Research And Development at "Dharmais” Cancer Center Hospital (National Cancer Center) - A new...

8/8/2019 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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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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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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Regional Cancer Centre

National Cancer Centre

Plan of Regional Cancer Center Indonesia


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Type of Cancer Center


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Dharmais National Cancer Hospital

I. Cancer Research Center (2012)

II.Comprehensive CancerCenter(2014)


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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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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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Scope of R-D in Dharmais Cancer

Hospital

Molecular biology Lab

Clinical TrialCancer Registry


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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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Some research, past and

on going


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HospitalMolecular biology Lab



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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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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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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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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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Therapy responses

Genetic study1. Polymorphism in CYP2B6 gene and

relationship with cyclophosphamidepharmacokinetic

2. P53 and K-Ras mutation in colorectal


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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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Supportive

THL in NPCNutrican in Head and Neck Ca


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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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R word of academic medicine was

Research


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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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Progress ReportCancer Registry (hospital)

Population- Based

KERJA k


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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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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 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.shtml


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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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