The Two Worlds Cancer Collaboration Foundation

G. Fyles – Director PAX India

Medical Leader PSMPC – SAHCSI, BC Cancer Agency

There are no relationships that pose a conflict of interest to declare AND this program has been developed

without support from commercial entities.

Covenant Health’s 25th Annual Palliative Care

Conference Faculty/Presenter Disclosure

International Network for Cancer Treatment

and Research (INCTR)

NGO founded in 1998 by UICC and Institut Pasteur in Brussels

Goal to assist resource constrained countries to:

– prevent as many preventable cancers as possible

– cure as many curable cancers as possible

– improve the quality of life of patients with cancer at all stages of their disease

Partners include: National Cancer Institute (USA and France), WHO, IAEA-PACT, European School of Oncology

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INCTR Palliative Access Program (PAX)

Goal is to decrease global suffering caused by cancer through improving access to palliative care services in developing countries.

Helped the establishment of Regional Palliative Care Centres in India, Nepal and Tanzania.

Centres provide specialized palliative care for adults and children as inpatients, outpatients, at home and in rural settings.

Also provide research and teaching resources as well as advocacy for palliative care

WHO Foundation Measures for

Implementing Cancer Pain Relief

Programs

Drug AvailabilityChanges in healthcare

regulations/legislation to improve drug availability

(especially of opioids)

Government PolicyNational or state policy emphasizing the need to

alleviate cancer pain

EducationOf the public, healthcare

professionals(doctors, nurses, pharmacists) & others (healthcare policy makers, administrators, drug regulators)

The Two Worlds Cancer Collaboration Foundation: INCTR – Canada

Created 2011

Currently focusing on palliative care in India, Nepal

Mission: to work with professionals in resource-challenged countries to reduce the burden of cancer by:

•building capacity for care, skill development and education ,

•promoting self-sufficiency

• 2.5 million people with cancer

• 0.4 million deaths/year

• Leading sites of cancer

– Men:

• oral cavity, lung, esophagus, stomach

– Women:

• cervix, breast, oral cavity

• Andhra Pradesh - 85 million

– One of highest HIV prevalences in India

– Hyderabad - pop. 7 million

Two Worlds Cancer Collaboration Foundation:INCTR - Canada and South Asia

• MNJ Institute of Oncology and Regional Cancer Centre (MNJ) Pain and Symptom Management and Palliative Care Program is focus of work in India

• Only gov’t funded Oncology Centre in the state – opened 1950s

285 beds, 74 pediatric beds

10,000 new pts/year - 50,000 f/u

• Surgery, Radiation & Chemotherapy provided free to all below poverty line.

• Pain Relief and Palliative Care

Program (PRPCP) began mid-2006

MNJ PRPC Program

• Clinical care –inpt, hospice and outpt

• Outreach –home care, rural program

• Teaching

• Advocacy

Clinical Service - Adult• 75% present in advanced stages

• Common problems – pain, nausea, family breakdown

• Extensive wounds also common

• Clinic runs 6 days/week

• 10 new inpt palliative beds in 2014

Adult Patients seen in the Department of Palliative Care 2006-2013

2160 2255 2236 2464 1812 1546 2141

0

2000

4000

6000

8000

10000

12000

2006 2007 2008 2009 2010 2011 2012 2013

Total Cases

New Cases

Pediatric Oncology

• 74 beds

• Parents sleep on floor

• Mostly acute leukemia

• High treatment abandonment

• Two Worlds with Pallium India and OSI funded and trained the first pediatric palliative care fellowship position in India in 2011

The two worlds healthcare “gap”

In high income countries

More than 80% of young peoplewith cancer survive

to live productive and fulfilling lives

However …in low income countries

More than 80% of young people die of their cancer before reachingadult life

•All children diagnosed with cancer who transit through MNJ Cancer Hospital are seen by the Palliative Care Program.

