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“DORLAN” Health Education in solving the physical and sexual problems of the gynecological cancer patients during chemotherapy
Dorlan Natalina Purba, Setyowati Setyowati
Corresponding author
wati123@ui.ac.id

Correspondinga author.
, Yati Afiyanti
Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The most common cancer in women is gynecological cancer&#46; In 2017 the estimation of death caused by this cancer was 9 million&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> According to The World Ovarian Cancer Coalition&#44; ovarian cancer is the most type of gynecological cancer that causing death&#44; around 152&#44;000 deaths every year worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> In Indonesia&#44; gynecological cancer is the seventh leading cause of death that attacks Indonesian women&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> According to the Ministry of Health that increasing mortality patients with gynecological cancer in Indonesia is caused by several factors&#44; including&#59; age&#44; lifestyle during treatment&#44; and obedience to comply with cancer treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the cancer treatments is chemotherapy&#46; Chemotherapy aims to kill cancer cells that spread to all parts of the body&#46; In general&#44; chemotherapy has side effects such as nausea and vomiting&#44; hair loss&#44; fatigue&#44; anemia&#44; and bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Chemotherapy also causes sexual problems in cancer patients&#44; especially gynecological cancer patients such as fear of sexual intercourse with a partner&#44; decreased sex drive&#44; and anxiety due to the inability to have sexual relations with a partner&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> Research had been done by Schover et al&#46; found that patients are afraid to have sexual relations with their partners because of the effects of chemotherapy treatment on reproductive organs&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Research conducted by El-Nemer&#44; El-Zafrani&#44; El-Sayed&#44; &#38; Saadoon illustrated that providing health education to patients who are undergoing chemotherapy helps patients identify the side effects that arise during chemotherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Health education provided to patients undergoing chemotherapy can reduce anxiety and fear of the side effects of chemotherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> Research conducted by Alhams&#44; El-Dien&#44; &#38; Elshaer found that providing health education to patients during chemotherapy can increase knowledge about how to overcome the side effects during chemotherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">&#8220;DORLAN&#8221; Health Education Package is a comprehensive health education has to consist of information about the side effect of chemotherapy physically and sexually and how to overcome and reduce that side effect&#46; For that reason&#44; this study was proposed in order to identify the effectiveness of &#8220;DORLAN&#8221; Health Education to reduce the physical and sexual problems among gynecological cancer women under chemotherapy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The design in this study was a quasi-experiment pre-post test with control group design&#46; The sampling method used is consecutive sampling&#44; with inclusion criteria are patients who received chemotherapy at least the second&#44; having cancer stage one until three&#44; and patients who did not experience mental disorders&#46; The number of samples obtained 94 respondents divided into 47 respondents in the intervention group and 47 respondents in the control group&#46; The study takes place between March and May 2019 in two referral cancer hospitals&#46; Data was collected with the use of questionnaires&#46; The questionnaire used in this study covered general data related to the characteristics of respondents&#44; including the identifying number&#44; age&#44; education&#44; marital status&#44; and stage of cancer&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The FACT-B questionnaire was used to measure physical problems&#46; It was developed by Cella&#44; the owner and copyright holder of the FACIT System&#44; where the physical function was determined from 10 items&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> The Sexual Satisfaction Scale for Women &#40;SSS-W&#41; questionnaire was used to evaluate sexual problems where validity and reliability tests have been carried out with Cronbach&#39;s <span class="elsevierStyleItalic">&#945;</span> score&#58; 0&#46;990 for SSS-W and Cronbach&#39;s <span class="elsevierStyleItalic">&#945;</span> score&#58; 0&#46;938 for MSPSS&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Health education is carried out with training&#47;lecturing&#44; group discussion&#44; and booklet&#46; Booklet was given to patients consist of information about the side effects of chemotherapy&#44; both physically and sexually&#44; self-management in dealing with the side effects of chemotherapy&#46; The family&#44; as the closest person&#44; can provide social support that can improve the status of one&#39;s health&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> &#8220;DORLAN&#8221; Health Education is carried out in two periods&#44; namely during the first batch of chemotherapy and the next meeting when the respondent were having the second batch of chemotherapy in the next period&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The implementation of &#8220;DORLAN&#8221; Health Education involves families&#46; The family&#44; as the closest person&#44; can provide social support that can improve the status of one&#39;s health information&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> Respondents are also asked to fill in a self-monitoring sheet to monitor their daily activities at home&#46; After third-week researcher evaluated the self-monitoring sheet&#44; then the post-test data were collected&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Data was assisted by a data collector&#44; and the interpreter reliability test has been performed with the kappa coefficient score&#58; 0&#46;952&#46; The Ethics Committee has approved this research by the Faculty of Nursing&#44; Universitas Indonesia&#44; with reference number&#58; 54&#47;UN2&#46;F12&#46;D&#47;HKP&#46;02&#46;04&#47;2019&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Based on <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; the analysis of homogenity showed that there were no differences in age&#44; marital status&#44; and education level of respondents between the control and intervention group or both groups are homogeneous&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that there are significant differences in physical and sexual problems before and after being given &#8220;DORLAN&#8221; Health Education in the intervention group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In the <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows that there are significant differences in physical and sexual problems between the intervention group and the control group after being given &#8220;DORLAN&#8221; Health Education in the intervention group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> showed that there were no significant differences between all confounding factors with the dependent variables&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Multivariate