-case (patients censored at last contact) and a worst-case scenario (assuming that patients who did not finish treatment or had disease at last contact would have died). The 2-year OS for patients without distant metastases was 39–71%.ConclusionTreatment outcome for young patients with NPC in this institute was poor. Improvement can be achieved when NPC is diagnosed at an earlier stage and when there is better treatment compliance.

Epidemiology and Inequality in the Incidence and Mortality of Nasopharynx Cancer in Asia

“…The prevalence of nasopharynx cancer in developing countries is higher, and this is attributed to the higher exposure of inhabitants to a variety of risk factors and lower budget allocations for health. For these people, diagnosis is often made when the disease is already in advanced stages, and, with the lack of access to treatment, the metastasis of nasopharynx cancer can be observed more often in these areas 36, 37.…”

“…Thus, only about 14% of patients who have metastasis at the initial diagnosis and 29% of patients without metastasis show response to therapy, about 70–95% response to therapy is good, so in general response to the therapy is poor. [36]. In Singapore, older patients diagnosed with stage 2 or stage 3 are at higher risk of recurrence and lower overall survival [47].…”

Incidence and Mortality of Nasopharynx Cancer and Its Relationship With Human Development Index in the World in 2012

“…Nasopharyngeal cancer prevalence in countries with medium and low HDI is greater due to higher exposure to a variety of risk factors related to the cancer and less budget allocations for health. Therefore, because of the diagnosis at an advanced stage and lack of access to treatment, metastasis of nasopharynx cancer can be observed more in these areas [ 32 , 33 ].…”

The Impact of the Overall Radiotherapy Time on Clinical Outcome of Patients with Nasopharyngeal Carcinoma; A Retrospective Study

“…; treatment response, LRC, DFS and OS. This was based on experience from previous studies where we found difficulties completing follow up data [ 4 , 30 ]. For every analysis, some patients had to be excluded due to uncertainty.…”