St. Jude trainings bring together clinical research community around the globe

Childhood cancer survival has risen dramatically in the United States over the past several decades, driven in large part by clinical research. The Total Therapy approach, innovated by the late Donald Pinkel, MD, the first medical director and CEO of St. Jude, helped lay that foundation by showing that combinations of therapies could outperform single agents. However, no single institution is responsible for all of the advances in childhood cancer treatment. Progress has depended on many hospitals, researchers and clinical teams building upon one another’s findings over time.

Today, the same collaborative principles are guiding efforts to improve childhood cancer outcomes globally. Most cases of childhood cancer, about 90%, happen in countries with limited healthcare resources, which may not be able to use clinical procedures from research published in resourced nations directly. St. Jude and St. Jude Global are working with investigators and clinicians worldwide to provide training designed to help them adapt evidence-based care to their own settings, strengthen clinical research capacity and share what they learn with others facing similar challenges. Through this effort, physician-scientists such as Khaled Ghanem, MD, BASMA medical director, Syria, are working to deliver the best care possible at their home institutions in a standardized way that can be published and shared.

“One of the major focuses of my research was to find appropriate adaptations of protocols that were proven effective in Western countries,” said Ghanem, who is a member of the St. Jude Global Eastern Mediterranean Regional Advisory Committee (RAC). “If St. Jude had not supported my training, we would not have been able to create my program, treating and adapting pediatric cancer care protocols, in Syria.”

In some cases, the differences are logistical, shaped by local access to medicines, diagnostics or supportive care. In others, they are biological. In others, it can be about differences that these researchers uncover in the population they serve.

“During my clinical fellowship training, we kept seeing that children in Lebanon were far more likely to develop thrombosis [a type of blood-clotting problem] during treatment than those treated in America,” Ghanem gave as an example. “We found that our children have genetic polymorphisms, making them more sensitive to toxicity from one of the chemotherapies used in treatment. Minor adjustments to the protocols helped us avoid these complications, which now we, and others, know to do.”

Building clinical research skills in Ghana

To accelerate such research, St. Jude Global offers a variety of trainings. While some are direct healthcare trainings, such as what Ghanem participated in, others are more varied.

“What I really appreciate with St. Jude Global is that they are tackling these issues on several fronts,” said Lorna Renner, MD, University of Ghana Medical School. “There are various fellowship programs, longer or shorter trainings, and other options.”

Those offerings emerged through collaboration with partner institutions and are designed to meet local needs. Some focus on infections, diagnostic testing or disease-specific care. Others address a different challenge altogether: how to move a promising idea through a hospital or health system effectively. Early results showed that some of the bottlenecks and problems encountered by collaborators were not strictly clinical or scientific. They reflected a need to build skills for project management. So, St. Jude Global created new offerings. 

“In addition to trainings that help with research skills, there are also leadership programs,” Renner explained. “That’s something that will be useful for all other diseases, not only children with cancer — St. Jude is helping train leaders for the future in global child health.”

Creating a cancer research community in Latin America

If global childhood cancer survival is to improve, countries will need to coordinate. This is already beginning in Latin America, where St. Jude Global is helping multiple countries, such as Colombia, Chile, Brazil and others, to work together to strengthen context-conscious childhood cancer care.

“It’s difficult when you have to make a decision only by yourself at your own institution,” explained Andres Portilla, MD, Clinica Imbanaco, Colombia; Professor of Pediatrics at Universidad del Valle, Colombia; and a recent member of the Latin America RAC. “Now, when we are all together with shared data and the support of other hospitals, improving our knowledge about the reality of childhood cancers in Latin America, I think we can have better decisions with better opportunity and support them with really good evidence that we are doing our best for our children.”

That regional model matters because nearby countries are often more likely to share resource constraints, patient populations and implementation challenges. By bringing those clinicians together in trainings and workshops, St. Jude Global is helping create communities that can learn from one another and begin building their own systems of shared education, which Portilla is already doing.

“For us, the experience right now is with the project of molecular biology; we want to see its landscape around Latin America,” Portilla said. “We are building a course to provide better knowledge about molecular biology for all the teams, and we are trying to create regional guidelines to use this tool in a better way.” 

This molecular biology effort is a regional initiative of the Latin America RAC Molecular Biology Working Group (St. Jude Global, with Latin American Continental Branch of the International Society of Paediatric Oncology, SLAOP), building on the region’s first systematic assessment of pediatric molecular diagnostics across 17 countries. The regional initiative is developing a shared Latin American course, educational materials, regional molecular biology guidelines and an expanded situational survey of the region.

Crossing the cultural divide to do better clinical research in China

Even in countries with substantial research infrastructure, training partnerships can still fill important gaps. In China, for example, clinical research is well established. Many post-graduate health degrees in the country, including nursing, require an academic faculty appointment and scientific training as well, though most clinical research still comes through physicians. However, the number of physicians is far less than needed nationwide, so the country plans to elevate nurses to the equivalent of what are known as advanced practice nurses, a position that has historically not existed there. 

Suzette Stone, PhD, MSN, MDiv, PPCNP-BC, NEA-BC, RN, formerly the St. Jude Center of Advanced Practice Providers senior director; now vice president - Chief Advanced Practice Officer at the University of Tennessee, School of Nursing, is working with Shanghai Children’s Medical Center to help develop an educational pathway for advanced practitioners.  “When we started, they didn’t have a curriculum pathway within their universities for advanced practice nurses anywhere in the country,” Stone explained. “They did not have the licensure for it or the specialty training in pediatric hematology oncology.”

To meet that need, Stone collaborates with her Shanghai colleagues to create the curriculum to support advanced nursing education in pediatric cancer care and research, adapted to the local context of China. The goal is to help create a cadre of highly trained practitioners who can contribute to both clinical and research needs. However, that work requires more than technical expertise. These training programs require understanding those local contexts to cross cultural divides and language boundaries.

“One of the hardest hurdles in our meetings is to come to a common understanding of what the terms mean,” Stone said, “but when we do find a way to communicate, it’s been really great to have this think tank of thought partners to work through theoretical and practical implementation.”

Stone is committed to continuing to navigate through those barriers because the benefits of doing so have so much potential. In Shanghai, the hospital receives essential training for its new advanced nursing staff from a country where such experts are well established. This benefits the overall cancer research community as well because, due to its large population, China has a significant number of childhood cancer cases. The newly trained advanced practitioners can both provide care and help analyze data from research to get rigorous and statistically meaningful results that cannot be obtained elsewhere.

Tackling clinical pediatric cancer research together

Across Syria, Ghana, Colombia, China and elsewhere, training from St. Jude Global is helping the childhood cancer care community do more than adopt existing practices. Institutions are building the capacity to ask their own clinical questions, improve care in their own contexts and contribute new knowledge back to the global community.

“Training these nurses is a way to use our expertise to elevate care around the globe,” Stone said. “We don’t presume that we know all the best answers. These types of training programs build a global network to discover and exchange new information using each institution and country’s strengths so that we can improve outcomes for all children with these catastrophic diseases.”

That exchange is central to the effort. Training creates skills, but it also creates relationships — and those relationships make it easier to share data, compare experiences and solve common problems together.

“As one community, we can take advantage of everyone’s knowledge, including how to get the best results with limited resources,” Portilla said. “The best way to do that is to have the opportunity to know a person, to have a space to talk about your problems and to share your knowledge — as we can do in these training sessions and meetings — so that together, we can improve childhood cancer survival.”