A story of hope and accomplishment
The Brazilian Cancer Foundation is a non-profit institution that raises funds and invests in cancer prevention, early diagnosis, assistance, programs and projects related to transplants of bone marrow and umbilical cord blood, as well as palliative care and research. Its mission is to promote strategic actions for prevention and control of cancer on behalf of society at large, and also to support the Brazilian National Institute of Cancer (INCA) and all activities of the Brazilian National Cancer Control Program. Moreover, it further provides consulting services for states and municipalities throughout Brazil so they can improve their processes in the treatment of cancer (Oncologic Attention Plan).
Cancer is considered a very serious public health problem all over the planet and its incidence has risen by no less than 20% in the past decade alone. In Brazil it is the second leading cause of disease-related deaths. Estimates for 2015 indicate that there will be roughly 580 thousand new cases in our nation this year. According to the UN’s World Health Organization (WHO), expectations for the year 2030 are 27 million new cases and 17 million deaths. Developing countries will be the ones most affected, including Brazil. The dreaded disease is one of the world’s major concerns in terms of public health policies.
Given this scenario, it is fundamental for the entire society to participate in the fight against cancer. To learn more about our actions, click here and access the English version of the Cancer Foundation’s Annual Report – 2014, or get in touch with us through our institutional e-mail address: email@example.com.
The Cancer Foundation began in 1991 under the legal name Fundação Ary Frauzino para Pesquisa e Controle do Câncer, paying homage to the doctor who directed INCA from 1980 to 1985. Since the original name was a bit long, it soon became known as the Ary Frauzino Foundation or by the initials of its Portuguese name (FAF).
In the year 2008, in order to facilitate communication with all segments of society, the name was simplified and the trademark was reformulated. The legal name Fundação Ary Frauzino para Pesquisa e Controle do Câncerwas retained, but at the same time the simpler name Cancer Foundation was adopted for communication with the public at large. Along with the summary name, the slogan “with you, for life” was added, in order to transmit its lifetime commitment on behalf of everyone’s life and health in a pithier manner.
The symbol for the new trademark was inspired by the consciousness-raising ribbons used to encourage people to sign on to great causes. The most well-known of these is red ribbon that symbolizes the fight against AIDS. Each color, however, symbolizes a different cause. Our color, purple, symbolizes the struggle to overcome cancer.
The Cancer Foundation is administered by its Board of Trustees, Board of Directors and Oversight Board. The members of all three governing Boards are representatives of various sectors of society and are all professionals recognized in their respective areas of activity who perform their functions on a voluntary basis. Periodic elections are held to renew the membership on the Foundation’s Boards, with the new member candidates being nominated and approved by the other Board members. All the activities of the three Boards are governed by the Foundation’s Bylaws.
Chairman: Marcos Fernando de Oliveira Moraes
Ana Dolores Moura Carneiro de Novaes
Antenor Gomes de Barros Leal
Arminio Fraga Neto
Carlos Mariani Bittencourt
Ivan Ferreira Garcia
Joaquim de Arruda Falcão Neto
Joaquim José do Amaral Castellões
José Ermírio de Moraes Neto
Luiz AntonioSantini Rodrigues da Silva
Maria do Carmo Nabuco de Almeida Braga
Paulo Niemeyer Soares Filho
Roberto Pontes Dias
President: Peter Byrd Rodenbeck
Vice President: Luiz Fernando Salgado Candiota
Technical-Administrative Director: Amaury de Azevedo
Treasurer: Sergio Tabone
Secretary: José Mauro Lorga
Eliane de Castro Bernardino
Thomas Chiereghini Ribeiro Monteiro
Board of Trustees / Oversight Board / Board of Directors / Executive Director’s Office / Financial Administrative Office / Marketing & Fundraising / Relations with Clients (Government / Private Sector) / Projects & Products / / Human Resources / Personnel Management / Training, Development, Jobs & Salaries
The Brazilian Cancer Foundation was created almost a quarter century ago, in 1991, by Dr. Marcos Moraes – at the time the general director of INCA – together with three other doctors, Jayme Brandão de Marsillac, Ulpio Paulo de Miranda and Magda Cortês Rodrigues Rezende. The objective was to seek economic-financial alternatives so as to expand INCA’s services for persons stricken with cancer and intensify efforts to prevent and control cancer.
