{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:52:55Z","timestamp":1787741575377,"version":"build-2784847793"},"reference-count":30,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,8,12]]},"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of a nasopharyngeal carcinoma (NPC) awareness programme on the short-term and long-term improvement of knowledge and referral of patients with NPC by primary healthcare centres (PHCCs) staff in Indonesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>The NPC awareness programme consisted of 12 symposia including a Train-The-Trainer component, containing lectures about early symptoms and risk factors of NPC, practical examination and the referral system for NPC suspects. Before and after training participants completed a questionnaire. The Indonesian Doctors Association accredited all activities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1 representative general practitioner (GP) from each PHCC attended an NPC awareness symposium. On the basis of the Train-The-Trainer principle, GPs received training material and were obligated to train their colleagues in the PHCC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>703 GPs attended the symposia and trained 1349 staff members: 314 other GPs, 685 nurses and 350 midwives. After the training, respondents\u2019 average score regarding the knowledge of NPC symptoms increased from 47 points (of the 100) to 74 points (p&lt;0.001); this increase was similar between symposium and Train-The-Trainer component (p=0.88). At 1\u00bd years after the training, this knowledge remained significantly increased at 59 points (p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The initial results of this NPC awareness programme indicate that the programme effectively increases NPC knowledge in the short and long term and therefore should be continued. Effects of the improved knowledge on the stage at diagnoses of the patients with NPC will still need to be scrutinised. This awareness programme can serve as a blueprint for other cancer types in Indonesia and for other developing countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-008571","type":"journal-article","created":{"date-parts":[[2016,3,1]],"date-time":"2016-03-01T22:15:03Z","timestamp":1456870503000},"page":"e008571","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Effectiveness of a multicentre nasopharyngeal carcinoma awareness programme in Indonesia"],"prefix":"10.1136","volume":"6","author":[{"given":"Renske","family":"Fles","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagung R","family":"Indrasari","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Dr. Sardjito General Hospital, Faculty of Medicine Gadjah Mada University, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camelia","family":"Herdini","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Dr. Sardjito General Hospital, Faculty of Medicine Gadjah Mada University, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santi","family":"Martini","sequence":"additional","affiliation":[{"name":"Department of Public Health, Airlangga University, Surabaya, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atoillah","family":"Isfandiari","sequence":"additional","affiliation":[{"name":"Department of Public Health, Airlangga University, Surabaya, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achmad C","family":"Romdhoni","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Dr. Soetomo Hospital, Faculty of Medicine Airlangga University, Surabaya, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlinda","family":"Adham","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ika D","family":"Mayangsari","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"van Werkhoven","sequence":"additional","affiliation":[{"name":"Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten A","family":"Wildeman","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bambang","family":"Hariwiyanto","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Dr. Sardjito General Hospital, Faculty of Medicine Gadjah Mada University, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bambang","family":"Hermani","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Widodo A","family":"Kentjono","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Dr. Soetomo Hospital, Faculty of Medicine Airlangga University, Surabaya, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia M","family":"Haryana","sequence":"additional","affiliation":[{"name":"Department of Histology, Cell and Tumour Biology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjanka K","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands"},{"name":"Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I Bing","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands"},{"name":"Department of Otorhinolaryngology, Dr. Sardjito General Hospital, Faculty of Medicine Gadjah Mada University, Yogyakarta, Indonesia"},{"name":"Department of Oral and Maxillofacial Surgery, Academic medical Centre, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,3,1]]},"reference":[{"key":"2025121221532558000_6.3.e008571.1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.25516"},{"key":"2025121221532558000_6.3.e008571.2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.16.790"},{"key":"2025121221532558000_6.3.e008571.3","doi-asserted-by":"crossref","first-page":"185","DOI":"10.5732\/cjc.011.10328","article-title":"Nasopharyngeal carcinoma in Indonesia: epidemiology, incidence, signs, and symptoms at presentation","volume":"31","author":"Adham","year":"2012","journal-title":"Chin J Cancer"},{"key":"2025121221532558000_6.3.e008571.4","doi-asserted-by":"crossref","first-page":"e63706","DOI":"10.1371\/journal.pone.0063706","article-title":"Primary treatment results of nasopharyngeal carcinoma (NPC) in Yogyakarta, Indonesia","volume":"8","author":"Wildeman","year":"2013","journal-title":"PLoS ONE"},{"key":"2025121221532558000_6.3.e008571.