Over the last 3 years, Zahra Lalani has made a huge contribution to the care of children undergoing chemotherapy treatment:

• Mentoring RNs in safe chemo prep, delivery, needle safety,hand hygiene

• Teaching humane IV and LP procedures to RNs and MDs

• Teaching and conducting art therapy

• Purchasing hygiene kits

Total Children Seen in the Department of Palliative Care 2006-2013

50 75369 311 245 278 334

0

500

1000

1500

2000

2500

3000

3500

4000

2006 2007 2008 2009 2010 2011 2012 2013

Total Cases

New Cases

Young People With Cancer Project

• In 2015, Two Worlds Cancer Collaboration, with Dr Palat will initiate an expanded program for young people with cancer and other life-limiting illnesses

• This will be in addition to its existing support for palliative and end-of-life care for adults and children with cancer

• Currently the MNJ Pediatric Program is the regional leader in the field and this new Project will build on this

Young People With Cancer Project will deliver:

• A new in-patient unit for 12 - 18 year olds with cancer who need treatment not only for cancer but also the physical, emotional, educational and social challenges of adolescent and teen years

• A new Palliative Care Program for children with illnesses such as HIV/AIDS, thalassemia and other non-cancer life limiting illnesses

• A dedicated Home Care Team for these children

• Expanded support for 0 - 5 year olds at MNJ and 0 - 12 year olds at Hospice House, MNJ and rural villages

Kumudini Devi Hospice

• 26-bed hospice opened in July 2013 (Four pediatric beds)

Kumudini Devi Hospice

Life at Your Doorstep Home Care Teams

Since 2008 - 1128 new pts and 3519 follow-ups seen

Rural Outreach Program

• 9 villages in Chevella Mandal - 90 minute drivefrom Hyderabad

• Screening, early detection, rehab and palliative care

• Trained village volunteers - partnered with foundation working to prevent child labor

Teaching

• PRPCP conducts an intensive month -

long Certificate Course every

2 months

• MNJ has become training centre for

other Indian cities/states and other

countries including Nepal, Ethiopia

and Somalia

• Since 2006, 140 MDs, 79 nurses,

32 healthcare volunteers and 11 social

workers as well as many students

have completed the Certificate Course

Health and Cancer Awareness Sessions in Schools

Advocacy• Facilitated inclusion of palliative care in state sponsored Health Insurance Scheme for people

below poverty line

• Convinced gov’t to amend opioid licensing regulations to improve access – national law passed Feb 2014

• Working with State AIDS Control Program re: inclusion of pall care training/services for people living with HIV/AIDS

Core Programs Supported by 2W in India

• Dr. Palat’s role both at MNJ and nationally/internationally for cancer and non-cancer palliative care for children and adults

• Dr J Reddy - Pediatric Palliative Care Specialist

• Life at Your Doorstep Home Care Team

• Rural Program

• Expanded pediatric program beginning 2015

2W is Making a Difference in South Asia Beyond Direct Clinical Care/Support By Assisting MNJ to :

• Develop local partnerships

– Local Indian NGO/Hospice now funding a 2nd and 3rd Home Care Vans and Team as of January 2013/Spring 2014

– Ambulance donated

Engage governments and develop self sufficiency

• Government/MNJ now funding salaries of some Team members

• Other states using health insurance scheme proposal

• 2W paying peds palliative care MD via MNJ - ? Will lead to MNJ taking over funding

• Support from Indo-Canadian community including visits to MNJ

• Build capacity:

– Certificate Course

– First pediatric palliative care fellowship position in India in 2011.

– Government officially recognized PRPCP and specialty

of palliative care and created Assoc Prof in Palliative

Medicine position

• Spread the word

– Multiple presentations at 2013 IAPC Conference

– 2015 Indian Assoc of Pall Care Conference in Hyderabad hosted by MNJ, 2W

Palliative Care Project - St Mary’s Hospital, Malur, Karnataka

• Envisaged as “total care with a community approach” for Malur and surrounding villages

• In its 2nd year:

– Building of 2nd story on rural hospital, with 10 beds devoted to pall care

– Outpt clinic

– Mostly seeing elderly with non-cancer and cancer

– Outreach and home visit program

Catholic Health Association of India• 71 yrs of experience in India, particularly with pts with HIV/AIDS

• 3300 member institutions providing care for up to 200 million of the poorest people in India

• 2W/MNJ/CHAI providing training and

accreditation for palliative course and eventually

a Palliative Care Training Centre and 10 – bed

Hospice in Medchal, India

Nepal

• INCTR working in Nepal for a decade on teaching, advocacy, twinning

• Two Worlds Projects include:

• Support for NAPCare led Palliative Care Course for nurses in 2013

• Nepali version of Essentials in Hospice Palliative Care for Nurses text and workbook

Community-Based Palliative Care in Makawanpur District – a Pilot Project

How donations are used

• The Canadian expertise used to develop these programs is volunteered through time, expertise, and absorbed costs with limited reimbursements from Two Worlds

• Less than 5% of the fundsraised by Two Worlds is used to fund volunteer travel and overhead costs

• How can you help?– Volunteer

– Donate

– Talk to one of us