Idealização Realização Chilean Pediatric Cancer Program Dr Myriam Campbell B. National Coordinator Dr Milena Villarroel PINDA Board
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