PAEDIATRIC AND ADOLESCENT CANCER
108 CANCER CONTROL 2014
Table 1: The St Jude Twinning Program's "Critical Cs" for childhood cancer care in low- and middle-income countries
Critical "C" Components Content Constraints
Commitment by
HIC partner
Commitment by
LMIC partner
Community
advocacy and
fundraising in
LMIC
Collaborative
spirit
Communication
Core activities
Capital and
operational
budget
Continuity
1. Leader in HIC (willing to
devote time and effort to the
programme)
2. Institutional commitment
1. Leader in LMIC (willing to
devote time and effort to the
programme)
2. Institutional commitment
1. Non-profit, nongovernmental
foundation to
solely support childhood
cancer care
2. One cancer foundation per
geographic area
1. Respect
2. Trust
3. Humility
4. Collegiality
1. Effective
2. Comprehensive
3. Multimodal
1. Based on the needs
identified in the LIMC and
the capacity of the HIC to
address the needs
2. Data collection and
analysis must always be
included
1. The HIC should seek funding
to initiate and maintain the
twinning relationship for at
least 5 years
2. Increasing local fundraising
capacity should be
part of most twinning
programmes
3. Ultimately, alliance with
government is necessary to
scale up the programme
A long-term relationship is
essential, because the goal is
to develop a self-sustaining
programme
Lack of leadership in HIC
makes a twinning programme
unlikely to succeed
Lack of leadership in LMIC
makes a twinning programme
unlikely to succeed
If multiple foundations
develop in a single region,
their message is diluted and
their ability to raise money
and advocate are diminished
A focus on individual
accomplishments is less
helpful than a focus on the
shared mission to cure
patients with cancer
Absent or dishonest
communication makes a
twinning programme
impossible
Improvements in cancer
diagnosis, infection control,
protocol design, education,
nursing, and outcome
evaluation are all important;
these needs must be prioritized
by the twinning partners
Large expenditures on
advanced technology or
bench research should be
deferred until basic cancer
care is excellent
Short-term projects have
some value, but a long-term
relationship is necessary to
gain the benefits of twinning
A committed leader is necessary to define, develop,
initiate, implement and maintain the programme.
The leader facilitates intra- and inter-institutional
communication and engages the hospital to mobilize
resources (human, technical and financial)
A committed leader is necessary to define, develop,
initiate, and implement the programme. The leader
facilitates intra- and inter-institutional
communication and must engage the hospital and
community to mobilize resources (human, technical
and financial)
Members of the supporting foundation should
include influential members of society, professionals
and parents/relatives of patients
The foundation works with both government and the
medical team to effect change
Credibility of foundations established yearly by
independent auditing agencies
Twinning must be a culturally sensitive relationship
of equals who are willing to learn from one another.
In the best programmes, the association is beneficial
and enjoyable on both sides
1. Rapid, honest, in the same language
2. Addresses programmatic aspects (contracts,
financial matters, documentation of activities),
patient care (individual cases, supportive care,
protocols), continuing education and hospital
infrastructure
3. E-mail, on-line meetings, phone conversations,
exchange visits of key personnel
1. Goals and specific activities must be very well
defined in writing. Goals may change over time by
mutual agreement.
2. Documentation of causes of treatment failure and
death is essential to target interventions and
measure progress.
Funding is needed to support key salaries in the
LMIC (medical director, nurse educator, data
manger), to provide some equipment and supplies,
and to pay for exchange visits. Expenditures should
be specifically tied to desired outcomes, with a focus
on developing leaders and implementing simple,
effective methods to improve cure rates. About US$
100,000 per year plus the time of the HIC
participants is sufficient to develop a strong
demonstration project in a public hospital managing
about 200 annual new cases of childhood cancer
At least a 5-year plan should be developed at the
very beginning so that both partners can agree on
the goals of the twinning relationship and timing of
the included activities