Creation of the Foundation opened up a new channel for receiving funds from private initiatives, as well as local public agencies and international institutions. The management model adopted has contributed since then to INCA’s steady growth.
The results over these past 24 years reflect the commitment made when the institution was created: contributing to the actions of the Brazilian National Cancer Prevention and Control Policy. The Foundation’s governance practices – including transparency, efficiency and nimbleness in managing funds – have assured the institution an outstanding position both in Brazil and around the world.
The Cancer Foundation has become a benchmark institution and earned the recognition of the medical and scientific communities. While it continues to be a major INCA partner, it has expanded its activities and the challenges it takes on. Among the short-term projects in the works are operating an oncologic hospital to be opened in 2016, and soon afterwards a palliative care unit.
Promote strategic actions for prevention and control of cancer on behalf of society at large.
To be recognized as an innovative institution in Research, Management and Dissemination of knowledge concerning cancer control.
. Commitment to life
. Sensitivity to people’s needs
. Appreciation of donors and volunteers
. Culture of Innovation
. Management with transparency
. Focus on results
The Cancer Foundation has played an important role in the victories and advances obtained by Brazil in the area of marrow transplants. This support comes in many forms, all the way from campaigns to mobilize donors to management and logistical structuring of projects. The entity is a partner of INCA’s Bone Marrow Transplant Center (Cemo) – a national benchmark in the treatment of hematologic diseases.
The Cancer Foundation is responsible for managing the project for expansion of the Brazilian Network of Public Umbilical Cord and Placenta Blood Banks – Rede BrasilCord (the BrasilCord Network), which is technically supervised by INCA and financed by the Brazilian Development Bank – BNDES.
Created in 2004, the BrasilCord Network is made up of 13 public blood Banks that store donated samples of umbilical cord blood, which is rich in stem cells and capable of reproducing the fundamental elements of blood that are essential for marrow transplants. The blood banks are located in every single region of the nation – in the North [Belém in the State of Pará (PA)], in the Central-West [the nation’s capital Brasília (DF)], in the Northeast [Fortaleza in the State of Ceará (CE) and Recife in the State of Pernambuco (PE)], in the South [Porto Alegre in the State of Rio Grande do Sul (RS), Florianópolis in the State of Santa Catarina (SC) and Curitiba in the State of Paraná (PR)], as well as in the Southeast [Lagoa Santa in the State of Minas Gerais (MG), Rio de Janeiro in the State of Rio de Janeiro (RJ), and Campinas and Ribeirão Preto in the State of São Paulo (SP), plus two in the capital of the latter State – the City of São Paulo].
Since 2006, the Cancer Foundationhas been in charge of management of the project for expansion of this network, with funding provided by BNDES. The first phase of the project involved transfer of R$ 4 million for expansion of INCA’s umbilical cord blood bank. In the second phase, which involved transfers of no less than R$ 32 million, seven new blood banks were built and the four already existing were remodeled, so as to provide them with more appropriate equipment and better-trained personnel.
The third phase of the project began two years ago, in the month of July 2013, with transfer of R$ 23.5 million by BNDES. This latest phase includes construction of four new umbilical cord blood banks in the cities of Manaus (State of Amazonas – AM) in the North, Campo Grande (State of Mato Grosso – MS) in the Central-West, and São Luís (State of Maranhão – MA) and Salvador (State of Bahia – BA) in the Northeast, for a total of 17 umbilical cord blood banks. With conclusion of the project for expansion of the BrasilCord Network, slated for 2016, Brazil will have capacity for storing a total of 80 thousand pouches, expanding the chances of patients requiring marrow transplants.
