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Research and Development Symp Nov 2010 1
Research And Developmentat
Dharmais Cancer Center Hospital(National Cancer Center)
A new Paradigm for National
Cancer Control Program inIndonesia
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Research and Development Symp Nov 2010 2
Cancer Control Facts in Indonesia
StrengthSub-directorate in Ministry of health (2006)
National Cancer Hospital (1993)Weakness
No National Control Programs
National Cancer Registry is still under way
National Cancer Center
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Research and Development Symp Nov 2010 3
Regional Cancer Centre
National Cancer Centre
Plan of Regional Cancer Center Indonesia
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Research and Development Symp Nov 2010 4
Type of Cancer Center
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Research and Development Symp Nov 2010 5
Dharmais National Cancer Hospital
I. Cancer Research Center (2012)
II.Comprehensive CancerCenter(2014)
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Research and Development Symp Nov 2010 6
PrimaryPrevention
Early Detection
Supportive & Palliative care Diagnosis & Treatment
Resources
Survival
Provide evidence forpolicy-makers
Cancer Registry & Surveillance
CancerControlProgram
Mortality Incidence
Understand cancerbiology/pathology
Develop diagnosis & treatment
Capacity
Building
Education & Public Campaign
Qualityof Life
Research Basic (Cohort) / Translational / Clinical / Policy
Concept of Cancer ControlProgram
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Research and Development Symp Nov 2010 7
Vision and Mission of DharmaisCancer Center Hospital
Vision :Toward National Cancer Control program based onevidence based by Cancer research and registry.
Mision :To conduct basic research in cancerTo conduct pre-clinic and clinical research improving
treatment, diagnostic and cancer prevention.Hospital based and community based cancer registry.
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Research and Development Symp Nov 2010 8
Scope of R-D in Dharmais Cancer
Hospital
Molecular biology Lab
Clinical TrialCancer Registry
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Research and Development Symp Nov 2010 9
Function of Dharmais CancerHospital
Leader, Reference, Bench-mark for
National Cancer Hospital, andNational Cancer Center
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Focus of Cancer Research,
should be:Research based on clinical or communityproblems back to clinical or community
benefitIntegrated and multi discipline researchteam
Impact to decision making on earlydetection, cancer prevention , diagnosis,and treatment
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Research and Development Symp Nov 2010 11
Some research, past and
on going
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Research and Development Symp Nov 2010 12
Scope of R-D in Dharmais Cancer
HospitalMolecular biology Lab
Clinical TrialCancer Registry
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Research and Development Symp Nov 2010 13
Pathogenesis
Epigenetic changes in Breast Cancer1. Hypermethylation in ER Gene ER
negative2. Methylation in HME-1 (G2-check
point in cell cycle)
3. Methylation in Tumor SupressorGene4. Methylation in WRN Gene
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Research and Development Symp Nov 2010 14
Risk Factor
1. Epidemiological study (hospitaland population based) incervical cancer, and breast
cancer2. Genetic study
Familial breast cancer
Polymorphism in nitrosaminemetabolism gene
3. Epig enetic study methylation
and metabolism of nutrition
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Research and Development Symp Nov 2010 15
Diagnosis
1. Genetic study in breastcancer diagnose basal like breastcancer by DNA expression microarray
2. Genetic study DNA EBV LMP2 Cut offpoint in NPC
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Research and Development Symp Nov 2010 16
Therapy
Stem cell Therapy for hematologycancer after ablative chemotherapy
Bone marrow and stromal bone marrowMobilized peripheral blood
Cell line study Potency of herbalmedicine in cancer cell
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Research and Development Symp Nov 2010 17
Therapy responses
Genetic study1. Polymorphism in CYP2B6 gene and
relationship with cyclophosphamidepharmacokinetic
2. P53 and K-Ras mutation in colorectal
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Research and Development Symp Nov 2010 18
Survival
Epidemiology study survival amongbreast cancer and LNH patientsSurvival rate in relation with ER status andamong BLBC
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Prognostic
LMP-1 and LMP-2 in NPCCytokine response in colorectal cancerand lung cancerK167 in basalioma as a proliferationmarker
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Research and Development Symp Nov 2010 20
Supportive
THL in NPCNutrican in Head and Neck Ca
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Research and Development Symp Nov 2010 21
Scope of R-D in Dharmais Cancer
HospitalMolecular biology Lab
Clinical TrialCancer Registry
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Research and Development Symp Nov 2010 22
Clinical trial
Multi Center CT : 12 trialsPharmacy sponsored : 10 trials
Investigator innitiated study : 2 trials (2 ofthese trials collaborate with NationalCancer Center of several countries)
Initiation phase : 3 trials
