In a daring new initiative, St. Jude prepares to take its research and clinical care to the 80 percent of kids worldwide who lack access to quality cancer care.
The little boy with the liquid brown eyes is shy and solemn as he awaits his turn for treatment in an El Salvador cancer clinic. Thanks to a partnership with St. Jude Children’s Research Hospital, he has a fighting chance at surviving his disease. But that scenario is not the case for tens of thousands of other children in low- and middle-income countries worldwide.
This year, more than 80 percent of all children with cancer in the U.S. will be cured. That’s great news. But Carlos Rodriguez-Galindo, MD, St. Jude executive vice president and Global Pediatric Medicine chair, has fixed his gaze on the horizon—far beyond the hospital’s campus.
“We do very well, but we are only reaching out to a small percentage of children with cancer in the world,” he says. “About 80 percent of children with cancer worldwide don’t have access to the St. Jude level of care. And that gap is only going to increase as the numbers of children with cancer continue to rise in the developing world.
“Solving the global pediatric cancer problem,” he says, “is the next frontier.”
Extending the reach
St. Jude has spent more than five decades perfecting its approach to pediatric cancer treatment. Technology, developmental therapeutics, surgeries, multidisciplinary approaches, child psychological support and family services are customized for each patient. The hospital’s research and clinical care has been shared with hospitals around the world, and patients have come to St. Jude from many countries.
But now, the mission is expanding, as St. Jude extends its medical footprint to the farthest reaches of the Earth.
According to James R. Downing, MD, St. Jude president and chief executive officer, an important component of the hospital’s strategic plan is to leverage its resources, position and knowledge to accelerate progress worldwide.
“We are in a position to set up global collaborations—big efforts others can’t do,” he explains. “We want to define how to treat cancer patients across the globe and teach clinicians and investigators around the world how to do this.”
We are in a position to set up global collaborations—big efforts others can’t do.
Throughout his career as a pediatric oncologist, Rodriguez-Galindo has always had a simple goal: “I want to bring my expertise and my knowledge to all children, regardless of where they are.
“How can we develop treatments to do that?” he says. “That’s the major challenge.”
For nearly two decades, the hospital has gradually increased its international presence, establishing 24 partner sites in 17 countries. The progress has been extraordinary, but thousands of children in countries around the world still lack access to adequate diagnosis and care.
Building on existing successes, the hospital’s new initiative, St. Jude Global, will address that challenge. St. Jude staff will develop models to advance the quality of research and care to children everywhere. Local and regional leaders in developing countries will be trained and fostered. St. Jude will also provide educational tools for program growth and research, while creating an infrastructure to sustain that growth.
“My hope is that by the end of the next decade, we will have been able to guarantee access to quality care to all children with cancer in the world,” Rodriguez-Galindo says.
Previously, the hospital’s international outreach efforts relied on a model called twinning to develop partnerships with medical institutions in other countries. This process pairs St. Jude experts with local health providers and community leaders in other countries, sharing expertise and promoting self-sufficiency.
“This is a very effective approach, but we need to go beyond that,” Rodriguez-Galindo says. His aim is to provide measurable outcomes to check program progress and to be more strategic. One way to do that will be through developing new consortia, or regional networks, that encompass not only education and regional capacity building, but also research methods.
There are many questions that keep Rodriguez-Galindo up at night.
“Is the cancer we’re seeing in the Middle East or Africa or Central America the same that we see here?” he asks. “Are the causes of cancer different? Do ethnic or racial backgrounds or environmental factors determine what kinds of cancer we see? How can we improve access to care to all children with cancer and blood disorders in the world in a way that is sensitive to the socioeconomic environment without lowering our aims? How can we develop new models for care and bring innovation to the bedside? And most importantly, how can we do all this without losing our patient-centered approach?”
Answering those kinds of questions is the job of the new Global Pediatric Medicine Department.
“We need to have a corps of physicians or researchers who can generate these kinds of answers and then help build programs and strategize at regional and national levels,” Rodriguez-Galindo says.
He aims to recruit faculty whose focus will be to conduct research in global health, with the ultimate goal of improving access to care and quality of care for all children with cancer and blood disorders.
A true global alliance
The St. Jude Global Alliance will consist of the following consortia created by St. Jude during the past two decades as well as newly created partnerships:
The Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA) provides education and training and fosters pediatric cancer collaborations throughout Guatemala, Honduras, El Salvador, Nicaragua, Costa Rica, the Dominican Republic and Panama. The organization has standardized treatment regimens across participating institutions, with thousands of children treated on AHOPCA-funded clinical trials.
The Pediatric Oncology East and Mediterranean Group (POEM) is a network of physicians, scientists and health care professionals from more than 50 childhood cancer centers across the Middle East, northern Africa and southern Asia. The network includes St. Jude partner sites in Armenia, Bahrain, Egypt, India, Iraq, Iran, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Saudi Arabia, Syria, Tunis, Turkey, United Arab Emirates and Yemen.
The National Childhood ALL Study Group in China has been created to ensure that Chinese children with acute lymphoblastic leukemia (ALL) receive the best possible treatment. Since 2005, St. Jude has collaborated with physicians at Beijing Children’s Hospital and Shanghai Children’s Medical Center. Those efforts led to establishment of the National Childhood ALL Study Group in 2014. Through that initiative, 20 medical institutions in China will treat 1,200 to 1,500 children with ALL per year.
The Consorcio Latinoamericano de Enfermedades Hematooncológicas Pediátricas (CLEHOP) was born as a result of the success of AHOPCA’s program for the treatment of children with Hodgkin disease. Those excellent results triggered interest to extend this work to other parts of Latin America. CLEHOP integrates collaborative groups from Argentina, Peru, Ecuador, Mexico, Venezuela and Brazil to expand beyond the treatment of Hodgkin disease and become a true Latin American cooperative group.
The Prevencionistas e Infectólogos para Cáncer Infantil en América Latina (PRINCIPAL) consortium integrates infectious diseases experts who support the pediatric cancer programs in Latin America. The consortium includes experts from Mexico, Honduras, Nicaragua, El Salvador, Ecuador, Bolivia, Paraguay and Argentina.
New consortia will be created in the near future. For instance, plans are in the works to create and strengthen groups similar to AHOPCA in Southeast Asia and South America. These consortia will integrate regional capacity-building strategies, training programs and research to improve the care and increase the cure rates of children with cancer and blood disorders.
If anyone has the capacity, the vision, the mission and the dream to reach every single child in the world, it’s St. Jude.
No corner unexplored
The hospital’s goals are ambitious and bold—but Rodriguez-Galindo believes they are achievable.
“We are prioritizing the global approach to childhood cancer, taking St. Jude to the world,” he says. “But at the end of the day, our outcomes will be about patients. We do what we do because of the kids; they are the ones who inspire us.
“If anyone has the capacity, the vision, the mission and the dream to reach every single child in the world, it’s St. Jude.”
From Promise, Spring 2016