The Foundation’s activities include the detailing of the architectural and engineering designs, contracting the civil construction, installation and specialized technical services, such as information technology, as well as purchase and installation of equipment and acquisition of operational and support materials. Our work also encompasses the logistics for training specialized personnel and controlling timetables so that the projects are delivered within the deadlines.
Umbilical cord donations
Donating the umbilical cord of a newborn infant to a public blood bank is voluntary and has to be authorized by the baby’s mother. The units stored are available for any person requiring a marrow transplant, such as patients with leukemia and other blood diseases. The more umbilical cords are stored, the greater the number of people who can benefit. The blood banks of the BrasilCord Network have agreements with certain maternity wards to pick up the cords. Donations can only be carried out at such credentialed hospitals, where there are teams on hand that have been trained to properly approach the pregnant woman, accompany her birth and gather the material at the moment the child is born.
The Brazilian National Register of Marrow Donors (Redome) was created in 1993 in São Paulo; as from 2000 it was transferred to Rio de Janeiro, where technical management was put under the charge of INCA’s Bone Marrow Transplant Center (Cemo); and ever since 2009 it has been able to count on the administrative and financial management of the Cancer Foundation. Now it is the world’s third largest register of voluntary marrow donors, with 3.5 million donors registered, putting it behind just the United States and Germany (the American register has almost 7.7 million donors while the German one has around 5.7 million).
Redome is linked to the registers of the entire world. At present searches for potential donors for Brazilian patients are carried out simultaneously in Brazil and overseas. The international registers also access the data of donor candidates based on specialized systems.
The functioning of Redome is directly related to the BrasilCord Network and to the Program for Search, Pickup and Transportation of Stem Cells for Non-Kin Marrow Transplants in Brazil and the National Register of Bone Marrow Recipients (Rereme).
The entire process for Redome consulting and searching is automated. The doctor in charge inserts the register and clinical information on the patient, including the results of their histo-compatibility exam – HLA (which identifies the genetic characteristics of each individual), — on the Rereme system. Once the data is approved, the search begins. When potentially compatible donors are identified, the information is transmitted to the doctor who, together with the Redeme search team, can analyze the best potential donors and make choices for the confirmation tests to be carried out.
After the search phase is concluded, if availability of the donor is confirmed and the patient is able to continue treatment, the donation procedures are commenced. The donor selected is invited to undergo clinical appraisal and removal of the material for donation can be performed at the qualified hospital closest to the donor’s residence. After removal, the material is transported to the center where the transplant will be conducted.
A marrow transplant is a type of treatment indicated for certain diseases that affect the blood cells, such as leukemia. It consists of replacing a diseased or deficient bone marrow with normal bone marrow cells, in order to reconstitute a new healthier marrow.
The transplant is performed based on material gathered from a donor or based on stem cells from the umbilical cords of the newborn, which are obtained and crio-preserved on the basis of voluntary donations authorized by the mothers of the babies. The blood banks of the BrasilCord Network (Rede BrasilCord) have agreements with maternity wards for pickup of the umbilical cords.
You have to be between the ages of 18 and 55, be in good health and not have any infectious disease that can be transmitted by blood. Donor candidates should seek out the blood bank closest to their homes, where they will be put on the schedule to clear up doubts regarding donations and then have a 5 to 10 ml blood sample taken in order to determine the type of their HLA (genetic characteristics that are important in selecting donors). The donor’s data are then inserted on the Redome register and, whenever a new patient inquiry is made, compatibility will be checked. Once this is confirmed, the donor will be consulted to decide on the donation.
A marrow transplant is a safe procedure and there are two manners of carrying it out, with the doctor choosing the most appropriate method for each case. One of the options is removing marrow from inside the donor’s pelvic bones by means of needle punctures. The procedure is carried out in a surgical center with the patient anaesthetized.
In the other transplant option, donors take medication that makes the bone marrow cells circulate through their blood veins. Such cells are then removed from the donor’s arm veins, and the procedure includes use of a specific machine (aphaeresis) to separate the blood cells required for the transplant.
In both procedures, the donor’s bone marrow is reconstituted in just 15 days.
