More than 80 percent of the world's children live in resource-poor countries where the cure rate for ALL is usually 35 percent or less, according to Raul C. Ribeiro, M.D., director of the St. Jude International Outreach Program and senior author of the JAMA article.
The increase in the cure rate for ALL in Recife, from 32 percent to 63 percent, falls short of the current 80 percent cure rate in the U.S. and Europe. However, the cure-rate increase occurred in a relatively short time span compared to the rate of improvement in the U.S. and Europe over the past 40 years.
"This rapid rate of improvement demonstrates that the most advanced treatments for ALL can be used successfully in a community that lacks a major medical institution, and whose patients are generally from poor families with limited ability to travel to health care facilities," Ribeiro said.
The St. Jude investigators reviewed the outcomes of 375 children (age 0.1 to 17.2 years) with ALL diagnosed between 1980 and 2002. ALL was diagnosed in 83 children during the early period of the study (1980-1989). At that time Recife lacked a dedicated pediatric oncology unit. The site also had no protocol-based therapy, specially trained nurses, 24-hour on-site physician coverage or adequate access to intensive care. In the middle period (1994-1997), 78 children were treated according to the most advanced St. Jude treatment protocol then available (Total XI). These children were cared for in the general hospital wards by nurses who had no specialized training in oncology. The 214 children who were treated during the recent period (1997-2002), benefited from a more advanced St. Jude protocol (Total XIIIB) in a dedicated pediatric oncology unit staffed around the clock by pediatric oncologists and oncology nurses.
The improvements were brought about by transfer of technology from St. Jude and by establishing a new, non-profit foundation supported by the private sector to support children with cancer. The foundation, called the Núcleo de Apoio à Criança com Câncer (NACC, The Childhood Cancer Support Center) raises funds from the private sector to assist families with a variety of needs, such as lodging, transportation and medical costs not covered by the hospital.
The NACC also operates parent support groups and tracks patients so they can be contacted within 24 hours of missing a clinic visit.
"The NACC helped to reduce the possibility of parents missing their child's treatment appointment or abandoning the treatment entirely," said Scott Howard, M.D., M.S., director of clinical trials for the International Outreach Program. Howard is first author of the JAMA paper.
"The rate of abandonment during the first year of treatment dropped from 18 percent in the early period to less than 1 percent in the recent period," said Francisco Pedrosa, M.D., director of the oncology unit in Recife. "Now we are even able to offer parents who come from distant areas the opportunity to earn money by making handcrafts and baked goods so their families can survive while they are unable to work at home. Everyone collaborates for the good of the children and families in need."
Ching-Hon Pui, M.D., director of the St. Jude Leukemia/Lymphoma division and the F.M. Kirby Clinical Research Professor for the American Cancer Society, said the research may have far-reaching implications.
"The most important lesson from this experience is that given the right support and training, even resource-poor communities can benefit from St. Jude protocols designed to increase survival of children with ALL," Pui said.
Other authors of the report are Marcia Pedrosa, Mecneide Lins and Arli Pedrosa (Instituto Materno Infantil de Pernambuco, Recife, Brazil).
St. Jude Children's Research Hospital
St. Jude Children's Research Hospital is internationally recognized for its pioneering work in finding cures and saving children with cancer and other catastrophic diseases. Founded by late entertainer Danny Thomas and based in Memphis, TN, St. Jude freely shares its discoveries with scientific and medical communities around the world. No family ever pays for treatments not covered by insurance, and families without insurance are never asked to pay. St. Jude is financially supported by ALSAC, its fund-raising organization. For more information, please visit www.stjude.org.
Journal
JAMA