Five-Year Cancer Epidemiology at the National Referral Hospital: Hospital-Based Cancer Registry Data in Indonesia

Abstract

Purpose: In 2016, there were 1,308,061 cases of cancer being treated in Indonesia, with 2.2 trillion rupiahs spent, amounting to $486,960,633 in US dollars (purchasing power parity 2016). The high burden of cancers in Indonesia requires a valid data collection to inform future cancer-related policies. The purpose of this study is to report cancer epidemiological data from 2008 to 2012 based on Hospital-Based Cancer Registry (HBCR) data from Cipto Mangunkusumo Hospital, Indonesia.

Methods: This was a descriptive study with cross-sectional design. Data were collected from Cipto Mangunkusumo Hospital HBCR 2008-2012. Demographical, diagnostic, stages of cancer, and histopathological types of cancer data were extracted.

Results: After screening, 18,216 cases were included. A total of 12,438 patients were older than 39 years of age (68.3%), with a female-to-male ratio of 9:5. Most patients have cancers at advanced stages (stages III and IV, 10.2%). The most common sites of cancer were cervix uteri (2,878 cases, 15.8%), breast (2,459 cases, 13.5%), hematopoietic and reticuloendothelial systems (1,422 cases, 7.8%), nasopharynx (1,338 cases, 7.4%), and lymph nodes (1,104 cases, 6.1%).

Conclusion: From this HBCR, cancer incidence in female was almost twice the incidence in male, largely because of the burden of cervical and breast cancers. The cervix uteri as one of the top five cancer sites based on this HBCR, 2008-2012, are still approximately consistent with Global Cancer Incidence, Mortality and Prevalence 2018, which portrayed that Indonesia has been severely afflicted by cervical cancer cases more than any other Association of Southeast Asian Nations countries. The HBCR could serve as a robust database of epidemiological data for cancer cases in Indonesia.

FIG 1

HBCR-PBCR Framework in Indonesia. In 2016, the Ministry of Health appointed Cipto Mangunkusumo Hospital as one of the regional cancer registry hospitals and Dharmais National Cancer Center as the national cancer burden control center. The vertical relationship between HBCR and PBCR shows that individual HBCRs are collected in a bottom-up fashion by the regional cancer registry hospitals, which form the regional PBCRs and submit them to the national cancer registry hospital. GLOBOCAN, Global Cancer Incidence, Mortality and Prevalence; HBCR, hospital-based cancer registry; PBCR, population-based cancer registry.

FIG 2

Study characteristics of the 2008-2012 HBCR patients at Cipto Mangunkusumo Hospital, Indonesia. The demographic profile of the HBCR patients are grouped based on admission year, age, domicile, sex, cancer stage, tumor location, and diagnostic basis. See Table 1 for the grouping based on the tumor location. HBCR, hospital-based cancer registry.

FIG 3

Top 10 cancer sites in male and female adults (%) at Cipto Mangunkusumo Hospital, Indonesia (2008-2012). (A) In male adults, top 10 cancer sites were nasopharynx, hematopoietic and reticuloendothelial systems, lymph nodes, liver and intrahepatic bile ducts, skin, rectum, bones, joints and articular cartilage, prostate gland, connective, subcutaneous and other soft tissues, and bronchus and lung. (B) In female adults, top 10 cancer sites were cervix uteri, breast, ovary, hematopoietic and reticuloendothelial systems, thyroid gland, lymph nodes, nasopharynx, corpus uteri, skin, and rectum.

FIG 4

Cancer cumulative incidence and cancer deaths stratified by sex (n) at Cipto Mangunkusumo Hospital, Indonesia (2008-2012). (A) In male patients, nasopharynx was the most common cancer site, but the highest proportion of deaths was due to the cancers of bronchus and lung. (B) In female patients, cervix uteri were the most common cancer site, but the highest proportion of deaths was due to the cancers of hematopoietic and reticuloendothelial systems.

FIG 5

Top 10 cancer sites in male and female children (%) at Cipto Mangunkusumo Hospital, Indonesia (2008-2012). (A) In male children, top 10 cancer sites were hematopoietic and reticuloendothelial systems, lymph nodes, eye and adnexa, bones, joints and articular cartilage, brain, connective, subcutaneous and other soft tissues, nasopharynx, kidney, unknown primary site, and liver and intrahepatic bile ducts. (B) In female children, top 10 cancer sites were hematopoietic and reticuloendothelial systems, eye and adnexa, bones, joints and articular cartilage, ovary, brain, lymph nodes, connective, subcutaneous and other soft tissues, thyroid gland, unknown primary site, and kidney.