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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 0 St. Jude Children’s Research Hospital 10 20 30 40 50 60 70 80 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 16 A Neuroblastoma (CANCER OF THE NERVOUS SYSTEM) (SOLID TUMOR AFFECTING MUSCLES) National Resource with a Global Mission 18 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. 1 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 2 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 3 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 1 • 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 4 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 5 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 More cancer and health education materials are available at: Cure4Kids is an initiative of St. Jude Children’s Research Hospital More cancer and health education materials are available at: www.Cure4Kids.org/Kids. You may print and download select content for educational use only. All materials are copyrighted by St. Jude Children’s Research Hospital. See legal terms and conditions at http://www.Cure4Kids.org/Kids 6