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Cancer clinic space
Garron Family Cancer Centre

PERCC Projects

Selected Current Projects

The cost-effectiveness of childhood cancer treatment units in Sub-Saharan Africa

Childhood cancer accounts for a rising proportion of childhood mortality. Cure rates for childhood cancer have dramatically increased in high-income countries with the survival rate reaching more than 80 per cent. However, similar outcomes for children diagnosed with cancer in low and middle income countries (LMIC) are far inferior. One of the main reasons for this limitation is lack of national policies on childhood cancer treatment in LMIC.
PERCC was awarded funding to study the cost-effectiveness of childhood cancer treatment in Sub-Saharan Africa. The objective of the study was to determine the cost and cost-effectiveness associated with delivering childhood cancer treatment in a diverse range of established Sub-Saharan African LMIC treatment units.

Representatives from Kenya, Tanzania, Zimbabwe and Nigeria met at a preliminary meeting, funded by CIHR, on March 6, 2019 in Cairo, Egypt. The team discussed data collection tool and timelines for the study. Data collection commenced in May 2019 in four main sites in Kenya, Tanzania, Zimbabwe and Nigeria.

Drug access initiative (ACCESS) and specific projects in East Africa

A major barrier to effective care of children with cancer in Low and Middle Income Countries (LMIC) is lack of timely access to essential medicine.  Access to Childhood Cancer Essentials (ACCESS) is a global initiative established in 2018 through the efforts of PERCC and others. Its mission is to create and implement innovative solutions to childhood cancer drug and radiotherapy access in LMIC.

In collaboration with the American Childhood Cancer Organization (USA) and the Centre for Global Child Health, ACCESS is working with key health system stakeholders across East Africa (Ethiopia, Kenya, Rwanda, Tanzania, and Uganda) to improve availability, accessibility and acceptability of essential medicines required to treat childhood cancer.

Over the next two years, the ACCESS core team, in collaboration with site leads from Ethiopia, Kenya, Rwanda, Tanzania and Uganda, will be mapping and analyzing the determinants of paediatric drug access in East Africa, with specific attention to political, macro-economic and health system contexts.

The ultimate aim of this work is to inform policy and programming for enhanced harmonization of care, and to prompt opportunities for coordinated procurement of childhood cancer drugs across the region.

For more details on this project, please refer to the ACCESS website.

Drug Access initiative in the Caribbean

A lack of evidence on drug access in many Low and Middle Income Countries (LMIC) is a key barrier to national and international efforts to reliably and efficiently obtain childhood cancer drugs and ensure they reach the population in need. The SickKids Caribbean Initiative (SCI) was formed in 2013 as a partnership between PERCC and the University of the West Indies, and seven hospitals in six English Speaking Caribbean (ESC) countries.
A joint initiative between PERCC and the SCI aims to bridge the existing knowledge gap on drug access in the Caribbean by accomplishing the following:
1. Pilot data collection instruments to obtain key metrics of drug availability and price
2. Describe policies and practices related to drug procurement and provision in select Caribbean countries
3. Analyze the key determinants of childhood cancer drug access in health system context in these jurisdictions
Key stakeholders have been identified in Bahamas, Barbados, Jamaica, and Trinidad & Tobago. These include healthcare providers, policymakers & civil servants, civil society organizations and representatives from pharmaceutical companies. 37 key informant interviews have been conducted and transcribed. The results of these findings were shared with the study team at the SCI annual work planning meeting in Barbados in September 2019.  
Quantitative data collection and analysis is in progress.

Partnership with World Child Cancer UK

This multi-site project, supported by the Optimus Foundation, aims to improve childhood cancer treatment outcomes in Sub-Saharan Africa through establishing Centres of Excellence for paediatric oncology in Ghana, building on a long-standing partnership between World Child Cancer UK and the Ghanaian pediatric oncology community.
PERCC is contributing to the project in several ways, including:
1. Improving the design and delivery of Early Warning Signs and Symptoms training
2. Studying the determinants of drug access
3. Improving the collection of data on patient outcomes to inform new initiatives to improve care

Lancet Oncology Commission

The Lancet Oncology Commission on Sustainable Paediatric Cancer Care is a joint partnership between PERCC, St. Jude Children’s Research and Hospital and the Harvard T.H. Chan School of Public Health. The Commission will undertake a comprehensive analysis to develop an investment case for funding management and control of childhood cancer. Cancer kills more than 100,000 children each year, and yet 80% of paediatric cancers are treatable with currently available interventions. Notably, the majority of these deaths occur in low-to-middle-income countries (LMIC) where children have poor access to health services. It is crucial that as countries transition to universal health care, childhood cancers are recognised as a priority for inclusion in benefits packages. Yet no reliable data are available in LMIC on current and future burden of childhood cancer; on cost of effective interventions; on current coverage levels for diagnostic, treatment, and care services; or on the cost, feasibility, or health and economic benefits of scaling-up effective coverage. There is an imperative for a comprehensive study to develop an investment framework to establish an evidence-based case for investing in effective interventions to address childhood cancer.
Learn more about this project.

Selected Past Projects

Uganda: Burkitt Project

 PERCC has partnered with an international team of collaborators at the Uganda Cancer Institute in Kampala, Uganda, and the Fred Hutchinson Cancer Research Center in Seattle, Washington, to evaluate a comprehensive treatment program for childhood Burkitt lymphoma. PERCC is leading the economic evaluation of the program, which will provide some of the first detailed data on the cost-effectiveness of treating pediatric cancer in a low-income country setting. Results of this work will aid both institutional and national priority setting, and will contribute policy-relevant knowledge on childhood cancer treatment in diverse health system contexts.  

Chile

One of the outputs of our successful Forum on National Childhood Cancer Strategies in Latin America in 2015 is a collaboration between PERCC, the Union for the International Control of Cancer, Childhood Cancer International, and the Foundation Nuestros Hijos in Chile to conduct a mapping exercise of how childhood cancer is delivered, financed, and governed across Latin America. This will allow successful models to be showcased, and provide a baseline informing future childhood cancer policy efforts across the region.