Donor candidates should keep their data updated on the Redome. To access the form for doing this, click here.
Cancer is the leading cause of disease-related deaths in the 5-19 age bracket in Brazil. The disease evolves rapidly in children and youths, yet early diagnosis and appropriate treatment increase chances of successful cure by up to 80%. The Cancer Foundation works closely with INCA’s Pediatric Section, which handles 70% of the cases in the State of Rio de Janeiro.
In recent years, the Foundation has contributed to expansion of the Pediatric Intensive Care Unit, construction of the Ophthalmologic Consulting Office and creation and maintenance of the Pediatric Emergency Ward. Some of these success stories came about through funds obtained in partnership with the Ronald McDonald Institute, based on sale of tickets for the Happy McDay campaign oriented to INCA’s unit dedicated to children and youths.
The Foundation is also a partner of the Desiderata Institute and closely monitors the issue of access to and treatment of cancer in children and adolescents through its active participation in the United for the Cure group, an initiative of the institute that brings together managers of Brazil’s Single Health-Care System (SUS), specialized services and civil society organizations. The group’s objective is to promote early diagnosis of cancer in children and youths based on training health-care professionals, access within no more than 72 hours to investigation of suspicion of cancer and tracking the flow of handling cases of cancer in children and adolescents.
In 2014, to call attention to this important issue, on the occasion of Brazil’s National Day for Fighting Children’s Cancer (November 23), the Desiderata Institute launched a bulletin with a panorama of pediatric oncology in the State of Rio, with the support of the Cancer Foundation. The publication is aimed at disseminating knowledge and analyses of strategic matters that provide objective inputs for decision-making to enhance the network for dealing with cancer among our youth.
To access the material in the Portuguese original, click on the link below:
Panorama of Pediatric Oncology
INCA is a benchmark in terms of clinical research, both in Brazil and in Latin America, and the Cancer Foundation has played a relevant role in this victory. The entity participated in structuring the area, creating together with INCA mechanisms for formalizing agreements with the pharmaceutical industry and to receive donations. The Foundation makes research protocols feasible, it provides administrative-financial support and manages funds donated to carry out clinical research on new therapeutic modalities and epidemiologic studies, including basic science and genomic analysis of the Brazilian population in order to appraise their profile. At present, it is handling several projects that are underway, both those induced and those that have been contracted with the pharmaceutical industry.
An important initiative that counted on the Cancer Foundation’s support was creation of the National Pharmogenetic Network (Refargen), a consortium of 18 groups of researchers from various Brazilian institutions. Sponsored by Finep through the end of 2011, the network was aimed at identifying genetic variations that explain the different responses of individuals to medicines. The studies will contribute to therapeutic individualization, that is, to the choice of the medicine and the dosage that is just right for each patient, according to their genetic characteristics.
Besides Refargen, the National Network of Cancer Clinical Research features the Cancer Foundation as the link that administers and invests private funds. It was conceived of as a specific oncologic area of this national network, through actions induced and financed by the Health Ministry’s Science & Technology Secretariat in 2005. Its priority is carrying out studies of interest to the Single Health-Care System (SUS) in the area of cancer. This network is organizing groups of excellence in clinical research throughout the nation in order to conduct multi-centric studies, with the initial projects being studies of lung cancer and lymphoma.
Cigarettes contain at least 70 substances that can lead to cancer – there are over 4,700 toxic components in them – and consumption thereof is the leading cause of lung, mouth and pharynx cancer. They are also associated with hyper-tension and diabetes. It is estimated that no fewer than 90% of lung cancer deaths are related to abusage of tobacco.
Out of its consciousness that prevention is the best route for fighting diseases, the Cancer Foundation has been seriously engaged, ever since its creation, in the struggle against tobacco abusage. It actively participates in actions for mobilizing civil society against the tobacco industry and conducts campaigns concerning the evils of cigarette consumption, chiefly on social networks.
