The St. Jude Global Central and South America Regional program (CASA) started in 2016 based on the foundation of a strong network of collaboration with multiple institutions and projects in the region that date to 1993. St. Jude had established programs throughout Central America, Dominican Republic, Haiti, Ecuador, Chile, Venezuela and Brazil. These humanitarian programs aimed to support the resource capacity needed to improve the level of care for children with cancer.
Since the inception of the CASA program, the focus has been to build local and regional networks of collaboration, facilitate access to St. Jude Global resources, and work with pediatric oncologists and key stakeholders to strengthen local health systems.
The global work of St. Jude has its roots in the Central and South America region when in 1993, the institution established its first international outreach program at Benjamin Bloom Hospital in El Salvador. After just three years of the twinning program between St. Jude and Benjamin Bloom, the survival rate of children with ALL in the country rose to 50 percent from near zero. This work led to the creation of the St. Jude International Outreach Program, which today is St. Jude Global.
In 1996, St. Jude established a program with Unidad Nacional de Oncología Pediátrica (UNOP) in Guatemala City, Guatemala, before continuing with other programs developed in Honduras, Nicaragua, the Dominican Republic and Haiti. St. Jude collaboration in the region through the years has included salary support for physician leaders and trainees, which is integral because it helps ensure providers have the ability to fully commit to the development of pediatric hematology/oncology in their respective communities.
These collaborative relationships across the region played an important part in bringing together institutions from Nicaragua, Guatemala, Honduras, El Salvador and Costa Rica in 1998 to form Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA). The network takes a regional approach with the development of resources in certain countries that are then shared across borders and throughout the region. The AHOPCA consortium develops and promotes shared protocols, educational programs for physicians and nurses, a more integrated role for psychologists and social workers, and collaborative research, such as the creation of a retrospective tumor registry, the activation of a prospective clinical registry, the adoption of psychosocial care guidelines, and the creation of pediatric hematology-oncology and nursing schools established in the region. Today, AHOPCA also includes institutions from Dominican Republic, Haiti and Panama.
In addition to AHOPCA, St. Jude Global played an important role in collaborating with regional partners to develop two other clinical research consortia in the region:
- The Consorcio Latinoamericano de Enfermedades Hemato-oncológicas Pediátricas (CLEHOP) began because of the success of AHOPCA’s program for the treatment of children with Hodgkin lymphoma. Those excellent results triggered interest to extend this work to other parts of Latin America. CLEHOP integrates groups from Argentina, Peru, Ecuador, Mexico, Venezuela and Brazil to expand beyond the treatment of Hodgkin lymphoma and become a true Latin American cooperative group. In addition to a protocol for Hodgkin lymphoma, the group has developed a new clinical trial for acute promyelocytic leukemia.
- Grupo de America Latina de Oncología Pediátrica (GALOP) originally started when a few institutions in South America teamed up with the Children’s Oncology Group to run common protocols.
The St. Jude Global CASA program has ongoing initiatives in the region that include strengthening collaborations with institutions in Brazil, implementation of the Global Initiative for Childhood Cancer (GICC) in Peru and development of Pediatric National Cancer Control Plans (PNCCP) in Central America, Haiti and Dominican Republic in collaboration with the Pan American Health Organization (PAHO) and the Comision de Ministros de Salud de Centro America (COMISCA).
The partnership between St. Jude and Brazil dates to the previous IOP. In its origins, St. Jude supported the pediatric oncology unit at Instituto de Medicina Integral Professor Fernando Figueira (IMIP) in Recife, achieving improvements in the outcome of children with cancer in the Northeastern region of the country. A fellowship with Hospital de Câncer Infantojuvenil de Barretos marked the next step in the collaboration in Brazil. In 2019, the CASA program supported two national workshops: in Recife bringing together numerous institutions, state health representatives and pediatric cancer stakeholders to locally design initiatives; and in Barretos, setting one of the foundational stones of Amarte Alliance, a collaborative national network. Continuing the expansion of our work in the country, in 2021 St. Jude and the Brazilian Society of Pediatric Oncology (SOBOPE) partnered in a workshop to strengthen different initiatives across the country that aim at the equitable care for Brazilian children.
St. Jude began collaboration in Chile in the 1990s with establishment of a bone marrow transplant program at Hospital Calvo Mackenna. One of only two ASH-designated training centers for pediatric bone marrow transplantation in Latin America, the clinic has provided hundreds of transplants over the past 20-plus years. A St. Jude-sponsored Osteosarcoma protocol has contributed to the care of a significant number of patients. In addition, a collaboration with Hospital Calvo Mackenna developed the content of a nurse educator training program that sponsors the training of nurses from the region. Ensuing collaborations included a St. Jude-sponsored Osteosarcoma protocol that contributed to a significant number of patients, showing that Chile could implement the same protocol. Following this, the Data Manager program began.
WHO Global Initiative for Childhood Cancer Focus Country: Peru
In 2018, St. Jude partnered with World Health Organization and other global stakeholders to launch the Global Initiative for Childhood Cancer, a collaborative effort to increase care access, quality and integration of childhood cancer in national and global agendas with a goal of reaching at least 60% survival for children with cancer by 2030. WHO designated Peru as the first focus country in the Region of the Americas for the Global Initiative for Childhood Cancer. Nearly 1,800 children and adolescents are diagnosed with cancer every year in Peru; however, up to 70% have advanced disease, often metastatic due to a delayed diagnosis and approximately half of the patients will die. To launch the initiative, St. Jude Global in its role as the WHO Collaborating Centre for Childhood Cancer, WHO and the Ministry of Health of Peru hosted the first Peru National Stakeholder Workshop on Childhood Cancer in June 2019 in Lima. Workshop participants identified initiatives to strengthen the health system in alignment with a national childhood cancer plan. This resulted in the enactment of the first Childhood Cancer Law in September 2020.
Collaboration between the St. Jude Global Nursing Program and institutions across Central and South America has led to many valuable educational and capacity building opportunities.
- Train pediatric oncology nurse educators through the Latin American Center for Pediatric Oncology Nursing Education, which provides a four-week training curriculum for nurse educators working in resource-limited settings
- Support the Latin American Nurse Educator Network
- Promote standardized chemotherapy/biotherapy certificate education for nurses in the region in partnership with the Association of Pediatric Hematology/Oncology Nurses (APHON)