Cytotoxic Activity of Curcuma Zedoaria in Anaplastic

Thyroid Cancer In Vitro and In Vivo.

1.1 Introduction
Anaplastic thyroid carcinoma (ATC) is an aggressive and usually rapidly fatal tumor with a
median survival after diagnosis of 6 months [Ain et al., 2000; Are and Shaha, 2006; Haddad et
al., 2005]. It accounts for 1–2% of all thyroid carcinomas [Giuffrida and Gharib, 2000;
Smallridge et al., 2009]. Current therapy consists of surgery, radiotherapy or
radiochemotherapy and chemotherapy.

Individuals newly diagnosed with cancer often undergo emotional stress, which increases
demands on cognitive resources and leads to fatigue. Additionally, the overall levels of stress
increase as fatigue causes reduced effectiveness of daily function [6]. Moreover, patients
waiting for surgery or medical treatment are burdened with a significant amount of stress and
anxiety [7, 8].

Patients with thyroid cancer show significantly increased perceived stress scores when
compared to the normal population and similar or higher scores than other oncologic patients
[9]. Therefore, health care providers should help the population with thyroid cancer alleviate
stress and fatigue. Pharmacological and nonpharmacological strategies can be recommended
to treat fatigue and stress [10]. Since the causes or consequences of these symptoms are related
to psychophysiological and psychobehavioral nature, a mindbody intervention such as guided
imagery can be considered for management of these symptoms [11, 12].

Complementary therapies, also known as integrative therapies, can be used to

improve pain control, reduce stress, and alleviate other symptoms experienced by

individuals with cancer (Running & Turnbeaugh, 2011). Integrative therapies are those

used concurrently with pharmacologic therapy (National Comprehensive Cancer Network

[NCCN], 2013).

Nevertheless, relatively few studies of the effectiveness of the guided imagery intervention
have been conducted among the cancer population in spite of the effects of the guided imagery
intervention on cancer-related symptoms in previous studies. Moreover, to the best of our
knowledge, no studies have examined the impact of guided therapy on fatigue and stress among
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the thyroid cancer. Therefore, this study was conducted to assess the effects of guided imagery
intervention on distress and fatigue among the population with thyroid cancer undergoing
radioactive iodine therapy after thyroidectomy

Guided Imagery might be the solution to increase the quality of life that would, in turn, reduce
anxiety of the Fukushima NPP Accident. Hence, it is necessary to develop and test the Guided
Imagery protocol in the given context of Fukushima NPP Accident. This study aims to initiate
such guided imagery protocol by thoroughly identifying the needs, possible barriers and
strategies for an guided imagery protocol, developing the model and subsequently
implementing and examining the program.

Undertaking a doctoral study is needed to obtain research competences and to have a

qualification of a researcher. Creating an impact in cancer management requires well designed
studies and sustained actions. This proposed study would be a beginning to induce further
studies and programs aiming at making thyroid cancer as a disease of the past in the future.

1.2 Research objectives

The overall aim of the study is to develop an organized cervical cancer screening using VIA in
Indonesia. The specific objectives are: 1) to explore the needs, possible barriers and strategies
for implementing an organized cervical cancer screening; 2) to develop an organized cervical
cancer screening model; 3) to implement the organized cervical cancer screening in the
community and 4) to evaluate the successes and limitations of the organized cervical cancer
screening program.

2. Method

2.1 Design

This research is an experimental research laboratory using post test with control group
design.

2.2 Population and Sample

The qualitative stage of the study will involve the head of the community health centre, head
of district, nurses, physicians, midwives and health cadres, from the community health centres
in the research site. Whereas, the quantitave stage of the study will use total sampling of
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subjects who meet the eligibility criteria and live in the chosen community location. The criteria
of inclusion for the cervical cancer screening participants are: 1) women aged 30-49 years-old
(WHO screening recommendation update 2014); 2) have the willingness to participate in this
study. Women who had hysterectomy with removal of cervix will be excluded.

2.4 Procedures

Scheme of actions and outcomes in three main phases of the proposed action research is
summarized in the following table.
Phase Activities Outcome
Problem Initial meetings (FGDs, Identification of needs, barriers
identification individual interviews) and strategies
Planning Developing model and action plans Model, action plans
Preparing for change Identification of targeted participants, health
care provider, supporting resources
Implementation Training of the health care providers (nurses Education
and evaluation and midwives) to perform IVA
Training to the community health cadres to Education
increase screening participation
Community education regarding cervical Education
cancer screening using IVA
Cervical screening using IVA with screen and Service provision
treat approach
Screening monitoring: Data of the screening result, programme
programme implementation, IVA monitoring
quality control with digital image
Focus group discussion on the programme Programme evaluation, Change in the
evaluation and sustaining effort cervical control programme in the
community
Table 1. Preplanned actions and outcomes

2.5 Data Collection

The qualitative data will be obtained through focus group discussion and individual
semistructured interviews. Quantitative data will be collected from the participants: the women
undergoing cervical screening and the screening providers. The field notes, reflective diaries
and the screening results will provide datasets. The evaluation of the programme will be
obtained from both of the community participants and the health care providers.

2.6 Data Analysis

Data from interview and focus group discussion transcripts, field notes and reflective diaries
will be analysed using a constant comparative approach. Data analysis for the quantitative data
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will be done using SPSS 22.0 statistical software. Descriptive statistics will be generated to
characterise the research sample in terms of demographic and screening test result variables.
Bivariate and multivariate analysis will be used to evaluate the programme.

2.7 Potential Challenges and Ethical Considerations

The main challenge may arise in initiating and maintaining the involvement of stakeholders,
health care providers and community during the study. Another potentially emerging issue
would be on overcoming the community’s resistance to undergo VIA, even though VIA
procedure has been proven to be safe. Ethical issue may come up if participants feel compelled
to participate in this study. However, it would be anticipated by delivering oral and written
education and debriefing for each prospective subjects about the purpose and procedures of the
study and by highlighting that participation in this study is voluntary and other ethical aspects
of the study. Written informed consent will be given to all participants. The principal
investigator will ensure that this study will be conducted conforming to the research code of
conduct. Ethical approval will be proposed to the Ethics Committee of the Ministry of Health,
Republic of Indonesia.

3. Timetable
Activities Year 1 Year 2 Year 3

1 2 3 4 5 6 7 8 9 1 1 1 1 2 3 4 5 6 7 8 9 1 1 1 1 2 3 4 5 6 7 8
0 1 2 0 1 2

Lit. review
Maturation of
protocol
Ethical rev. &
administration
FGDs,
interviews
Developing
model & plans
Preparation
Training of
care providers
Training of
cadres
Community
education
screening
Monitoring
Analysis and
Evaluation
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Report

Dissemination

4. Conclusion
Organised cervical cancer screening using VIA might increase the coverage of cervical cancer
early detection in an efficient and effective way that would, in turn, reduce the morbidity and
mortality rate of cervical cancer among Indonesian women. Therefore, it is essential to develop
and test the organised approach of cervical cancer screening using VIA in the given context of
Indonesia. This proposed study aims to initiate an organised screening by thoroughly
identifying the needs, possible barriers and strategies for an organised cervical cancer
screening, developing the model and subsequently implementing and examining the
programme. This study has the potential to impact the coverage of cervical cancer screening in
Indonesia.
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