Doctors, researchers and policy makers from around the world are in Seattle this week for a symposium on global cancer issues at the Fred Hutchinson Cancer Research Center.
Recent media attention on the disease, including a three-part Ken Burns public television documentary based on Siddhartha Mukherjee’s book, “The Emperor of All Maladies,” has focused mostly on advanced cancer treatment in the U.S.
The meeting at the Hutch, though, is about an emerging topic — the idea that cancer is not just a disease that occurs in rich countries, and that prevention, diagnosis and treatment can and should be provided in low- and middle-income countries.
You can see those ideas at work in the life of one of the attendees, Dr. Federico Antillón. Antillón is a Guatemalan pediatric hematologist/oncologist who trained in Spain and at St. Jude Children’s Research Hospital in the US in the 1990s. He learned that many pediatric cancers are survivable with proper treatment. But when he returned to Guatemala in 1997, he found himself without most of the tools he needed to treat cancer. “We didn’t have chemotherapy,” he says.
At that time, most Guatemalans saw cancer as a death sentence – even doctors. “When a patient with cancer got sick and had to go to the ICU, they said, ‘Why should we spend resources on someone who’s not going to make it?’” says Antillón. The ICU doctors would turn down his patient and take an asthma patient instead.
Many studies have shown that cancer survival depends on where you live. Antillón wanted to improve the odds in Guatemala.
What started things off was a big donation from the head of Pollo Campero, a Guatemalan fried-chicken franchise with global outlets. The local division of Pepsi, a national bank and a cellphone company followed suit. Today the companies sponsor a lottery that brings $5 million a year to the Fundación Ayúdame a Vivir (The Help Me To Live Foundation) for pediatric cancer patients at Unidad Nacional de Oncología Pediátrica in Guatemala City. And the Guatemalan Ministry of Health and Social Welfare came through.
With resources now available, doctors began to see that cancer care could be successful in Guatemala. Antillón’s biggest challenge was convincing patients and families. He studied the charts of children who had gotten cancer diagnoses and found that 42 percent abandoned treatment because it was difficult for parents to support their children in the hospital. Parents also didn’t have much hope that treatment would work.
With the funding from Ayúdame a Vivir, Antillón’s center was able to provide chemotherapy and other treatments. Specially trained nurses, social workers and psychologists came on board. Successfully treated patients proved Antillón’s point that childhood cancers can often be cured. And his staff learned that if they provided transportation, lodging, and food for those families that needed it, the families would bring their children back for care.
Today, nearly two decades after Antillón returned to Guatemala, fewer than one percent of the patients at his hospital abandon treatment, and things are going well. “We have 60 beds, which includes our own seven-bed ICU. We have devoted and educated nurses,” says Antillón.
Meanwhile, the Hutch has partnered with the Uganda Cancer Institute in Kampala to make cancer care more widely available there. Ten years ago, there was only one oncologist in the entire country, a U.S.-trained Ugandan named Jackson Orem. Orem teamed up with the Hutch’s Corey Casper, and the two, with others at the UCI and the Hutch, built a training program in Kampala and Seattle. Now there are more than a dozen cancer experts in Uganda, a new clinical center is about to open, and the Ugandan government has built an in-patient hospital.
Antillón’s bottom line, and his reason for coming to the Seattle meeting to describe Guatemala’s success, is simple – he says what has happened in his country and in Uganda should happen everywhere.
Editor’s note: This story has been changed to clarify the Guatemalan government’s support of the cancer center.