In more than 20 years of activities and struggles, the institution has made a major contribution to cutting the percentage of smokers in the Brazilian population from almost a third (32%) in 1989 to well under a sixth (14.7%) in 2013. Despite this impressive victory, the latter percentage still represents a cigarette consumer market of almost 21.5 million dependents. The latest figures are the results of the National Health Survey conducted by the Brazilian Ministry of Health (MS), the Oswaldo Cruz Foundation (Fiocruz) and the Brazilian Statistics Bureau (IBGE).
Despite the steep reduction in the number of smokers, the battle for compliance with and enhancement of legislation in this regard requires ongoing actions. The Foundation has been active for over two decades in partnership with INCA, contributing to the development of public policies for control of tobacco abusage, such as environments that are 100% free of tobacco, prohibition against additives in tobacco products, restrictions on advertising, increased taxes on the products, insertion and enhancement of images and health warnings on packages, among other such initiatives.
The nation’s conquests in the struggle against cigarettes are in keeping with the WHO Framework Convention on Tobacco Control, the first international health treaty, which includes Brazil among its 168 signatories. The Framework Convention calls for measures for controlling the consumption of tobacco products, out of its understanding that tobacco abusage is a world-wide epidemic. According to the WHO, smoking threatens a third of the world’s population and in 2012 dependence upon tobacco was the determining cause of over 13.7 thousand deaths per day.
Parallel to its coordination with entities of the nation’s civil society and pressure for advancement of legislation, the Cancer Foundation has been investing in surveys aimed at monitoring and appraising public tobacco control policies, contributing to the planning of actions at both the local and nation-wide levels.
Furthermore, the Cancer Foundation’s Health Promotion team offers training modules for companies and municipalities in how to go about setting up healthy working environments that are tobacco-free. Such consulting work involves adaptation to federal legislation, as well as helping whole groups quit smoking, conducting situational diagnoses, training people and conducting follow-ups on actions taken.
The functioning of the Brazilian National Institute of Cancer (INCA) and execution of the National Cancer Control Program coordinated by the Institute require a powerful technological apparatus. To this end, the Cancer Foundation has developed projects involving systems that consolidate the existing data on cancer and also tools to improve assistance, providing greater swiftness in handling patient needs.
Among the main investments made were purchase of the software program Business Intelligence (BI) and acquisition of the ownership rights to a hospital administration system. At present, in order to contribute to the enhanced performance of more than a hundred systems, a team of around 30 analysts, maintained by the Foundation, performs services for INCA.
The information-processing area gained impulse as from 1997 when the Foundation bolstered the professionalization of its human resources, contracting managers who act in key areas of the institution. In the field of Information-processing technology, the target was to implement tools to provide support for INCA’s major pillars: assistance, research, instruction and prevention.
The first big project began that year 18 years ago, in order to integrate the assistance area. One system brought together everything from scheduling to the handling of inquiries and exams, electronic prompt-books to hospitalizations, all the way through the medicines consumed by each patient, centralizing the control over the entire hospital movement. At the turn of the millennium, a managerial software program (ERP) was acquired and integrated with the hospital system, making it possible to control storeroom inventories, fixed assets and the flow of purchases, as well as make reports available on accounting and purchasing between other facilities.
Another major advance was the development of the systems relating to bone marrow transplants in Brazil, with full automation of the National Register of Bone Marrow Donors (Redome) and the National Register of Bone Marrow Recipients (Rereme).
Yet another enhancement in the assistance area was the digitalization of all computer tomography, magnetic resonance and X-ray images. This initiative made it possible for doctors to have access to exams at any INCA unit, or even in their own homes, thus boosting speed and savings.
In the area of epidemiologic vigilance in partnership with the SUS Information-Processing Department (Datasus), the Cancer Foundation developed the Siscolo (2001) and Sismama (2006), in order to record the occurrences and track the evolution of colon-uterine and breast cancer, respectively. Besides these systems, the Foundation aided creation of the Cancer Hospital Register and the Population Base Cancer Register.
