Nickhill Bhakta, MD, MPH

We do not know how many children throughout the world develop, are diagnosed with, receive treatment for and ultimately survive childhood cancer. Many low- and middle-income countries lack reliable estimates for pediatric cancer, which leads to a fundamental limitation in data around global disease burden. This fundamental limitation in data contributes to the striking disparities in pediatric cancer survival rates around the world. The majority of my work focuses on this data limitation as I work with global groups to help regions strengthen their data collection and analysis capabilities. 

To better understand and improve estimates of the global burden of disease for childhood cancer and catastrophic blood diseases, I run our disease burden and simulation research unit within the Department of Global Pediatric Medicine. Our focus is on epidemiology, cost-effectiveness and decision analysis.

In addition to our methods work, my team also supports several large global collaborative programs with key global agencies and partners that generate global childhood cancer burden data. I am the St. Jude principal investigator for the Institute for Health Metrics and Evaluation (IHME) collaboration, a global program that provides annual global incidence, prevalence, mortality and morbidity estimates for many chronic conditions, including cancer. We also participate in collaborations such as the International Agency for Research on Cancer (IARC), in which we formed a collaborative working group focused on childhood cancer registration (ChildGICR), and the CONCORD Global Cancer Survival program.

The costs associated with providing childhood cancer care around the world deserves reliable examination and quantification. To contribute to this goal, I conduct health economics studies and tool development in topics such as health services delivery costs, cancer control planning budget impact analyses and other topics that have received little formal academic attention. The results of this work allow us to form policy action by translating results into budgets for childhood cancer services within national cancer control plans.

As we move forward, the ability to sustainably finance childhood cancer and catastrophic blood disorder interventions while tying these costs to outcomes and policy decisions continues to be a goal. Through the SJCARES registry and ARIA guidelines, we can help providers around the world integrate data and conduct chemotherapy forecasting estimates for procurement and budget planning purposes. The goal is that in coming years, we will be able to develop comprehensive forecasting tools and allow for data-driven cancer planning for the first time. 

To understand how the health of childhood cancer survivors progresses in the years after treatment completion, the field of epidemiology is focused on quantifying multimorbities. In collaboration with Yutaka Yasui, PhD, I developed a novel method in morbidity research called the cumulative burden metric. Using this metric, St. Jude was able to analyze and publish the most comprehensive characterizations of long-term health-related morbidities of childhood cancer survivors using the St. Jude LIFE study cohort. Our work also allowed us to implement this metric in evaluations of clinical protocols of childhood cancer therapy to determine temporal trends in multimorbidity. The success of these initial endeavors allows us to move forward with an expansion of this model and apply it to a non-malignant hematology cohort (SCCRIP).

As Director of the Sub-Saharan Africa regional program for St. Jude Global, I focus on developing country-specific, trust-based partnerships that enable our partners to establish scalable, quality pediatric cancer care in their respective countries. What started as a partnership in Zimbabwe has now expanded to countries throughout the region, which culminated in our first Sub-Saharan Africa regional meeting with 100 colleagues from 22 countries, held in 2023. Our work allows our partners to see across their country-level teams to collaboration opportunities throughout the region.

As Director of this region, many of my clinical research efforts revolve around implementation science topics. All our approaches focus on leveraging co-design models from inception, a robust method where my team collaboratively creates frameworks with our partners to advance a unified approach to global pediatric cancer care in their context. Using these co-design methods, we work closely with multilevel stakeholders from governments, healthcare providers and patient advocates to conduct national and regional prioritization activities, support organizational planning to facilitate local implementation and design health services and systems projects. We are also focused on capacity building by dissemination St. Jude Global led educational opportunities, support our Global Child Health MSc candidates and St. Jude Global Scholars, medical fellows and frontline healthcare workers in the region in implementation science methods with a special emphasis on childhood cancer control topics.

As my work in these areas progresses, my long-term goal is to integrate data streams and create a globally recognized data unit for childhood cancer disease burden. At the core of my work is a philosophy of partnership and co-creation with international partners to bolster the broader global health infrastructure.