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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