When it comes to research, highlights of the Cancer Foundation’s work include creation of a management program for the National Tumor Bank (BNT), an important study tool that brings together data related to tumor samples collected from patients. In 2007, this application was ranked as the finest in the entire world in its category at the annual meeting held by the International Society for Biological and Environmental Repositories (ISBER).
In the area of palliative care, a software program developed by the Cancer Foundation allows home-care teams for patients beyond therapeutic possibilities to have direct online access to the INCA system by means of their smartphone. Doctors and nurses cannot only check the patient’s record, but they can also update data in real time. In 2009 the application was ranked the best in the health-care area by the Brazilian Association of Information Technology Companies (ASSERPRO).
The Oncobiology Program (Programa de Oncobiologia) of UFRJ’s Leopoldo de Meis Biochemical Institute has counted on support from the Cancer Foundation since 2005. Each year two graduate scholarships are offered and 15 research fellowships are awarded as well, in addition to funds invested in actions for health-care communication aimed at contributing to demystifying public perception about cancer.
By the end of 2014, the Cancer Foundation had invested around R$ 2.7 million in the Oncobiology Program. Most of this funding (R$ 1.5 million) was invested in scholarships and research. One of the projects involves construction of an auditorium for use in giving courses, lectures and symposia at the UFRJ Health Sciences Center.
The UFRJ Oncobiology Program is an inter-institutional organization that brings together groups of researchers from different entities in Rio de Janeiro. Besides UFRJ itself, there is INCA, the Rio de Janeiro Federal Rural University (UFFRJ), Rio de Janeiro State University (UERJ) and Fiocruz.
Currently, there are 41 lines of research in progress, with dozens of projects in each one of them. Among those that began in 2014 there are groups involved in studies for identification of new therapeutic targets for control of mammary tumors and endometriosis lesions, protogenomic appraisal of the resection margin of patients with gastric cancer, etc. Continuing from past years are translational research into infant leukemia, a panel for appraisal of instability in the prospect for enhanced diagnosis, and a study devoted to clinical and experimental research on differentiated thyroid carcinomas, among others.
The UFRJ Oncobiology Program is made up of the Management, Research, Instruction, Symposia and Dissemination nuclei. The research groups supported are involved in the following lines of study: search for new markers in order to achieve more effective early diagnoses and/or prognoses for the various types of cancer; search for new treatments against cancer; comprehension of the action mechanisms of the various types of cancer, as well as risk and epidemiologic factors; and development of disclosure and prevention strategies.
Inasmuch as the program also features a Dissemination Nucleus, the projects do not exclusively use professional from the medical-scientific community. In 2013, for instance, the Dissemination Nucleus developed Acubens, a virtual museum on the playful side that broaches the thorny subject of cancer in a differentiated manner. The aim is to present to the public, especially youths, the risk factors associated with the disease, in order to encourage adoption of a healthy lifestyle, based on games, videos and comic book stories in virtual format.
Likewise in 2013, a survey was conducted by the Nucleus to gauge public perception of alcohol as a risk factor for cancer. With the results obtained, besides permitting comprehensive understanding on the subject, the Dissemination Nucleus launched an animated video in 2014 as part of the strategy of dealing with cancer among Brazil’s young populace.
The Cancer Foundation performs Consulting services for states and municipalities all over Brazil in order to enhance the processes for cancer prevention and treatment. Such work encompasses actions, programs and projects that are needed for implementation of the National Oncologic Attention Policy in all aspects involving education, promotion of health, prevention, diagnosis, treatment, rehabilitation, palliative care, information-processing systems and assistance regulation. It is developed in partnership with the state and municipal health secretariats involved. The States of Rio de Janeiro and Amazonas already have such a Plan, as does the municipality of Macaé.
The consulting work performed together with the Rio de Janeiro State Health Secretariat was concluded in 2013. The Oncologic Attention Plan developed, based on the diagnosis of the situation in the state, was aimed at rational use of the resources available, with targets and indicators for tracking and appraising results. The basic principle was the equity and integrity of the treatment for the population, with a view to cutting down the incidence of cancer and deaths caused by the disease.
