Levelling the Odds for Caribbean Children With Cancer

Surviving cancer, for many children, can come down to where they live. In several regions around the world, the risk of poor clinical outcomes for cancer and serious blood disease patients is determined by ongoing economic challenges, limited access to essential medicines and specialized diagnostic services, and not enough health care professionals with specialized training.

Although the survival rate for children living in Canada who have access to treatment at first-class facilities such as The Hospital for Sick Children (SickKids) in Toronto is more than 80%, survival rates for children in the Caribbean are much lower. Changing those odds was the impetus for the 2013 launch of the SickKids-Caribbean Initiative (SCI), a collaboration between SickKids Centre for Global Child Health, the University of the West Indies (UWI) and ministries of health and key hospitals and institutions in six English speaking Caribbean countries: The Bahamas, Barbados, Jamaica, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago, supported by SickKids Foundation.

The biggest way the program has made headway for the practitioners on the ground is in building out the capacity to make a difference for these children. The addition to the region of four Caribbean physicians newly trained in blood disorders and paediatric cancers and 42 nurses with specialized training goes a long way toward improving survival rates, says Dr. Michelle Reece-Mills, a Paediatrician/Paediatric Haematologist/Oncologist at University Hospital of the West Indies.

During her paediatric residency in Jamaica, Dr. Reece-Mills formed an emotional attachment to a leukemia patient who died one month after her transfer to Jamaica for care. That set the doctor on a journey that would see her undertake formal oncology and haematology training in Canada at the Children’s Hospital of Eastern Ontario in Ottawa and SickKids in Toronto starting in 2009.

“Generally, for the paediatric haematology community in the Caribbean you would only have one or two specialists at most on each of the relevant islands, so you often felt alone,” Dr. Reece-Mills said about her first years in practice. SCI has created significant bridges between the countries, she said, adding, “We’re more aware that we’re all facing similar challenges and we’re trying to solve this as a group.”

The seeds for SCI were planted when a Canadian whose son had leukemia and who frequently travels to Barbados asked her son’s paediatric haematologist/oncologist what her son’s chances of survival would be if he was living in the Caribbean. When Dr. Victor Blanchette, originally from Barbados, then Medical Director of the Paediatric Thrombosis and Hemostasis Program in the Division of Haematology/Oncology at SickKids, told her the numbers and outcomes were not tracked, she offered to help fund a needs assessment to determine whether SickKids could help make a difference.

SCI was set up with the goal of helping the region build sustainable, local capacity to diagnose, treat and manage paediatric cancers and blood disorders by providing education in specialized areas, developing local hospital-based paediatric oncology databases and establishing an integrated communications structure.

Building local capacity is important, and having a way for physicians to tap into SickKids’ diagnostic testing and expertise was also key. With Scotiabank’s help, SCI was able to build out seven Telemedicine hubs, which have facilitated more than 500 case consultations from all six partner countries. These case consultations empower Caribbean physicians to make timely and accurate diagnoses, plan appropriate treatment and adjust the plan when necessary.

“Scotiabank has been a tremendous leader in facilitating this program. It wouldn’t have happened without that kind of financial support,” Ted Garrard, Chief Executive Officer of SickKids Foundation, said.

Scotiabank’s commitment also supported the creation of local hospital-based paediatric oncology patient registries to track their outcomes and improve life-saving care for children with cancer. The data has revealed that, while the region’s childhood cancer incidence rate is similar to that of other countries in North America, the health outcomes are significantly poorer.

There have also been advancements in the diagnosis and treatment of sickle cell disease (SCD), an inherited disease more common in certain ethnic groups, including people of African descent. In Jamaica, SCD affects one in 200 children, with a high risk of severe illness and early death. Through SCI’s support, more than 90,000 babies have been tested in Jamaica and St. Lucia, with follow-up of those who test positive for the disease.

“We’re at the point where at all hospitals in Jamaica where children are being delivered, we can test for sickle cell disease. This outstanding achievement has been spearheaded by Professor Jennifer Knight-Madden and the group at CAIHR (Caribbean Institute of Health Research),” Dr. Reece-Mills affirmed.

Support for SCI has come from Canadian and Caribbean donations from both individuals and major corporations, to the tune of $8 million CAD for Phase 1, and $5 million CAD to date for Phase 2, which is set to run until March 31, 2022, with $1 million CAD coming from Scotiabank.

“We care about the communities in which we live and work. Through our support of SCI, we’re helping children with blood disorders such as leukemia and sickle cell disease in the region receive better health-care,” stated Stephen Bagnarol, Managing Director of Scotiabank Trinidad and Tobago and Senior Vice President and Head of the South and East Caribbean. “At Scotiabank, we are deeply committed to helping our young people lead fulfilling lives. Ensuring they are healthy and receive the best medical care forms part of this commitment.”

“It’s a great point of pride for the hospital, for the people who work there and for SickKids Foundation to be part of something that is truly saving lives that otherwise might not be saved,” Garrard said.

This initiative is one more collaboration in a longstanding relationship of trust between the region and Canada, Garrard added. “The Canadians who were involved in this initiative were doing this as a collaborative project, as opposed to taking over. At the end of the day we were able to help build capacity and feel really good about what we’ve been able to contribute,” he concluded.