IdealizaçãoRealização

Chilean Pediatric Cancer Program

Dr Myriam Campbell B.National Coordinator

Dr Milena VillarroelPINDA Board

Creation of the NATIONAL SYSTEM of HEALTH. Law N°10.383 ; to takecare of and promote health of individuals, workers and their families.MINISTRY of Health steering and policymaking role. Programming,coordination and regulation of health activities and interventions.

Cancer 7th leading cause of

death

Development of private institutions for healthcare of their affiliates (ISAPRES)

Cancer 2nd

leading cause of

death

Chilean System of Health

NATIONAL CANCER COMMISSION was established with members of scientific societies, universities, public and private systems of health.

1952

1981

1986

Cancer 2nd

leading cause of

death

5 Hospitals create Chilean Pediatric Oncology Group GOPECH.Common treatment protocols

1978

1987 Strategies and General Guides for Cancer Control in Chile

1988. MINISTRY OF HEALTH launches the Program of Antineoplastic Drugs PANDA -PINDA

1988. Beneficiaries of the Public System of Health. National network. Initial budget U$ 500.000

Santiago (6)

Talca

TemucoValdivia

Concepción

Viña del Mar Valparaíso

Arica

Antofagasta

Copiapó

Punta Arenas

Puerto Montt

Osorno

PINDA NETWORK

11 Comprehensive centers4 Partial centers5 Satellite Centers to facilitate:

Coquimbo

Coyhaique

CHILEAN POPULATION

- 17 million inhabitants

- 3,5 million < 15 years

- 85% Public System of

Health

Referral centers:Radiotherapy (4)Lab:INM-ERM-CGNeurosurgery (7)BMTOsteosarcomaIntraocular RB

PINDA Protocols 1988

Leukemia and Lymphoma BFM

Germ Cell Tumor MAKEI

Neuroblastoma SIOP

Wilms Tumor NWTS III

Osteosarcoma St’Jude

Ewing sarcoma St’Jude

Soft Tissue Sarcoma IRS III

Hodgkin Lymphoma Chile (EORTC, Stanford)

Histiocytosis Chile-Soc. Int. Hist

Retinoblastoma Brasil (Pratt)

CHILEAN NATIONAL PEDIATRIC CANCER PROGRAM (PINDA)

• Provides treatment to all types of cancers, relapses, late effects, pain and palliative care.

• Several committees• improve quality of treatment

• best use of resources

• support for the patient and family during treatment.

• Trial Committees• Interdisciplinary

• Assessment and analysis of results

• Periodic report and publication of results

• New protocols

• Case Discussions

PINDA COMMITTEES

Infectious diseases Stem Cell Transplant

Pharmacy / Clinical Pharmacist

Pediatric Oncology Nurses

Surgery Pain and Palliative Care

Pathology Phsycosocial

Radiotherapy Education (Special School)

Stem Cell Transplant Late Effects of Treatment

A Bone Marrow Transplant Unit was developed in 1999. H Luis Calvo Mackenna.

A Bone Marrow Transplant Unit was developed in 1999. H Luis Calvo Mackenna.

Cancer 2nd leading cause of

death

Healthcare reform begins

Health Authority Act and Explicit Healthcare Guarantees System Act (GES) come into effectPediatric Cancer included in “ decreto Nº 170 , VII 2005”.

PINDA was selected for the pilot

2002

2002

2005

Chilean System of Health

Cancer 2nd leading cause of

death

Cancer 2nd leading cause of

death

Cancer National Registry developed in 2006.

Based on IARC e ICCC-3

0

125

250

375

500

nuevo recaida

200920102011201220132014201520162017

PINDA : New cases and relapses 2009-17

Average 470 new cases- 77 relapses

Pediatric Cancer Incidence = 14,8 cases x 100.000 < 15 years

Primary Healthcare: Information and Education

• When to suspect cancer and referral system

• Palliative Care

Commitment to Quality

www.minsal.uvirtual.cl

Cuando sospechar cáncer…..Aprendizaje autogestionado

2012

➢Referral from Primary Care

➢Ensured attention in PINDA center < 7 days

➢Diagnosis and Staging

From admission in PINDA center: Leukemias 7 days.

Solid Tumors 30 days

➢Treatment

➢Follow-up 10 yearsErice Statement: The long-term goal of the cure and care of the child with cancer is that

he/she become a resilient, fully functioning, autonomous adult with an optimal health-related

quality of life, accepted in the society at the same level of his/her age peers

Commitment to Opportunity

No waiting list

Haupt R et al : Long term survivors of childhood cancer: Cure and care European Journal of Cancer 1778-80,2007

14

Pediatric Cancer . Pag. 155 -214

FINANCIAL PROTECTION

Foundations and Social Volunteering

• Support to patients and their families

• Recreational activities

• Support to Oncology Units

• Support for Hospital Schools

• Research grants

Program of Antineoplastic Drugs

Comprehensive Pediatric Cancer

Program

Survival according to cancer typeRENCI 2007-2011

Death Rates from Pediatric Cancer

Rate per 100.000 < 15 yearsDEIS MINSAL, Depto. Cáncer

2015:

2,5x100.000

CHILEAN NATIONAL PEDIATRIC CANCER PROGRAM (PINDA)

Decade Treated %OS Cured1988 – 1997 3339 58 1937

1998 - 2007 4579 65 2976

2008 – 2017 4647 75 3485

TOTAL 12.565 8.398 pts

Over 8000 patients have been treated, with an impact on children

mortality due to cancer dropped from 4,8 x 100.000 in 1987 ,

to 2,5 x 100.000 in 2015.

National Cancer Program

➢ Reduce cancer related deaths

- Prioritized interventions of proven efficacy

- Functional and dynamic network

- From health promotion to palliative care

➢ Ensure equity, resolution and satisfaction

- Impact indicators

- Periodic evaluations

National Cancer Program

➢ Cooperative, interdisciplinary and comprehensive

cancer program that gives an adequate treatment to

children of the whole country.

- Periodic assesments, compliance with protocol

guidelines and regulatory issues

➢ Provide high-quality treatment with focus on the

physical, psychological, and emotional well-being of

children and adolescents

Obrigada