St. Jude Global: What We Do

Critical illness in children with cancer is common: one in every 3 to 4 will require critical care during their cancer treatment. Unfortunately, this is a high-risk population with a high mortality, particularly in resource-limited settings. Improving management of critical illness in children with cancer is integral to development of new global standards and improved patient outcomes including reducing rates of toxic death.  

Vision

A world where all children with cancer who develop critical illness have access to quality health care provided by trained and skilled nurses and physicians.

Mission

Aligned with the St. Jude Global mission, the Global Critical Care Unit aims to strengthen hospital care for critically ill children with cancer and other catastrophic diseases through innovative interventions, education, research and multidisciplinary collaboration. 

Examples of ongoing initiatives include:

Innovative Evidence-Based Interventions

Multidisciplinary, evidence-based interventions to improve the quality of care for critically ill children with cancer. These efforts include:

• Multicenter PEWS (EVAT) Program: Collaboration of 62 pediatric hemato-oncology centers in Latin America and one in Europe, dedicated to early identification of clinical deterioration in hospitalized children with cancer through the implementation of a Pediatric Early Warning System (PEWS).

Education

To improve health care provider knowledge on the care of critically ill children with cancer we work with experts in the field to develop curricula, workshops and training materials on Pediatric Onco-Critical care. These efforts include:

• Pediatric Onco-Critical Care workshops and conferences, including the annual Pediatric Onco-Critical Care Symposium (POCCS) at St. Jude
• Curriculum development for physicians and nurses on Onco-Critical Care in Spanish
• St. Jude Global Academy in Pediatric Onco-Critical Care
• Critical Care Observerships in the St. Jude PICU

Research

High-quality research on topics related to pediatric onco-critical care in high-resource and resource-limited settings. These efforts include:

• PROACTIVE. Development of a tool to assess capacity and quality of pediatric onco-critical care in resource-limited settings.
• Communication. Qualitative study regarding interdisciplinary communication around patient deterioration.
• Barriers and enablers. Mixed-methods approach study to identify hospital, team and implementation characteristics contributing to successful PEWS implementation
• Clinical Sustainability Assessment Tool (CSAT). This tool will help structure the current ability of a center to evaluate a range of specific organizational and contextual factors. The yielded answers will identify the strengths and challenges of sustainability, and the findings will then be used to guide a sustainability action plan for the clinical practice.

Horizontal Collaboration Network

A collaborative network of providers interested in improving the care and survival of critically ill children with cancer worldwide through sharing knowledge, experience and best practices. These efforts include:

• GLECIOP (Grupo Latinoamericano de Estudio para Cuidados Intensivos de Oncología Pediátrica), a group for Spanish-speaking providers interested in Onco-Critical Care.

The St. Jude Global Disease Burden and Simulation Unit is a multidisciplinary program that aims to provide key pediatric cancer and catastrophic blood diseases data for clinicians, health administrators and health policy stakeholders to make the best decisions possible. Our team includes core faculty, staff and collaborators with expertise in statistics, decision sciences, cancer survivorship, health economics and epidemiology.

In 2017, St. Jude and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington began a formal partnership with the aim to advance knowledge and understanding of childhood cancer burden globally. This collaboration combines institutional expertise in health metrics, global health, epidemiology and disease burden estimation to provide more accurate estimates of the global burden of childhood cancer. The ultimate goal of this effort is to generate evidence that allows all stakeholders – including policymakers, health advocates and public and global health communities – to improve outcomes for childhood cancer patients around the world.

In addition to data generation, we are also the home for the development of new tools such as the St. Jude Global Childhood Cancer Analytics Resource and Epidemiological Surveillance System (SJCARES) Registry, a new and modern hospital-based pediatric cancer registration and reporting system. Using an intuitive and secure cloud-based platform, the program is designed specifically for low- and middle-income country contexts so that only the relevant information from which to make decisions is collected.