Further in the year 2013 the Foundation signed an agreement with the Municipal Prefecture (City Hall) of Macaé to develop the Oncologic Attention Plan for the city, including expansion of the Macaé Oncologic Center. Both aspects of the project were concluded in 2014, in order to make the city a benchmark for high-complexity assistance in oncology. The plan involved entire design of the municipal health network and its developments for full oncologic assistance, going all the way from diagnosis through palliative care, treatment including surgery, radiotherapy and chemotherapy, besides cancer records and research.
In 2014, the Foundation performed Consulting services for the Amazonas State Health Secretariat and Government. Among the services were diagnosis and recommendations for actions to enhance access and quality of care provided by the Amazon State Oncologic Attention Network. The project, concluded in December of the same year, also included appraisal of medical services, operational procedures, information-processing systems, billing and monitoring of results of the Amazon State Oncologic Control Center Foundation (FCECON).
Additional information on the consulting services for states and municipalities related to oncologic attention can be requested via e-mail (firstname.lastname@example.org) or by phone (21) 2157-4600.
Palliative treatment is fundamental for controlling the symptoms of a chronic disease in the advanced stage and also to enhance the quality of life of the patient and his or her next-of-kin. In Brazil, the aging of the population and the rise in the incidence of cancer have made sick people lacking palliative care an issue with tremendous social impact and increasing importance in terms of public health. In our country we do not yet have a palliative care structure that is adequate to handle the existing demands, both from a quantitative and qualitative point of view.
The Cancer Foundation has been engaged for a long time in trying to overcome this scenario. In 1998 it provided support for creation of the Oncologic Therapeutic Support Center, currently Cancer Hospital IV (HC IV), an INCA unit devoted exclusively to patients beyond the possibility of cure. And among the projects now underway, we are searching for installations to set up a palliative care unit in the central region of Rio de Janeiro and also are looking to build a model unit on land already acquired for this purpose, located in the district of Vargem Pequena, in the city’s Western Zone.
The WHO estimates that at least 80% of deaths due to cancer and other life-threatening diseases correspond to patients in the terminal phase that could benefit from palliative care. Out of every 1 million inhabitants of Earth, around 1,000 patients per year need palliative care. Although this calculation may be an under-estimate, since it only reflects the need for care in the terminal phase, it is nonetheless still a good reference regarding the need for palliative care.
In the State of Rio de Janeiro, taking into account INCA’s estimates for 2014 (and still valid for 2015) – excluding the cases of non-melanoma skin cancer – the number of patients requiring palliative care per year, from the time of diagnosis, is around 12,576 in the state capital and 27,816 in the rest of the state. As next-of-kin who provide care should be included among those benefitting from this type of treatment, the demand doubles, that is to say, 25,152 in the capital and 55,632 out-state.
In the second half of 2015, the Cancer Foundation will be starting up the National Radiotherapy Training Program. The objective is to train 20 physicists with a transdisciplinary view and 80 radiotherapy technicians and also to provide updating courses for 300 doctors, radiotherapists, technicians and physicists. The project further includes developing and making available an ongoing virtual learning environment to train residents and update radiotherapy doctors, physicists and technicians throughout the country.
In the line of oncologic care, radiotherapy is recognized as an essential component of assistance for cancer patients. About 60% of them will benefit from such therapy at some point in their treatment, and results indicate a cure rate of 50% on an isolated basis and 60% when associated with chemotherapy or surgery.
The National Radiotherapy Training Program was conceived of by the Cancer Foundation and developed in partnership with INCA’s Instruction Department and UERJ’s Radiologic Science Laboratory in order to supplement the training and updating courses for radiotherapy area professional, pursuant to the requirements of the SUS, in conformity with the Health Ministry’s National Radiotherapy Program.
Created by the Federal Government, the National Radiotherapy Program involves the purchase of 50 machines to be installed at 50 new treatment centers and 50 machines to be installed at existing centers that need updating. The bidding process for purchase of the equipment included the requirement for the company winning the bid to set up a manufacturing plant in Brazil.
