Nearly half of all oncologists in Chile are based at a single hospital.
That hospital, Clínica Las Condes in Santiago, has served as a bright spot on an otherwise grim canvas. With cancer statistics in Chile reaching alarming levels, a widespread lack of specialty and advanced care for the disease has left the population severely underserved. Clínica Las Condes’ ability to establish itself as an advanced cancer center may demonstrate a path to upgraded healthcare systems in regions that lack them. For Clínica Las Condes, the path was paved by a close collaboration with Johns Hopkins International, a leading healthcare institution thousands of miles away.
Chile sees approximately 24,000 recorded deaths from cancer cases each year, which account for over a quarter of the national mortality. That’s a rate 25 percent higher than in neighboring Argentina. The relative burden of cancer mortality has been steadily increasing over the last several decades, nearly tripling from 8.4 percent in 1960 to 24 percent in 2011. Stomach cancer, colorectal cancer and gallbladder cancer are of particular concerns to the mountainous nation compared to the rest of the world, as Chile reports much higher rates of incidence and mortality for the three diseases.
Meanwhile, that high incidence rate is paired with a dearth of resources for diagnosing and treating the disease. The Chilean Society of Medical Oncologists lists only 67 practicing members within the country, a per-capita rate one-fifth that of the U.S.
In its quality of cancer care and other ways, Clínica Las Condes (CLC) has become a sharp exception in Chile. A private hospital located just outside of central Santiago in the foothills of San Carlos de Apoquindo Park, CLC has built a comprehensive cancer treatment center that earns high praise from outsiders. The hospital is home to 31 of the nation’s 67 oncologists, including physicians who sub-specialize in adult, pediatric, surgical, radiation, dermatological, breast, hemo-, palliative and surgical oncology.
A critical element of that success has been an affiliation with Johns Hopkins International, the global arm of Johns Hopkins Medicine, a U.S. healthcare institution widely regarded as one of the best in the world. “The main purpose of the partnership was to certify our reputation on the international stage,” says Gonzalo Grebe Noguera, CEO of Clínica Las Condes. The partnership was in place by 2006, and the first big project was to achieve accreditation by the Joint Commission International (JCI), the U.S. non-profit organization that assesses non-U.S. healthcare facilities against high standards of quality and safety.
An initial JCI accreditation typically takes years and hundreds of thousands of staff hours. Hopkins began the process with a thorough assessment of the CLC’s procedures and clinical facilities, then followed up with detailed recommendations on needed improvements. Though CLC was the first hospital in Chile to even attempt the accreditation, it managed to achieve the distinction in under a year, gaining JCI’s gold seal. Hopkins has since helped CLC through three additional accreditations, including a JCI reaccreditation in 2012.
Other improvement projects soon began rolling out. After streamlining CLC’s revenue systems, Hopkins helped guide the hospital through operating-room and emergency-department upgrades, and an intense patient-safety program. Hopkins also helped design and plan an expansion that nearly doubled CLC’s capacity to 430 beds. Staff-education efforts centered around observerships that saw groups of CLC clinicians traveling to the U.S. to visit Hopkins in Baltimore, Maryland, and shadow leading clinicians there. An ambulance-coordination program resulted in CLC becoming the lead supplier of emergency response services throughout the Santiago metropolitan region.
CLC had unsuccessfully tried to found a top-notch cancer center two times previously. To avoid a repeat, the Hopkins team conducted more than 50 meetings with the Chilean facility and medical staff to better understand CLC’s organizational structure and cancer-care needs. After this initial assessment, a team comprised of administrators and physicians from both institutions created a strategic plan detailing the long-term goals for the center. “We helped them see that developing a clear vision for the center’s future would be crucial from the very beginning,” says Irma Purisch, Managing Director of Global Services at Johns Hopkins International, and one of the leaders of the CLC collaboration.
What CLC needed most was access to advanced physician and staff training. So Hopkins made available a series of additional Baltimore-based observerships for key CLC clinicians, including the head of radiation oncology and several pathologists. One key goal of the observerships was to give the Chilean physicians exposure to the diagnosis and treatment of less-common cancers, which they had little experience with. Some of the CLC physicians observed multidisciplinary tumor boards at Hopkins. “The partnership with Johns Hopkins International has been especially helpful in enabling physicians here to do the observerships in the U.S.,” says Dr. Christina Adaniel, an American radiation oncologist who currently practices at CLC. She adds that any education CLC physicians receive at Hopkins is always filtered through the lens of how processes and resources can be adapted to suit the needs of the Chilean population.
Also bolstered by the partnership was CLC’s ability to provide emotional and other non-medical support to patients and their families — an important function of good cancer centers. As with most Chilean hospitals, care coordination service was previously provided by nurses who had no specialized training and had to fit these responsibilities into their other clinical duties. Hopkins helped CLC establish a formal patient-support network staffed by psychologists and nurses trained in social work. They provide counseling and help navigating the healthcare system, including coordinating exams and clinician appointments, and dealing with insurance plans and other aspects of addressing the costs of treatment.
One gap remains between CLC and its American counterparts: integrating clinical research. The causes of Chile’s high incidence of gallbladder cancer, which have long been something of a medical mystery, was one research question Hopkins thought it could help answer. CLC is now working with Hopkins to develop protocols that could make inroads into the genetic origins of gallbladder cancer, with CLC sending samples from cancerous gall bladders to collaborating Hopkins researchers. Obesity is another target of collaborative CLC-Hopkins research. CLC has also participated in various international clinical trials, but challenges to performing research remain. The Chilean government’s research-funding arm focuses on basic rather than clinical research. In addition, would-be researchers at CLC don’t have experience in navigating the complex, bureaucratic framework of international pharmaceutical regulations. “The logistics of importing and storing drugs proved to be a huge hurdle,” says CLC oncologist Adaniel.
CLC has forged other helpful international relationships, including a research collaboration with Tokyo Medical and Dental University (TMDU) focusing on secondary prevention of colorectal cancer. In concert with the Chilean Health Ministry, CLC and TMDU established the Latin American Collaborative Research Center within CLC in 2010. The Center has screened more than 15,000 participants and diagnosed 140 patients in three cities across Chile. The institutions have also co-hosted symposium and training courses in Santiago, including a 2011 educational conference that drew over 200 physicians and esophago-gastric and colorectal cancer specialists from across Latin America. In 2015, CLC, TMDU and the University of Chile unveiled a joint MD/PhD program in Medical Sciences. The degree, which is the first of its kind in South America, draws on resources from all three institutions to give students a rigorous education in clinical medicine that requires training in both Chile and Japan.
CLC clinical department heads and other physicians at the hospital have also been reaching out throughout Chile and Latin America to share the expertise gained in the collaborations. Hopkins has helped arrange visits from teams at other Hopkins-affiliated hospitals in the region. And now CLC is looking to share knowledge, training and even care delivery outside of Latin America. “We would really like to expand more on the international stage,” says CEO Grebe. That would provide a chance to pass along the improvements CLC has achieved, to the benefit of other populations around the world.
— Ali Greatsinger
Ali Greatsinger is the senior editor at GHCi.