A health systems approach is necessary to sustain pediatric oncology program development and implementation across all St. Jude Global regions. Health systems-strengthening efforts must expand beyond improvements aimed at clinical services to work not only with clinicians, but also to build a diverse stakeholder base with policymakers, government leaders, civil society, and global health leaders and researchers to address needs at the policy and system levels.

To improve health outcomes for children with cancer, the St. Jude Global Health Systems Unit aims to support the integration of childhood cancer care in national, regional and global priorities, including via activities to:

• Support health systems strengthening across national and regional cancer programs. The Health Systems Unit works with collaborators to apply health systems science to effectively develop, implement and evaluate cancer control initiatives on a national and multi-national level. Successful initiatives have been launched in Myanmar and the Philippines, with emerging regional collaborations in Eurasia and Central and South America.
• Systematically collate, analyze and strengthen national policies pertinent to childhood cancer. The Health Systems Unit has established a comprehensive core bank of more than 800 national policies and strategic documents regarding cancer control, noncommunicable diseases and health. Collated policies span every region of the world and all country income levels. An extended core bank features monitoring and evaluation reports, and related documents that highlight plan-to-action and implementation outcomes. To date, in-depth comparisons of more than 250 national policies in more than seven languages have been completed, providing a platform for ongoing global, regional and national analyses to inform action. In addition to core analyses that examine inclusion in national policies and implementation plans, analytic frameworks also have been applied to address key global priorities beyond childhood cancer, such as equity and palliative care integration.
• Develop and implement tools to assess and support the strengthening of health systems and comprehensive childhood cancer control. The Health Systems Unit is developing assessment and opportunity mapping tools aimed at fostering collaborations across institutions, sectors, national programs and regions to drive evidence-informed decision-making. Initial tools have been designed to facilitate stakeholder mapping and national strategic planning, thus highlighting opportunities to integrate the needs of children with cancer while also achieving sustainable improvements across the health system.
• Liaise and collaborate with global and regional stakeholders to embed childhood cancer in global and regional agendas. With stakeholders around the world, the Health Systems Unit is applying health system science and research to integrate childhood cancer needs, advances and evidence into decision-making platforms. This includes working with national governments and civil society partners as well as with global bodies such as the World Health Organization (WHO). In March 2018, St. Jude was officially designated as the first and only WHO Collaborating Centre for Childhood Cancer, and in September 2018, WHO officially announced its Global Initiative for Childhood Cancer. The Health Systems Unit and St. Jude Global provide ongoing coordination and technical support for collaborative efforts with WHO at its headquarters, regional and country offices.

The Global Infectious Diseases (ID) Unit works to improve the survival rates for children with infectious diseases, especially those with depressed immunity. The program collaborates with local health care professionals at international sites to raise standards of care and promote evidence-based best practices.

The Global ID Unit aims to:

• Improve quality of health care practices through education and training guided by research
• Foster and participate in international collaborative research on infectious diseases
• Establish and maintain a network of health care providers working in infection care and prevention to stimulate a continuous exchange of knowledge and expertise in infectious diseases-related areas between St. Jude Global and its members     
  

Through targeted initiatives, the Global ID Unit helps clinicians gain knowledge, access to technology and organizational skills needed to prevent, diagnose, manage and minimize the consequences of infectious diseases in children, particularly those with cancer. With a team of education, subject matter experts and global collaborators, the Global ID Unit creates and administers up-to-date training resources to enhance the workforce around the world.

Global ID designs, conducts and implements collaborative research and quality improvement studies to gain a better understanding of the reasons for the high incidence of infections and poor outcomes and to find and implement successful and sustainable solutions.