Such a decision will no doubt provide medium- to long-term benefits (5- to 10-year time frame), with installation of new centers and replacement of obsolete equipment. Even so, the greatest impact of the National Radiotherapy Program will be even more long term, what with production of equipment in our country, making the machines cheaper due to the reduction of taxes and the possibility of financing in Brazilian currency, creation of jobs and technical know-how.
The acquisition of radiotherapy machines, besides including future production here in Brazil, will also no doubt expand our capacity to handle cases and cut down the waiting time for treatment. Nonetheless, as radiotherapy is a highly complex process, characterized by a specific physical structure, a differentiated technological park and multi-professional action (doctors, physicists, technicians, nurses) in the various stages of planning and execution, adequate training and updating of the human resources involved are just as fundamental as the availability of the equipment. Hence the importance of the National Radiotherapy Training Program as proposed by the Cancer Foundation.
The program for updating and training will begin in the second half of 2015 and involve a group of 20 companies and two individual donors that will carry out the execution phase of the program that will contribute mightily to improve the quality of radio-therapeutic treatment in Brazil.
Since it was created with the mission of collaborating with the Brazilian National Cancer Control Program, the Foundation could not fail to also focus its attention on the research area. Oncologic research opens up paths for discovery of new biological markers for early detection, besides the possibility of individualization and optimization of therapeutic treatment and development of more effective exams and new pharmaceuticals. Our research work has further contributed to understanding of the complexity of the disease, as well as improvements in prognosis.
Over the course of more than two decades, the Foundation has signed agreements with companies and institutions for development of research projects. It has been the major entity for incentivating INCA’s research area. Among the important initiatives it has supported are the Program for Internal Fostering of Research (Profip) and the National Cancer Clinical Research Network, besides various projects that permit creation of a research structure at INCA involving leading-edge technology. It also has carried out agreements with foreign institutions in order to finance research in Brazil, such as NCI/USA and the Swiss Bridge Foundation.
The Foundation also supports the National Tumor Bank and Oncobiology Program of Rio de Janeiro Federal University (UFRJ).
The National Tumor & DNT Bank in Brazil (BNT) is the first public bank of this type that is nation-wide in scope. It arose based on an initiative of INCA’s Research Coordinating Office that was aimed at setting up the first Brazilian network for collecting and transferring to the Institute’s Research Center samples of tumors and blood from patients with the most common tumors in the country – based on their frequency and death rates – for definition of their genetic profiles.
Construction of the BNT was managed by the Cancer Foundation and its infrastructure was developed in 2004 with funding provided by the Brazilian Government’s Finance Agency for Studies & Projects (Finep) and the Swiss Bridge Foundation, which is a non-profit entity based in that European nation. A bio-data-processing platform was specially created to organize and store BNT data that began functioning in 2005.
Centralization of data allows research studying the behavior of tumors based on the genetic standard of the Brazilian population and defines diagnoses and treatments with greater speed and safety. The current storage capacity of BNT is roughly 88 thousand samples, which are donated by patients undergoing surgical procedures in all the medical-surgical services of INCA’s hospitals.
More than 25 projects approved by INCA’s Ethical Research Committee(CEP) were carried out with biological samples taken from patients registered at the institution, thus leading to technical-scientific collaborations with Brazilian and international research groups. The results achieved with these research projects may make a marked contribution to actions for cancer prevention and treatment, through enhancement of technologies oriented to diagnosis of the disease and identification of molecular markers that can serve as “targets” for specific therapeutic activities in various types of cancer.
The challenge now is expanding the collection of samples with implementation of the Brazilian Bio-Bank Network, a technical-scientific cooperation exercise with cancer assistance and research institutions associated with the BNT, located in other regions of the country.
Another initiative led by the BNT was creation of the Network of Tumor Banks of the Latin American & Caribbean Alliance, the main objective of which is establishing actions aimed at setting standards for bio-bank processes – standard operating procedures, analysis of costs of biological samples, etc. – in governmental oncologic attention institutions. So far, the following countries participate in this network: Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, Peru, Mexico and Uruguay.