PAEDIATRIC AND ADOLESCENT CANCER
110 CANCER CONTROL 2014
treatment of childhood cancer. The NGOs are also an
important vehicle for community education and fundraising
for additional services, such as bone marrow transplantation,
clinical investigation, and continuing education of clinicians.
The key leaders of the local NGOs are trained by ALSAC, the
St Jude fundraising organization. Importantly, all funds raised
in partner countries are used within that country.
Some key members of the partner-site multidisciplinary
teams receive salary supplementation from the NGOs to
allow them to work full-time in the paediatric oncology unit.
Although the amount varies among the different partner
sites, annual salary supplementation is commensurate to the
salaries of the physicians working in paediatric
haematology/oncology that combine academic and private
activities. This strategy aims to retain these individuals in the
public hospitals, which serve large patient populations and
have insufficient personnel, medications, and infrastructure.
The St Jude IOP twinning programmes have demonstrated
that it is feasible and affordable to rapidly improve the cure
rates of children with cancer in countries with limited
resources and to improve their access to care in public
hospitals. The major challenge is to scale up the quantity and
quality of care and services for partner sites and countries in
the region. Recently, St Jude IOP has initiated an innovative
model in an effort to help partner sites expand their local
programmes in a regionally oriented fashion. In this new
model, a St Jude international partner site will be equipped to
provide most of the services required in paediatric oncology
including diagnosis, supportive care and training
opportunities. After reaching this status, the centre (Hub) will
be able to provide assistance to other centres that exist both
within the country and regionally (Spokes). This Hub-Spoke
model has not been tried before in health care. We hope to
see paediatric international oncology become an academic
discipline within paediatric and medical oncology, with the
goal of creating models to implement existent knowledge in
countries with limited resources to avoid unnecessary death
and suffering caused by childhood cancer. l
This work was supported in part by a Cancer Center Support
Grant (CA21765) from the National Institutes of Health and by
the American Lebanese Syrian Associated Charities (ALSAC).
Dr Raul C Ribeiro, MD, works at the Department of Oncology at
St Jude Children's Research Hospital, Memphis, TN, USA and at
the Department of Pediatrics, University of Tennessee Health
Science Center, Memphis, TN, USA.
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