The unit stimulates collaboration, communication and local engagement of participating health care providers by integrating them into professional regional networks to optimize the care of infections in children with cancer, address the educational needs of their care providers and participate from research. In 2017, the first such network was established in Latin America, the Prevencionistas e Infectólogos para Cáncer Pediátrico en América Latina (PRINCIPAL) network. This community establishes and implements strategies for better care and prevention of infections in pediatric oncology units associated with the St. Jude Global Alliance. The network includes 21 institutions in 13 countries, with close to 40 collaborators throughout Mexico, Central and South America and the Caribbean. The goal is to integrate the PRINCIPAL network with all St. Jude Global regional networks.

To deliver high-quality childhood cancer care, regional programs must take into account the local context in which care is delivered. What are the resources available to the health care program? How do internal and external factors affect that care?

Simply cataloguing resources and capabilities offers little long-term value for patients, leadership and staff. That’s why St. Jude Global Metrics and Performance Unit has developed a 360-degree modular self-assessment tool.

To help us better understand these issues, the Pediatric Oncology Facility Integrated Local Evaluation Tool (St. Jude PrOFILE) will:

• Reveal how childhood cancer care is delivered globally
• Transform our typical needs-assessment processes into priority-setting mechanisms
• Establish appropriate benchmarks

Eventually, this tool will be used globally through the SJCARES system.

To improve patient care and survival in low- and middle-income countries, the St. Jude Global Nursing Program promotes the implementation of pediatric hematology-oncology nursing standards at St. Jude member sites.

The St. Jude Global Nursing Program works to:

• Train pediatric oncology nurse educators through the Latin American Center for Pediatric Oncology Nursing Education. This center provides a four-week training curriculum for nurse educators working in pediatric oncology resource-limited settings. Trainees come to the center from hospitals in Mexico and Central and South America. Upon returning to their local hospitals, they develop an orientation program for newly hired nurses and a continuing education program. They also have regular meetings with St. Jude Global nursing staff. Before this program launched in 2008, no participating hospitals in Latin America offered formal orientation programs for pediatric oncology nurses. Today, over 25 hospitals offer or are developing such programs. This model was recently adapted and expanded to Southeast Asia. Additionally, St. Jude Global plans to expand this model to other St. Jude Global Alliance regions.
• Implement the pediatric oncology nurse educator role and hospital-based programs
• Support the Latin American Nurse Educator Network. An outcome of the multi-faceted, regional program in Chile is creation of a St. Jude Latin American Nurse Educator Network, which currently includes 35 active members from 30 centers in 14 countries and affects more than 1,000 nurses at any given point in time.
• Offer self-paced and instructor-led online training modules through Cure4Kids
• Promote standardized chemotherapy/biotherapy certificate education for nurses in Latin America in partnership with the Association of Pediatric Hematology/Oncology Nurses. St. Jude Global Nursing collaborates with the Association of Pediatric Hematology/Oncology Nurses (APHON) to implement standardized chemo/biotherapy certificate education in Latin America. From 2016 to 2019, more than 300 nurses in Mexico, Central America and South America have been trained through six courses. Work continues with APHON to optimize the process, develop a sustainable instructor network in Latin America and eventually take this initiative global.
• Provide nursing quality assessments and recommendations
• Coordinate multi-site quality improvement projects (e.g. positive patient identification with 15+ sites in Latin America)
• Promote baseline nursing standards for pediatric oncology in limited-resource settings through advocacy, dissemination and research related to the International Society of Pediatric Oncology (SIOP) Baseline Nursing Standards
• Create nursing partnerships and collaborations across St. Jude Global regions:
  • In March 2019, the St. Jude VIVA Asia Pacific Nursing Institute was launched. This is a collaborative initiative between St. Jude, VIVA Foundation for Children with Cancer, National University Hospital and KK Women & Children’s Hospital in Singapore to increase nursing education and capacity in Southeast Asia. The program consists of an onsite theoretical and didactic intensive in Singapore, with subsequent online support and mentoring of the nurse fellows’ implementation of quality and education projects within their local institutions.
  • The Euro Pediatric Hematology/Oncology Nursing Working Group was established in October 2018 at the 2nd Experts in Pediatric Cancer of C.I.S. Countries meeting. It operates under the umbrella of the Eurasian Alliance in Pediatric Oncology (EurADO). The working group facilitates collaboration, communication, sharing of best pediatric hematology/oncology nursing practices and education within and across C.I.S. countries. Nurse leaders from more than 10 countries comprise the group.
  • To promote scholarly inquiry, critical appraisal and evidence-based practice in Eastern Mediterranean institutions, a monthly online journal club was launched in February 2019 with members of the Pediatric Oncology in the Eastern Mediterranean (POEM) Nursing Working Group. More than 40 nurses from 10 countries are represented.
  • Additional projects are underway in countries such as Zambia, Zimbabwe, Morocco and Cambodia.

The Neuro-Oncology Unit of St. Jude Global works to improve diagnosis, treatment and research for children with cancers of the brain and spinal cord. Among other projects, leaders of this unit are building certificate-based courses to train clinicians worldwide in the care and treatment of children with these cancers.

Tailoring efforts to local needs and resources, St. Jude Global Pathology and Laboratory Medicine works with partner institutions to enhance clinical diagnostic laboratories and anatomic pathology services in low- and middle-income countries. These services are essential for the accurate diagnosis and treatment of pediatric cancers.

The approach is multi-faceted and comprehensive, including:

• Focused expertise through consultations based in the St. Jude Department of Pathology
• Ongoing support to develop services through regional educational activities and working groups
• On-site visits, with both targeted and comprehensive assessment of pathology and laboratory medicine services and quality, the development improvement plans, goals and priorities

Goals are to establish sustainable local diagnostic expertise and develop regional centers of excellence. These relationships are viewed as long-term partnerships to grow both local and regional capacity. Such relationships will also help to instill a culture of quality like that seen at St. Jude and other leading clinical and anatomic pathology laboratories.

The St. Jude Global Childhood Cancer Analytics Resource and Epidemiological Surveillance System (SJCARES) is an integrated solution to support evidence-based pediatric cancer care decision-making in low- and middle-income countries. This St. Jude-developed suite of toolkits can help institutions and governments continuously identify, target and monitor the vital health metrics that affect patient outcomes.

By using SJCARES, St. Jude Global Alliance sites can optimize the use of valuable resources. This will allow regional hospitals and research groups to collaborate, further improving the quality of childhood cancer care delivered worldwide.

SJCARES offers:

• Evidence-based tools
• Staff training
• Data quality support
• Regular reports
• Integrated data analysis
• Improved population-based registries
• Comparison to peer groups

Learn more about SJCARES >

In April 2018, St. Jude was officially established as the first World Health Organization Collaborating Centre for Childhood Cancer.

St. Jude will support the WHO by:

• Including childhood cancer in national cancer control plans through tools for prioritization, costs and framework for monitoring and evaluation
• Developing tools for health systems innovation diffusion and leadership engagement in childhood cancer management
• Strengthening childhood cancer control and management through technical support, as well as global and regional stakeholder engagement.

Obtain more information on WHO Collaborating Centres >

Researchers in the Disease Burden and Simulation Unit partner with collaborators at institutions around the world. Starting in 2018, St. Jude faculty joined with colleagues at the Institute for Health Metrics and Evaluation, an independent global health research center at the University of Washington, to quantify the burden of childhood cancer using multiple outcomes measures including mortality, morbidity and other indicators of disease burden. These data are critical for ongoing global pediatric cancer control efforts and will inform initiatives to improve health systems, direct public policy and enhance patient advocacy.

A hub for health care professionals focused on pediatric cancer, this resource offers providers a site to collaborate, connect and find the latest information on COVID-19 as it relates to childhood cancer. Health care professionals can access a collection of current resources and a pediatric cancer registry with real-time results. 

Find more information about the Global COVID-19 Observatory and Resource Center for Childhood Cancer