Download The St. Jude International Outreach Program St. Jude International

Cure4Kids Global Summit
June 9 June 9 –– 11, 2011
The St. Jude International Outreach Program
St. Jude International Outreach Program
Introduced by Eric D. Perakslis
Introduced by Eric D. Introduced by Eric D Perakslis, PhD
Perakslis, PhD
PhD
Cure4Kids Global Summit
Raul C. Ribeiro, MD
Raul C. Ribeiro
Raul C. Ribeiro, MD
, MD
June 10, 2011
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St. Jude Children’s Research Hospital
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90
100
Acute Lymphoblastic Leukemia
1962
(CANCER OF THE BLOOD)
2010
Ewing Sarcoma
(TYPE OF BONE CANCER)
S
U
R
1962
2010
V
I
Finding cures.
Saving
children.
No child
should die in
the dawn of
life.
Non-Hodgkin Lymphoma
(A MALIGNANT TUMOR)
Osteosarcoma
(BONE CANCER)
L
Retinoblastoma
(CANCER AFFECTING EYES)
Rhabdomyosarcoma
Cancer Incidence & Death Rates in
Children 0-14 Years, 1975-2005
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A
Neuroblastoma
(CANCER OF THE NERVOUS SYSTEM)
(SOLID TUMOR AFFECTING MUSCLES)
National Resource with a Global Mission
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V
Hodgkin Disease
(CANCER OF LYMPH NODES)
Incidence
Wilms Tumor
(CANCER OF THE KIDNEY)
Source:
St. Jude
Staff
Estimates
Success Factors in
Pediatric Cancer Care Worldwide
14
12
10
8
6
4
Mortality
2
All successful countries’ pediatric cancer
care programs resemble one another,
but each deficient country’s program is
deficient in its own way
0
1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005
Rate Per 100,000
*Age-adjusted to the 2000 Standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2005,
Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.
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Under-5 Mortality Rates as an
Indicator of Children’s Health
Status of
Children’s
Health
Under-5 Mortality Rates
World Health Statistics 2004, WHO
Queen Elizabeth Children’s Hospital
Department of Pediatrics—Malawi
150 admissions daily
• Malaria, Pneumonia,
Diarrhea
• Malnutrition, HIV, TB
Photos: Israels, Trinj. .Amsterdam: Buijten and Schipperheijn, 2009.
160 new patients per year
• 50% Burkitt lymphoma
• 15% Wilms tumour
• 5% ALL/AML
Double burden
Pediatric Cancer Worldwide
• United States: 12,000-13,000 cases/yr.
• European Union countries (27 members):
10 000 12 000 cases/yr
10,000-12,000
cases/yr.
• Globally: 160,000 cases/yr.
• 80% of children with cancer live in low- and
mid-income countries
– Survival varies from 0 to 60%
World Health Organization
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IOP Mission and Vision
Statements
• Improve the survival rates of children with
cancer and other catastrophic illnesses
worldwide by sharing knowledge, technology,
g
skills
and organizational
• Pursue these through the development of
demonstration projects in low- and middleincome countries
“Cancer and other non-communicable diseases are often
hidden by the diminutive “other” in tallies of healthcare
expenditures. Classifying the disease this way keeps it out
of sight—and out of the line of targeted action.”
www.ncdalliance.org/
Strategy
“ The silence in those
parts of the world where
cancer goes undetected,
undiagnosed and
untreated adds another
dimension to the threat—
these are manifestations
of a growing but hidden
epidemic.”
