Download Children`s Cancer Programme Partnership between NUH-NUS

St Jude-Singapore Programme
A Proposed Outreach Programme by
St Jude Children's Research Hospital &
Viva Foundation
for Children with Cancer (Singapore)
Goal
To improve the cure of childhood
cancer in Singapore and
Southeast Asia
Strategy
• To set up a centre of excellence for childhood cancer in
Singapore
– Children's Blood and Cancer Institute @ National
University Hospital
• Collaborative research on childhood cancers between
National University of Singapore, Agency for Science,
Technology and Research (A*STAR) and SJCRH
• Outreach Programme to region through teaching and
training
St Jude-Singapore Programme
St Jude Children's Research Hospital
Children's Blood
and Cancer Institute
@NUH
St Jude-NUS St Jude-Asia
Outreach
Research
Viva Foundation for
Children with Cancer
Children's Blood and Cancer
Institute @NUH
• Paediatric oncology care in Singapore is fragmented with
160 new patients per year managed in 2 main centres
• Focus resources to improve facility for a one-stop centre
in the academic unit with strong research and results
• Encourage governmental support to develop one centre
of excellence with Viva Foundation help.
• Development of haploidentical stem cell transplant with
SJRCH to address lack of HSC donors in Singapore
• Improving nursing, doctors and operational support by
Viva Foundation to augment existing facilities
St Jude-NUS Programme
• National University of Singapore (NUS) has a strong
research programme in leukaemia in children
• Receives US$600,000 per year competitive funding for
multi-centre, multi-faceted childhood leukemia studies
• Synergy with SJRCH on
– Epidemiology
– Pharmacogenetics, pharmakinetics
– Treatment protocol development
in a multi-ethnic Asian population.
• SJCRH to train doctors, nurses, PharmD and
researchers to facilitate dissemination of knowledge
developed by SJCRH
St Jude-NUS Programme
• Agency for Science, Technology and Research
(A*STAR) is the major research funding agency in
Singapore
• It has 5 research institutes including
– Genome Institute of Singapore - Prof Edison Liu (previous in
NCI)
– Institute of Molecular and Cell Biology - headed by Prof Sir David
Lane (authority in p53)
– Mouse facility - Neal and Nancy Copeland
• High level collaboration in SJRCH in these areas are
possible.
• Mr Philip Yeo, Chairman of A*STAR has also visited
SJRCH and impressed with its set up.
St Jude-Asia Outreach
• Asia is a diverse continent with huge differences in
culture, language and population
• Singapore as a platform for St Jude Outreach into the
region as a training centre and source for trainers
• Annual ASEAN Childhood Cancer Workshop for training
doctors and nurses ( 4 years continuously since 2003)
• Platform for sharing research on childhood leukemias
and transplant for Asian groups - like the I-BFM meetings
dedicated for Asian investigators with SJRCH
– Flow cytometry for MRD detection Workshop
– Childhood ALL and AML studies
Addendum slides
Infant mortality rates and life expectancy in
selected countries compared to Singapore.
Singapore
Hong Kong
Japan
USA
Infant
World Ranking mortality rate
for Infant
Per 1000 live
Mortality
births
1
2.29
3
2.96
4
3.26
42
6.5
(Source: Central Intelligence Agency, USA)
Life
expectancy
79.30
81.39
81.15
77.71
Overall Survival of Childhood Cancer
90
80
70
60
50
40
30
20
10
0
Singapore
USA
196877
197887
198897
1998-
Song YS
SEER
MASPORE ALL 2003
OS and EFS
Cum Survival
1.0
0.8
0.6
0.4
Censored
Total
N
0.2
194
194
N
Death =8
Event=22
N
186
172
Percent
95.9%
88.7%
0.0
0.00
1.00
2.00
efs
3.00
4.00
ALL-Relapse-free survival: By Protocol
protocol
1.0
HK
MASPORE 2003
MASPORE
NUH
HK-SG 1997-02
NUH site only
0.8
HK-censored
NUH I/II
1988-96
MASPOREcensored
NUH-censored
0.6
1988-97*
0.4
Cum
Survival
1978-87*
1968-77*
0.2
0.0
0.00
2.00
4.00
6.00
Relapse free survival time
8.00
10.00
12.00
14.00
AML therapy
1.0
0.8
NUH MRC AML 10 1996-2004
0.6
1973-81
1988-95
0.4
0.2
0.0
0.0
2.0
4.0
6.0
8.0
overall survival/yrs
10.0
12.0
14.0
Growth of programme
90
80
70
60
Residents
50
Non-residents
40
Total
30
20
10
0
Paeds Oncology Landscape in Singapore
• National University Hospital/NUS
– 3 consultants, 1 + 2 fellows
– local patients 1/3
– Foreign patients 50% of load
• KK Women's and Children's Hospital
– 2 consultants, 2 rotating fellow
– local patients 2/3 of Singapore
– Foreign patients 10% of load
• Parkway Children's Blood & Cancer Ctr
– to be built in latter half 2006
St Jude-Singapore Synergy
• NUH - care for children with cancer
• NUS - research, Comprehensive Cancer
Programme
• St Jude - Outreach, improving cancer care
• Children's Cancer Foundation
Viva F
NUS
NUH
A*STAR
KKWCH
St Jude Mission & Outreach
NUS - research collaboration
ASEAN Workshop
St Jude-Asia Forum
NUH - improving cancer rx facilities
Dedicated environment
BMT - haploidentical transplants
Graft engineering
Children's Blood and Cancer Institute @NUH
•
•
•
•
•
•
•
•
•
•
•
•
•
•
3 consultation clinics,
1 day therapy area with 10 beds (5)/ chairs (5)
1 blood taking room
1 waiting area
1 family counseling room/ multidisciplinary meeting room
medical records storage
1 general anaesthesia/procedure room
4 HEPA filtered BMT rooms,
3 isolation rooms/Single bedder,,
2 X 4- in-patient beds
1 chemotherapy reconstitution pharmacy
1 prayer room
1 refreshment rooms with microwave oven.
1 playground in the space in between ward 46 and 48
Problems
• Young parents - little savings
• Inadequate government subvention
– Improve Rx, increased losses
• Require enhanced medical facilities
St Jude-NUS
NUS
Viva Foundation
3 labs
Grant $1M/yr
2 doctors
6 lab res
Funding
Equipment
Staff - Research Prof
St Jude training
2 years start up research
3rd year - co-funded research with St Jude
St Jude Asia Outreach
St Jude
Viva Foundation
Teaching faculty
• nurse
• doctors
• research
Doctor
Secretariat
Funding Conference
Funding training
Setting up ASEAN
Centres of excellence
St Jude-Singapore
• Education
– I-BFM like forum in Asia
– Paed Onco Nursing Certification
– ASEAN Childhood Cancer Workshop
• Research synergy
– Epidemiology
– Leukaemia studies
– Pharmacogenetics
Short term goals (1-5 years)
•
•
•
•
•
Children's Blood and Cancer Institute@NUH
Training doctors and nurses from ASEAN
ASEAN Childhood Cancer Workshop
St Jude-Asia Forum for Childhood Cancer
Learning from St Jude - MRD, Haplo BMT
Long-term goals
• Partner St Jude to reach into ASEAN and
Asia
• Collaboration centre for research and
treatment - combined funding with SJCRH
• Centre of excellence for childhood cancer
therapy - St Jude of the East
• Planting centres in ASEAN and beyond