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20Dec 2016

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On Wednesday, December 21 Renske Fles will defend her thesis

On Wednesday, December 21 Renske Fles will defend her thesis, entitled "Evaluation of diagnosis and treatment of nasopharyngeal carcinoma in Indonesia; the necessity of a multilevel approach". Her promotor is Bing Tan; the co-promotors are Marjanka Schmidt and Sofia Haryana. The public defense will take place at 14:00 at the University of Maastricht.

Nasopharynx carcinoma is rare here in The Netherlands, but it is quite common in Indonesia. The prognosis of nasopharynx cancer in Indonesia is poor, especially compared to the international survival rates. This is in part caused by the fact many patients are diagnosed and treated when the tumor has already reached an advanced stage (with metastasized disease).

In her thesis Renske Fles shows that timely diagnosis and improving treatment outcomes is only possible if the problem is addressed at multiple levels: that of the patient, the general practitioner, the specialist and the health care system. The studies within the thesis show that Indonesian patients with nasopharynx cancer often wait a long time before they seek medical help. Being unfamiliar with the disease, the costs of travel and health care and relying on alternative healers all contribute to this. It also became clear that general practitioners at GP centers are insufficiently informed about this type of cancer, causing them to untimely refer patients to specialists. Therefore, most patients are diagnosed with late stage disease. After the diagnosis patients are often confronted with long waiting lists for proper treatment, and there are also often deviations from the regular treatment scheme.

Improved awareness among the public could help to convince patients to seek help at the right place sooner. Next to this an educational program for paramedics and general practitioners in GP centers should result in more timely referral to specialists. Finally, the facilities for both diagnostics and treatments should be expanded, given the shortages of both in Indonesia. In the meantime more energy can be invested in optimizing the use of the existing facilities, so patients can start their treatment in time and can actually finish it.    

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