St. Jude doctors successfully develop early warning systems to help kids with cancer in Latin America 

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Image: Dr. Federico Antillon, seen here with a patient in Guatemala, worked with doctors and researchers in the St. Jude Department of Global Pediatric Medicine to implement the Pediatric Early Warning Systems that helped save more kids' lives in his country. 

Over the last 25 years, the progress Dr. Federico Antillon has seen for kids with cancer in Guatemala has been so promising it brings him to tears. 

“It’s been an amazing journey, we’ve come a long way,” Antillon said. 

He has seen survival rates for children with cancer in his native country improve from roughly 20 percent to more than 40 percent and even 60 percent in some types of cancers. 

After completing fellowship training at St. Jude Children’s Research Hospital in 2003, Antillon laid the groundwork for a non-profit foundation that helped with fundraising and awareness, AYUVI, so families of kids with cancer could better afford and access the care they needed to save lives. He also helped establish his country’s first dedicated pediatric cancer hospital, Unidad Nacional de Oncología Pediátrica (UNOP). 

But even as that progress continued, Antillon and his colleagues faced a tough reality: They were losing half of their pediatric cancer patients because the cancer treatment itself was so toxic. 

These were preventable deaths, Antillon said. If doctors and nurses could identify early signs of distress in patients and then more effectively administer the support necessary – intravenous antibiotics, oxygen, fluids – those kids could be saved.   

In 2013,  Antillon worked with Dr. Asya Agulnik, MD, MPH, who now directs the St. Jude Global Critical Care Program, to implement a system in Guatemala that not only monitored and identified patients who were critically ill, but also quickly offered support to improve their health. 

It worked so well that it caught kids before they became critically ill so that more of them survived treatment. It resulted in less burden on the hospital’s intensive care resources and even improved fatigue and stress experienced by healthcare providers.  

The promising progress in Guatemala spurred Agulnik to work with doctors and nurses in other hospitals across Latin America. They implemented Pediatric Early Warning Systems (PEWS) in 32 hospitals in 11 countries showing that the intervention saves lives — often in the hospitals with the greatest need. 

“We see this as a real call for the need to scale PEWS globally,” said Agulnik, who is working with a team to more rapidly scale implementation in Brazil, as well as countries in Africa and Asia.  

Agulnik’s research, which was published in Lancet Oncology in 2023, is at the heart of the work St. Jude is doing to accelerate progress in treatment and care for children with cancer around the world. 

As part of its six-year, $12.9 billion strategic plan, St. Jude aims to improve cure rates for pediatric cancer and catastrophic diseases worldwide through St. Jude Global and the Global Alliance.

The ultimate goal of her team’s work, Agulnik said, is to erase disparities in outcomes of childhood cancer globally. 

“In resource-limited settings, children with cancer have worse outcomes and higher treatment-related mortality, often because supportive care systems and hospital systems in place to care for critically ill children are much less developed,” Agulnik said. “This means PEWS are usually not used in the settings where potentially they’re the most needed.”

In the research published, Agulnik and her team compared outcomes from 32 centers that implemented the early warning systems between April 2017 and May 2021, examining how well children with cancer fared before and after PEWS implementation.

The warning systems tested in these hospitals are a scoring tool, with a set of evaluations tied to an action algorithm that guides the clinical team on what to do to help a child with cancer who is in distress. Bedside nurses apply the algorithm based on vital signs, the symptoms the patient is experiencing and whether there are signs of crisis, like infection. If the patient is not doing well, the early warning system flags the patient for increased frequency of monitoring and a physician evaluation to decide the needed interventions. 

“These systems are essential for caring for children with cancer, who experience more frequent deterioration, and are more likely to develop a critical illness, have serious consequences, or die,” Agulnik said.

Agulnik and her research team found 18 percent fewer instances of children dying from life-threatening side effects in the 32 centers across Latin America once the early warning systems were implemented. They found fewer cardiac arrests outside of the ICU, and patients with deterioration were identified and transferred to a higher level of care before their illness became severe. 

“This intervention should be used in the care of every single child with cancer who is hospitalized. Everywhere,” she said.