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Dr. Julio Barredo Helps Peru Improve Outcomes of Kids with Leukemia

For Peruvian native Julio Barredo, M.D., director of children’s cancer programs at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, visits to his home country were often painful.

From left, Diego Venegas, M.D., advisor, Julio Barredo, M.D., international advisor, Patricia Garcia, M.D., M.P.H., Ph.D., Minister of Health, Franklin Aldecoa, M.D., advisor, and Gino Venegas, M.D., senior advisor.

Barredo, professor of pediatrics, medicine, and biochemistry and molecular biology, and Toppel Family Chair in Pediatric Hematology-Oncology, saw a cure rate of only 40 percent for the 700 Peruvian children diagnosed annually with acute lymphoblastic leukemia (ALL), the most common childhood cancer. By contrast, the cure rate for ALL throughout the industrialized world — such as in the U.S., where 6,500 children are diagnosed with the disease each year — is 90 percent. He knew that many Peruvian children were dying unnecessarily.

“There are a number of reasons for this disparity,” said Barredo. “Peru is not lacking in doctors who know how to treat the disease, but almost all of them work at one of the three hospitals in Lima, Peru’s capital city, which is located on the coastline in the center of the country. Many of the children who develop ALL live in other areas, some of them remote. They are never referred to a place where they can be treated because there are no places outside of Lima. Even for those who do make it to Lima, the hospitals often have no available beds. Or if there is a bed at one of the hospitals, it may have run out of the chemotherapy drug needed for the child’s treatment.

“As a result, patients experience unnecessary delays in their therapy, and as a result, some abandon their treatment. Moreover, there are no standard treatment protocols for childhood ALL that are subscribed to by all practitioners and hospitals in the country. All these factors have contributed to the lower cure rates in Peru.”

Barredo knew that improving outcomes would require direct action by Peru’s Ministry of Health and a nationwide plan for revamping how childhood ALL cases were treated. For a decade he tried presenting his own recommendations to the Ministry of Health, but until last year they fell on deaf ears.

On July 28, 2016, Patricia Garcia, M.D., M.P.H., Ph.D., was sworn in as Peru’s new Minister of Health, finally opening a door for Barredo. Garcia had gone through the William J. Harrington Internal Medicine Residency Training Program at the Miller School’s International Medicine Institute, and was a strong public health advocate who understood the often-complex interrelationships between public policy and disease outcomes. Barredo met with her last December while on vacation in Peru, and he presented a basic plan for gradually improving childhood ALL outcomes.

As a result of that meeting, in January Garcia brought Barredo on as a formal unpaid advisor to the team she was assembling to tackle a variety of health issues. Since then, the team has developed a comprehensive national plan that will begin being implemented later this year. The plan has several components that address issues affecting childhood ALL outcomes:

• Two additional regional referral centers — medical facilities with staff knowledgeable in the treatment of childhood ALL — will be opened, one in the north and one in the south of the country, to give more children access to proper treatment.

• A set of national treatment protocols has been developed that the three hospitals in Lima and the two new regional facilities will all follow. This framework for standardized treatment is similar to that used at North American comprehensive cancer centers, but adapted for Peru, and a decree issued in May by the Ministry of Health requires its adoption.

• The number of pediatric beds has been increased in the three Lima hospitals, as has the number of pediatric oncologists.

• Chemotherapy drugs will be purchased in bulk through a new government program to assure a consistent supply, and the best pricing and quality. Traditionally each hospital was responsible for its own purchases, creating fluctuations in pricing and availability.

• A new IT infrastructure has been created to collect and analyze outcomes data to help the program respond to and evolve from the initial protocols.

• Government funding has been established to support the program for five years.

“This is a long-term project,” said Barredo. “ALL is highly curable, but the treatment takes three years, so it will be three to five years before we see the results of what we are doing now. Cure rates will most likely be incremental rather than dramatic, but just getting everybody to follow the same treatment guidelines will be a huge accomplishment. Most important, it will benefit the Peruvian children with ALL. I’m doing all this because I want to help my home country, and for the first time, I’m very optimistic.”

The 50th anniversary of the William J. Harrington programs will be celebrated at the Miller School in November. Garcia will speak at the event, providing a status report of the childhood ALL program in Peru.

Tags: acute lymphoblastic leukemia, ALL, Julio Barredo, Miller School of Medicine, Patricia Garcia, Peru, Sylvester Comprehensive Cancer Center, University of Miami, William J. Harrington programs