Virginia McKay, a research assistant professor at the Brown School at Washington University in St. Louis, is leading a five-year $3.5 million project to test whether an effort to improve cancer treatment for children in Latin America is sustainable over the long term.
A partnership with St. Jude Children's Research Hospital in Memphis, Tenn., the new research is a massive expansion of a pilot project funded by a grant from the National Cancer Institute, part of the National Institutes of Health (NIH), for early-career investigators. The funding is split between McKay and Asya Agulnik, MD, an associate member of the St. Jude faculty and director of the global critical care program at St. Jude Global. At the end of five years, the project will be eligible for two additional years of funding.
"This grant is an exciting opportunity to develop strategies to sustain a system that works to improve cancer treatment for children and reduce disparities in childhood cancer outcomes around the world," McKay said.
Children who develop cancer in low-resource settings are far less likely to survive than those in wealthier nations. In the U.S., for example, over 80% of children with cancer survive, compared to only 20% in low- or middle-income countries due to a lack of access to cancer treatment and resources for supportive care.
McKay's research will examine hospitals that use a Pediatric Early Warning System (PEWS) for detecting complications during treatment for child cancer patients in Central America and South America. This system, which is designed to detect when a patient is deteriorating as a result of their cancer treatment, is being implemented in over 80 hospitals in 20 countries that treat over 8,000 new cancer cases each year among children and adolescents.
A recently published study by McKay and Agulnik in the journal Cancer concluded that the early-warning system in Latin American hospitals was a success and could point the way to improve its use in low-income countries. This new study is looking at whether that success can be extended long term.
In addition to McKay and Agulnik, faculty on the project include Douglas Luke, the Irving Louis Horowitz Professor in Social Policy and director of the Center for Public Health Systems Science at the Brown School; and Sara Malone, an instructor of surgery at the Washington University School of Medicine in St. Louis. McKay said staff and students at the Brown School also will be part of the research team.
Sustainability is especially important in low- and middle-income countries because the initial investment is expensive.
"You have to make judicious decisions about how to use limited resources, or you risk causing even greater harm," McKay said.
The team will also conduct a series of focus groups with doctors, nurses and hospital administrators to identify ways to improve the system's lasting power. The additional two years of funding will be used to test those strategies in hospitals.
"We're going to be following hospitals over the next five years to see if they're able to sustain PEWS and determine what factors are influencing that," McKay said. "We'll also be developing strategies to support better cost-effective sustainability. Following hospitals will tell us a lot about whether they can keep PEWS in place over time."