Tanzania media reports say the east African
country paid up to $2.5 million as a match fee
to the Brazilians, June 6, 2010
Model of Collaboration
Twinning Program
• Pediatric Hematology/Oncology Unit
• Community support (grassroots Foundation)
• Communication with St. Jude
• Commitment of a long-term partnership
Pursue the vision and mission through
the development of demonstration
projects in low- and middle-income
countries
Development of local capacity
Integrating Community and Health
Care in Pediatric Oncology
Community Engagement
Health Care Delivery
– Dedicated physicians and nurses
– Full time program director (physician) and nurses
– Building local capacity and sustainability
• Record keeping and data base
Late Diagnosis
Abandonment
Lack of Access to Care
Early Mortality
Relapse
Clinical Investigation
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Cure4Kids Live Meetings
Educational Strategies: Cure4Kids
Over 300 regional and international groups meet
online to discuss patient’s clinical cases, research,
protocols, training.
• Electronic Library
– Lectures, conferences, grand-rounds, courses
and other
– Full text medical books and journals
– Medical evidence treatment guidelines
• Web-based communication system
– Real-time consultation
– Working groups
• Oncopedia
– Case reports from international community
Rabat, Morocco
El Salvador Project
History of the Program
• Prior to 1994
– International exposure
– Collaborative research projects
• 1994
– El Salvador, the humanitarian focus
• 1997
– IOP Board Committee established
– Governing documents approved, including
templates for collaborative agreements
St. Jude, USA
Casablanca, Morocco
Foundation “Ayudame a vivir”, Non-governmental
organization
• Only focus is on childhood cancer
• Economic, psychosocial and educational support,
community outreach
– Lodging and food
– Essential medications
• Fundraising campaigns
• Alliances and partnerships
Features of the Guatemalan Project
El Salvador-1 Leukemia Study
5-year Event-free Survival
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• About 300 children with newly diagnosed cancer
are treated each year at the Unidad Nacional de
Oncología Pediátrica
• 50% patients have moderate or severe malnutrition
• 35% advanced disease
• 90% have family income less than US $180 month
• 23 different Mayan Languages, 50% of population
Mayan descent
• The Mayan vision of life and medicine radically
different from the Western view
Probability of Evvent-free Survival
0.9
0.8
Before
0.7
After
0.6
0.5
0.4
N = 151
0.3
0.2
0.1
0
0
1
2
3
4
5
6
7
Years after Enrollment
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Guatemala Project: Outcome Measures
1990/5
PreProgram
1998/
99
2000
UNOP
2007
2008
Abandonment
42%
25%
17%
4.7%
2.5%
Overall Survival
<20%
50%
Cases per year
Admissions
2009
Guatemala Partner Program
Budget (US x 1000)
2%
70%
100
110
129
280
287
300+
-
-
566
2,024
2,060
2,000+
Unit Occupancy
-
-
67%
90%
95%
98%
Outpatient
encounters
-
-
4,268
14,737
17,485
~19,600
Oncology Unit 2009 Budget
Guatemalan Program: 12 years
October 22, 09
45%
55%
• Large Corporations
• Small Business and Foundations
• Individuals
• Events
Ministerio de Salud Pública
y Asistencia Social
Q 26 MM* ($3.25 )
• Projects
Q 21 MM ($2.63)
St. Jude Children's Research Hospital
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Program Expansion
• International Outreach Programs
– Dedicated health care professionals
– Specific funding
• Alliances between public and private sectors
– Locall community support is essentiall
• Community Outreach Activities
– Integrate activities into existing health care
infrastructure
– Treatment based on evidence adapted to each area
Alliances
•
•
•
•
•
•
Integrated Model in Global Pediatric
Hematology/Oncology Care
Pediatric Cancer Units
in Low- and MidIncome Countries
Cancer Centers
and Organizations
in High-Income
Countries
Community Outreach
Activities
St. Jude Children's Research Hospital
• Increase Access and Survival of
Children with Cancer
• Increase Research Opportunities
St. Jude IOP Teamwork
IAEA (United Nations)
World Child Cancer (London)
UICC (Geneva)
SIOP (France)
NCI (Comprehensive Cancer Centers)
Other Institutions in high-income countries
Acknowledgements
Thank You for Your Support of the 2011 Cure4Kids Global Summit
End
Raul C. Ribeiro, MD
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