analysis with logistic regression was used to validate the effect of the &#8220;DORLAN&#8221; Package in reducing physical and sexual problems &#40;see <a class="elsevierStyleCrossRefs" href="#tbl0025">Tables 5 and 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the factors that most influence physical problems are the &#8220;DORLAN&#8221; package&#46; This result means that the &#8220;DORLAN&#8221; Health Education Package has a positive effect on not experiencing physical problems&#46; The OR value in the &#8220;DORLAN&#8221; health education variable is 6&#46;105&#46; This result means that gynecologic cancer patients undergoing chemotherapy who received the &#8220;DORLAN&#8221; health education package had a 6&#46;105-time chance of not having a physical problem &#40;95&#37; CI&#58; 1&#46;038&#8211;6&#46;292&#41; after controlled by age variable&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> shows that health education &#8220;DORLAN&#8221; is the factor that most influences sexual problems marked by Wald&#39;s value of 18&#46;208&#46; The direction of the relationship shows a positive relationship&#44; which means that the health education package &#8220;DORLAN&#8221; has a positive effect on sexual problems&#46; This is indicated by an OR value of 1&#46;282&#44; which means gynecological cancer patients who receive health education &#8220;DORLAN&#8221; have a 1&#46;228 times chance of not having sexual problems after controlled by the education variable&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The result of this study showed that there was a significant difference of respondents who under chemotherapy after having the DORLAN Health Education Package to solve their physical and sexual problems&#46; This is in line with research conducted by Dahiya et al&#46;&#44; which found that patients with cervical cancer who undergo chemoradiation have increased physical health quality and have the ability to carry out physical activity even though they are undergoing chemoradiation&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">According to the Cancer Council Australia&#44; one of the treatments that can be given to minimize the side effects of chemotherapy is the provision of health education&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> This is in line with the research conducted by Salakari et al&#46; about the effectiveness of providing health education to reduce the side effects of chemotherapy in breast cancer patients&#46; The effect felt by patients is reduced physical symptoms such as fatigue&#44; nausea&#44; and vomiting&#44; which are side effects of chemotherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The results of this study indicate that there is an effect of the provision of &#8220;DORLAN&#8221; health education on sexual problems&#46; Matzo&#44; Graham&#44; Troup&#44; &#38; Ferrell found that women with gynecological cancer who get treatment experience changes in sexual function in the form of changes in the role of partners&#44; lack of confidence in sexual relations&#44; and the inability to achieve sexual function to the full&#46; Providing sexual health education to patients undergoing chemotherapy can assist patients in maintaining sexual function both for themselves and for partners&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Research conducted by Stabile et al&#46; found that patients diagnosed with gynecological cancer are very important to get health education about sexuality&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> Health education about sexuality in gynecological cancer patients is useful to provide important information about the problems that patients will feel while getting treatment as well as sexual problems that are felt after the completion of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The results of this study indicate that the &#8220;DORLAN&#8221; health education package influences the physical and sexual problems of gynecological cancer patients who are undergoing chemotherapy&#46; &#8220;DORLAN&#8221; health education should be given before chemotherapy to prevent physical and sexual problems during chemotherapy&#46; The &#8220;DORLAN&#8221; Health Education Package can be used as a component of nursing discharge planning for patients undergoing chemotherapy&#46; Further research with more appropriate sampling in a more big population is recommended&#46; Also&#44; the research by using &#8220;DORLAN&#8221; Health Education Package in a very specific stages of gynecological cancer&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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                  \t\t\t\t">5&#46;621&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#46;208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;058&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Education&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;174&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;236&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Incidence and death in 29 cancer groups in 2017 and trend analysis from 1990 to 2017 from the Global Burden of Disease Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Lin"
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                            2 => "Y&#46; Liu"
                            3 => "F&#46; Yuan"
                            4 => "H&#46; Li"
                            5 => "J&#46; Ni"
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                    0 => array:2 [
                      "doi" => "10.1186/s13045-019-0783-9"
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                        "tituloSerie" => "J Hematol Oncol"
                        "fecha" => "2019"
                        "volumen" => "12"
                        "paginaInicial" => "96"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31511035"
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                      "titulo" => "Side effects of chemotherapy among cancer patients in a Malaysian general hospital&#58; experiences&#44; perceptions and informational needs from clinical pharmacists"
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                            0 => "H&#46;K&#46; Chan"
                            1 => "S&#46; Ismail"
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                    0 => array:2 [
                      "doi" => "10.7314/APJCP. 2014.15.13.5305"
                      "Revista" => array:6 [
                        "tituloSerie" => "Asian Pac J Cancer Prev"
                        "fecha" => "2014"
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                        "paginaInicial" => "5305"
                        "paginaFinal" => "5309"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25040993"
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                      "doi" => "10.33371/ijoc.v11i1.494"
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                        "tituloSerie" => "Indonesian J Cancer"
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        "texto" => "<p id="par0115" class="elsevierStylePara elsevierViewall">This work is supported by Hibah PITTA 2019 number&#58; <span class="elsevierStyleGrantNumber" refid="gs1">NKB-0500&#47;UN2&#46;R3&#46;1&#47;HKP&#46;05&#46;00&#47;2019</span> funded by <span class="elsevierStyleGrantSponsor" id="gs1">DRPM Universitas Indonesia</span>&#46;</p>"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos