St. Jude Global: Where We Are

A diverse part of the world spanning a large geographical area, the Asia Pacific region encompasses nearly half of the known global burden of childhood cancer. St. Jude Global’s work regionally is detailed below for two countries, along with an overview of the extended engagement across more than 15 countries in the region.

Philippines

• A partnership with Southern Philippines Medical Center in Davao in 2006 supported the expansion of care for children with cancer from four beds shared with other services to a 25-bed Children’s Cancer and Blood Diseases unit in 2011. This partnership demonstrated the value of dedicated pediatric oncology providers, including trained nurses. Collaborative efforts supported locally have since led to a new Children’s Cancer Institute inaugurated in 2016 with a full complement of multidisciplinary staff dedicated to the care of children with cancer. An active regional network has been created on the island of Mindanao to facilitate timely diagnosis and referrals.
• More recently, St. Jude Global partnered with the University of Philippines-Philippine General Hospital in Manila. Initiatives to date include the formalization of embedded roles for pediatric oncology nursing education and palliative care; establishment of quality improvement processes in blood bank safety, pathology, infection prevention and care; development of a regional referral model for retinoblastoma care; and analyses to address preventable treatment failure.
• Building on these and other relationships, St. Jude co-hosted the country’s first National Childhood Cancer Control Workshop in August 2017 with the national Pediatric Oncology Society and the Philippines Department of Health. Diverse stakeholders throughout the country met for two days to define the situation and opportunities for childhood cancer care and to establish a national collaborative action plan considering needs across the health system.

Myanmar

• With approximately 2,000 new cases of childhood cancer anticipated per year, only two primary hospitals have dedicated units for children with cancer: Yangon Children’s Hospital and the 300-bed Mandalay Children’s Hospital. St. Jude Global, along with other regional and international organizations, have supported the local leaders and the Myanmar Ministry of Health and Sports to establish a national program to strengthen childhood cancer capacity. At the invitation of the World Health Organization (WHO) and local leaders, since 2016, St. Jude has helped to coordinate a global collaboration of stakeholders including government, civil society, academic and hospital leaders together with international partners, including co-organization of the first and second national workshops on the childhood cancer control program in Myanmar in May 2016 and May 2019.
• The number of children diagnosed in Myanmar each year has increased by more than 50% since 2013. St. Jude Global has supported the creation, mapping and structured collaborative assessments of the first organized national referral network for children with cancer. Formally approved by the Ministry of Health and Sports to involve the two dedicated units alongside 17 divisional and state hospitals as community network sites and three as shared care network sites, the new national network has engaged more than 35 clinicians and nurses since 2018, and facilitated the referral of more than 100 patients to the dedicated units. To guide progress, St. Jude Global meets regularly with local and international stakeholders, including hospital leaders, the Ministry of Health and Sports, and WHO partners.

Other programs

• In addition, St. Jude Global works closely with leaders in Cambodia, with collaborative efforts to date including co-hosting a national childhood cancer stakeholder meeting in March 2018, enabling additional specialty training for the first pediatric radiation oncologist in the country, and continuing technical support for the National Cancer Center to develop a pediatric oncology nurse educator program. St. Jude Global also has led stakeholder mapping and strategic planning activities to improve childhood cancer care with partners in Sri Lanka and Indonesia. 
• In addition to institutional and national programs, St. Jude Global coordinates regional opportunities that extend our reach to more than 40 institutions across more than 15 countries. Sample initiatives include online educational and case-based multidisciplinary meetings with resource sharing via Cure4Kids, as well as supported onsite specialty training regionally and internationally for young investigators, clinicians and program leaders. Recurring online meetings coordinated by St. Jude Global include the St. Jude-VIVA Asia Pacific Tumor Board, and the St. Jude Leukemia Lymphoma Hour with more than 240 regional cases discussed and associated resources identified and shared. More than 30 multidisciplinary providers in the region have been supported to attend short- and long-term international training in the past three years.
• St. Jude Global is also partnering with key institutions in Singapore including the VIVA Foundation, National University Health System and KK Women’s and Children’s Hospital to continually improve the treatment and research of childhood cancers, and the training of pediatric oncologists in Asia and beyond. Collaborative initiatives include an annual meeting in Singapore, the St. Jude–VIVA Forum. This scientific forum helps global experts and local providers exchange information and resources on best practices, alongside an annual pre-forum dedicated to low- and middle-income country needs and working group meetings to advance regional research and multidisciplinary practice. In recent years, St. Jude Global also has co-sponsored and co-organized specialty training symposia on retinoblastoma (2017) and pediatric cancer pathology (2018) and pediatric cancer surgery (2019). These meetings connected providers across institutions and countries to facilitate practice improvements and continuing collaborations. St. Jude Global helps facilitate access to this educational and networking opportunity for participants from institutions and countries throughout the Asia Pacific region, involving a core of more than 35 institutions and 11 countries.

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).

Brazil

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.

Chile

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.

Nursing:

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)

St. Jude Global’s work in China is a testament to partnerships formed by St. Jude through the decades.

Each year, about 50,000 children are diagnosed with cancer in China, about 12,000 of whom have acute lymphoblastic leukemia (ALL). Prior to 2010, fewer than 30% of children with cancer received treatment because individual families were required to shoulder the financial burden of therapy. But thanks to the collaboration between St. Jude and local partners in China, the number of children receiving cancer treatment has skyrocketed.

A few of the achievements in this region include:

• In 1991, St Jude partnered with Shanghai Children’s Medical Center and Beijing Children’s Hospital to train physicians and nurses to treat children with ALL, and to improve their diagnostic capability.
• In 2005, St. Jude worked with Partner in Hope Foundation (Hong Kong) to raise funding to treat underprivileged children with ALL. To treat these patients, St. Jude designed an effective and cost-efficient clinical trial jointly with Shanghai Children’s Medical Center and Beijing Children’s Hospital.
• This effort was a success, with 86% of more than 153 patients treated remaining in continuous remission. This excellent result with affordable cost was published in an international journal and attracted the attention of the Chinese Ministry of Health. As a result, childhood ALL was selected as one of the first three diseases covered by the New Rural Cooperative Medical Care Scheme in 2010, in which central and local government provide health insurance to citizens with catastrophic diseases. To provide optimal treatment to many patients, St. Jude worked with Shanghai Children’s Medical Center to establish the China National Childhood ALL Study Group, supported by VIVA China Children’s Cancer Foundation. Since 2015, more than 6,000 patients with ALL have enrolled in the national clinical trial in 20 major hospitals and medical centers covering 65% of Chinese population.
• In 2017, the Chinese government approved the creation of the first National Children’s Medical Center, which St. Jude proposed. Shanghai Children’s Medical Center and St. Jude are developing a framework for cancer treatment, training and research for the center.
• In 2018, the Pediatric Leukemia Cancer Registry, the first comprehensive national cancer registry in China was initiated to collect data on demographics, disease subtypes and treatment outcomes for all children with newly diagnosed leukemia prospectively and retrospectively back to 2015.
• To further strengthen research on childhood cancer and blood diseases in China, St. Jude Global staff are forming partnerships with two other outstanding institutions in China: Guangzhou Women’s and Children’s Medical Center, and Tianjin Institute of Hematology and Blood Diseases Hospital.

The St. Jude Global Eastern Mediterranean Regional Program aims to increase access to quality care for children with cancer and blood disorders by supporting the creation of partnerships and cooperative regional networks of health care providers, to build capacity, strengthen educational and research programs, and reinforce advocacy and resource mobilization in the region.

The St. Jude Global Eastern Mediterranean Regional Program began more than two decades ago with the former twinning model, focused on four partner sites in three countries: Lebanon (Beirut), Jordan (Amman), and Morocco (Casablanca and Rabat). In the ensuing years, St. Jude has collaborated with more than 80 institutions in 28 countries across the region, helping develop national programs, unified standard of care protocols and cancer networks. In recent years, St. Jude Global has adopted a tiered model to expand the reach in the region through strategic planning of collaborative workshops and developing structured working groups at the regional, country and hospital levels. The Eastern Mediterranean program offers a platform for collaboration to key stakeholders such as local leaders, government and hospital administrators, and international organizations.

Pediatric Oncology East and Mediterranean Group (POEM)

The Pediatric Oncology East and Mediterranean Group (POEM) was established in 2013. The mission of POEM is to continuously improve pediatric oncology care, research, training and advocacy in the East and Mediterranean region by means of integrated teamwork. This network of physicians, scientists and health care professionals is spread across more than 80 childhood cancer centers in the Middle East, northern Africa and southern Asia. The network includes sites in Algeria, Armenia, Bahrain, Bangladesh, Egypt, Georgia, India, Iraq, Iran, Jordan, Kuwait, Lebanon, Libya, Morocco, Nepal, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Sudan, Syria, Tunisia, Turkey, the United Arab Emirates and Yemen. Twenty-two POEM centers in 12 countries have joined the St. Jude Global Alliance since March 2019.

National Programs

The regional approach is crucial in building a collaborative global network. The Eastern Mediterranean program is focused on building strong national programs in select regional countries and bringing all key stakeholders together to work toward improving access to quality care to all children with cancer within the country. This effort so far includes engagements in Morocco, Pakistan and Palestine.

Cancer care for displaced children

Relationships with partner institutions in Lebanon and Jordan set the foundation for a strong network to ensure a continuation of care for children with cancer who are displaced. The war in Syria resulted in a large refugee and displacement crisis in the region, with Lebanon holding the highest number of refugees per capita followed by Jordan. A humanitarian fund has assisted in the care of displaced children with cancer in the region. In addition, St. Jude Global has provided guidance and oversight in budgeting, prioritization and allocation of resources to save the maximum number of lives with available funds. In parallel to the response to assist displaced children in Lebanon and Jordan, the Eastern Mediterranean program initiated a long-term plan to support a capacity building program in Syria aimed at preparing for the return of displaced children.

In Mexico, 5,000 to 6,000 children through age 18 are diagnosed with cancer each year. About 60 pediatric hematology-oncology units are accredited by the government-sponsored health insurance program. These units are spread throughout the 32 established, federated states. The first capacity-building partnership in Mexico was established in 1999 with the Hospital Pediátrico de Sinaloa in Culiacán, followed by Hospital Civil de Guadalajara in 2001 and Hospital Pediátrico de Tijuana in 2007.

During the last two years, the Mexico program has increased significantly. With the development of a broader and more comprehensive regional initiative, the three-institution program has expanded into a network of 11 institutions.

Through strategic planning meetings and workshops, the group set the following priorities and areas of work:

• Collaboration: Integrate more than 10 pediatric disciplines in this multidisciplinary group. The group includes more than 100 health care professionals from 11 pediatric oncology units.
• Modernization: Standardize and modernize the diagnosis of acute lymphoblastic leukemia through a clinical trial that features risk-adaptation with minimal residual disease evaluation.
• Quality improvement: Implement quality improvement initiatives for a broad range of topics, from cancer treatment delivery to supportive care.
• Evidence-based interventions: Develop a clinical and epidemiological research platform in pediatric oncology to help generate evidence-based interventions.

The goal of the Mexico region is to increase the survival of children in that country from a baseline of less than 50% to greater than 75% in the near future.

Nearly of a quarter of the world’s children ages 0–14 live in Sub-Saharan Africa, one of the world’s most resource-limited settings. Through a new regional program within St. Jude Global, local physicians and leaders of existing partnerships in high-income counties have been engaged to develop mutually beneficial collaborations and build a regional alliance. Initial efforts involve countries such as Zimbabwe. In that country, work has started to improve the quality of care for both childhood cancer and life-threatening blood diseases such as sickle cell disease.