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66698-6"},{"key":"2025121221532558000_6.3.e008571.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1044579X0200086X"},{"key":"2025121221532558000_6.3.e008571.7","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.24293"},{"key":"2025121221532558000_6.3.e008571.8","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.25696"},{"key":"2025121221532558000_6.3.e008571.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.semcancer.2012.01.009"},{"key":"2025121221532558000_6.3.e008571.10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-10-446"},{"key":"2025121221532558000_6.3.e008571.11","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.21946"},{"key":"2025121221532558000_6.3.e008571.12","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0215(19980717)77:2<228::AID-IJC11>3.0.CO;2-7"},{"key":"2025121221532558000_6.3.e008571.13","first-page":"3048","article-title":"Herbal medicine use, Epstein-Barr virus, and risk of nasopharyngeal carcinoma","volume":"52","author":"Hildesheim","year":"1992","journal-title":"Cancer Res"},{"key":"2025121221532558000_6.3.e008571.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197611112952003"},{"key":"2025121221532558000_6.3.e008571.15","doi-asserted-by":"publisher","DOI":"10.1136\/oem.57.6.376"},{"key":"2025121221532558000_6.3.e008571.16","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-012-0077-9"},{"key":"2025121221532558000_6.3.e008571.17","doi-asserted-by":"publisher","DOI":"10.1023\/A:1008893109257"},{"key":"2025121221532558000_6.3.e008571.18","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws479"},{"key":"2025121221532558000_6.3.e008571.19","doi-asserted-by":"publisher","DOI":"10.1257\/089533006776526058"},{"key":"2025121221532558000_6.3.e008571.20","unstructured":"Wood J , Line D . Old problems, fresh solutions: Indonesia's new health regime. Economist intelligence unit; 2010."},{"key":"2025121221532558000_6.3.e008571.21","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.midw.2011.09.005","article-title":"Health reporting system in two subdistricts in Eastern Indonesia: highlighting the role of village midwives","volume":"28","author":"Ngana","year":"2012","journal-title":"Midwifery"},{"key":"2025121221532558000_6.3.e008571.22","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/1472-6920-10-81","article-title":"Knowledge of general practitioners about nasopharyngeal cancer at the Puskesmas in Yogyakarta, Indonesia","volume":"10","author":"Fles","year":"2010","journal-title":"BMC Med Educ"},{"key":"2025121221532558000_6.3.e008571.23","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.critrevonc.2012.01.003","article-title":"Cancer education for medical students in developing countries: where do we stand and how to improve?","volume":"84","author":"Amgad","year":"2012","journal-title":"Crit Rev Oncol Hematol"},{"key":"2025121221532558000_6.3.e008571.24","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1017\/S0022215112000333","article-title":"Establishing a head and neck unit in a developing country","volume":"126","author":"Aswani","year":"2012","journal-title":"J Laryngol Otol"},{"key":"2025121221532558000_6.3.e008571.25","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1007\/s00405-011-1665-0","article-title":"Exploring the knowledge of nasopharyngeal carcinoma among medical doctors at primary health care level in Perak state, Malaysia","volume":"269","author":"Balachandran","year":"2012","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"2025121221532558000_6.3.e008571.26","first-page":"1","article-title":"Nasopharyngeal carcinoma: a delay in diagnosis","volume":"2","author":"Prasad","year":"2000","journal-title":"Med J Malaysia"},{"key":"2025121221532558000_6.3.e008571.27","doi-asserted-by":"crossref","first-page":"e32756","DOI":"10.1371\/journal.pone.0032756","article-title":"Short-term effect of different teaching methods on nasopharyngeal carcinoma for general practitioners in Jakarta, Indonesia","volume":"7","author":"Wildeman","year":"2012","journal-title":"PLoS ONE"},{"key":"2025121221532558000_6.3.e008571.28","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdm105"},{"key":"2025121221532558000_6.3.e008571.29","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdl983"},{"key":"2025121221532558000_6.3.e008571.30","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.2349\/biij.4.3.e42","article-title":"History and growth of radiation oncology in Indonesia","volume":"4","author":"Gondhowiardjo","year":"2008","journal-title":"Biomed Imaging Interv J"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2015-008571","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:53:43Z","timestamp":1765605223000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2015-008571"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,3]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2016,3,1]]},"published-print":{"date-parts":[[2016,3]]}},"alternative-id":["10.1136\/bmjopen-2015-008571"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2015-008571","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,3]]}}}