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ASCO Educational Book; 2009
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Sustainable Improvement of Pediatric Cancer Care in Low- and Middle-income Countries: The Experience of the St. Jude International Outreach Program

Raul C. Ribeiro, MD, and Scott C. Howard, MD

From the Department of Oncology and International Outreach Program, St. Jude Children's Research Hospital, and the Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN

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).

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Raul C. Ribeiro, MD, Department of Oncology and International Outreach Program, St. Jude Children's Research Hospital, 262 St. Jude Pl, Memphis TN 38105-2794; e-mail: raul.ribeiro{at}stjude.org

Overview: The 5-year survival rate for childhood cancer is approaching 80% in high-income countries. However, only approximately 20% of children with cancer benefit from this progress. For the remaining 80%, who reside in low- and middle-income (LMI) countries, the survival rate is estimated to be only 20%. Therefore, childhood cancer is becoming a leading cause of death among children aged 1 to 14 in LMI countries as mortality from communicable diseases falls, but pediatric cancer care remains largely unavailable. The St. Jude International Outreach Program (IOP) was created to improve the survival of children with cancer in LMI by sharing knowledge, technology, and organizational skills. We use the "twinning" model of mentoring, evaluation, consultation, and collaborative research to accomplish this mission. A twinning program is defined as a close, long-term relationship between a center in a LMI country and one in a developed country. The main goals of our twinning projects are to improve cure rates of childhood cancer, improve access to care, and demonstrate to local communities that progress in cancer care is both necessary and feasible. The first step is the implementation of pediatric oncology units in public pediatric hospitals in the selected countries. In this report, we describe the rationale, methods, and outcome of the St. Jude twinning programs.