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Research and Development Symp Nov 2010 23
R word of academic medicine was
Research
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Research and Development Symp Nov 2010 25
Scope of R-D in Dharmais Cancer
HospitalMolecular biology Lab
Clinical TrialCancer Registry
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Cancer registry in Dharmais
Human resources :Registrar : 10 bachelor of public healthVerificator : 2 medical doctor
Validator : 1 pathologistFacility :
Cancer registry room
Software canreg -4ComputerServer
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Research and Development Symp Nov 2010 27
Progress ReportCancer Registry (hospital)
Population- Based
KERJA k
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Research and Development Symp Nov 2010 28
ALUR KERJA SESUAI KEPMENKES No : 1068/Menkes/SK/XI/2008
PusatData Kanker
Nasional
RS RegionalJakarta Selatan(RS Fatmawati)
RS RegionalJakarta Timur
(RS Persahabatan )
RS RegionalJakarta Barat
(RSKD)
RS RegionalJakarta Pusat
(RSPAD)
RS RegionalJakarta Utara(RSUD Koja)
5 RS LokalJakarta Barat
6 RS LokalJakarta Utara
10 RS LokalJakarta Pusat
11 RS LokalJakarta Timur
8 RS LokalJakarta Selatan
membentuk timregistrasikanker,melakasanakanreg.kanker danmelaporkan ke
RS regional
Memvalidasidata kanker RSdi wilayahRegionalnya danmelaporkan ke
Pusat DataKanker Nasional
Memvalidasi seluruh datadari 5 Regional danMelaporkan ke DirJenP2PL, DirJenBinYanMed,PusDatIn Depkes
DirJen
P2PL
DirJen
BinYanMed
PusDatInDepkes
Sifat kegiatan Registrasi Kanker :
Reg.Kanker Aktif :
RS lokal dan RS Regional mengirimkandata ke Pusat Data Kanker Nasional
Reg.Kanker Pasif :
Pusat Data Kanker mengumpulkan danmenjemput data ke RS Lokal dan RSRegional
S f D
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Source of Data
2 Clinics
79 Hospitals
Vital StatisticsDeath Certificates
301 Primary
Health Care
Central National Dataof Cancer
90 Laboratories
44 Municipals
Health Care
J k t Mi i C I id (C g 70% )
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Jakarta Minimum Cancer Incidence (Coverage 70% )79 Hospitals. 2 Private Clinics, 90 Pathology Laboratories,
44 Municipals Primary health Care (as a coordinator of 301Primary Health Care in District area).
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LETS THINK
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Aim of research study asCancer Hospital
DiagnosticTreatment
PrognosticDharmais Hospital Ca Registry surveillance, provide feedback on performance
Better Outcome
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Aim of research study as NationalCancer Center,
Prevention:Risk Factors
EtiologyDiagnosticTreatmentPrognostic and every level of action across alldisease spectrumNational Cancer Registry (hospital & pop)
Prevention to Treatment
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Cancer Registry
Provides data:IncidencePrevalenceSurvivalDensity of cancer diseases in particular area
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Dharmais Hospital Cancer Registry
Need to be establishedIndicator of Treatment Outcome:
Survival: over-all & stratified, disease free, etc
Obstacles:Medical records incompleteAccess to medical recordsLoss to follow up needs networking
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Planning for the future
Focusing on hospital levelStrengthen the systems; cancer
registry, clinical trial, bio-molecularresearch
Man power, Funding
Policy and political positionNetworking
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Research and Development Symp Nov 2010 38
Planning for the future
Focusing on National Cancer CenterStrengthen the systems: NationalCancer Control Program, National
Cancer Registry, Develop NationalGuidelines/Recommendation, NationalResearch center (clinical trial, bio-molecular, epidemiology research)
Man power, FundingPolicy and political positionNetworking
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Research and Development Symp Nov 2010 39
Research Area
Cancer pathologyCa PathofisiologyImmune geneticProteomicHerbal medicine for cancer treatmentResearch :
Epidemiology clinical and molecular (1. risk factors:molecular, genetic, socio-biology; 2. clinical:diagnostic, treatment, prognostic)Clinical trial applied (screening, diagnostic,treatment)
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Institutional Review Board
Patient safety
Improving Protection for Research Subjects Robert Steinbrook, M.D. Volume 346:1425-1430 May 2, 2002New England Journal of Medicine
http://content.nejm.org/content/vol346/issue18/index.shtmlhttp://content.nejm.org/content/vol346/issue18/index.shtml8/8/2019 Research And Development at "Dharmais Cancer Center Hospital (National Cancer Center) - A new Paradigm for National Cancer Control Program in Indonesia
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Execution of Clinical Trial
Patient recruitmentFollow the protocol
Be scientific and objectiveMaintain a highly ethical approach
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Research RVU
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Focus on Disease Topics for
Research Development1. Breast Cancer2. Gynecological Cancer
3. Hematology Cancer4. Nasopharingeal Cancer5. Lung Cancer6. Colorectal Cancer7. Skin Cancer
8. Cancer Stem Cell
Strategic Planning
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One Voice
No one can whistle a symphonyyou need a team to make that kind of music!
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