Tatiana Vidaurre is currently chief of Instituto Nacional de Enfermedades Neoplásicas (INEN), Peru’s sole institution dedicated to cancer. She talks about the importance of global collaboration and their ultimate goal of preventing advanced-stage cancer.
INEN’s history dates back to 1939, with a colorful history in Peru throughout the decades. What attracted you to this organization?
INEN is the National Cancer Institute from Peru and essentially has leading action nationwide as a center of excellence for prevention and treatment for comprehensive cancer healthcare, research, specialized training and development, implementation and dissemination of public policies for prevention and cancer control in coordination with the Ministry of Health of Peru.
Our institution is the national gold standard for prevention and oncology healthcare practices. Additionally, the high level of excellence and competence in cancer research and oncology education, technical and regulatory control actions in oncology delivery services for health promotion, prevention, early detection, comprehensive oncology healthcare (multidisciplinary oncology treatment and palliative care) and complementary support is working as a platform support for the Peruvian regions. INEN can be match with the best oncological institutions worldwide. All efforts are devoted to cancer control in Peru and contribute substantially to the global health efforts for cancer control.
Plan Esperanza is a result of 75 years of INEN’s hard work in tandem with the Peruvian Government and civil society, and has been a great technical-scientific challenge. Peru has finally established a National Cancer Control Plan with an original and innovative model based on the perspective of the population and patient. This plan functionally integrates the health sector with independent routes and budgets for cancer control actions like prevention, comprehensive oncology healthcare and decentralization. We address this in a comprehensive, multidisciplinary, multi-institutional and multi-sectorial way, facing in the continuum of health-disease processes with interventions at nationally, regionally, and locally, resulting in actions for cancer control with specific products and goals linked to an intangible public budget measured by results.
Consequently, we will close to the Peruvian community approaching oncology health services, having implemented in all country prevention services for cervical, breast, gastric, colon and prostate cancer. We have mobilized Peruvian society with the health campaign “Tell me everything… about cancer”. This will provide cancer information and create societal awareness regarding healthy lifestyles, early detection and overcoming fear of cancer.
Training through the INEN’s Excellence School has been paramount, as well as partnerships with prestigious oncology scientific networks and global public health organizations worldwide as NCI-US collaborative groups and networks, MDACC Sister Institution Program, IARC, UICC, SWOG, EORTC, RINC-UNASUR, ICCA, IRD, among others. The collaborative work at the national and international level is critical to the success of our institution. We are working hard to change pain for color and hope in thousands of cancer patients’ lives and health.
The ongoing work for technical support to transfer scientific knowledge and innovation to different regions of the country is allowing to consolidate oncology healthcare delivery services’ decentralization with adequate quality and consistent with the different levels of complexity needs using a cultural approach; our pillars for basic prevention services include counseling and basic early detection services for cervical and breast cancer and specialized prevention services include counseling and specialized early detection services for cervical, breast, gastric, colon and prostate cancer. We are promoting services for comprehensive oncology healthcare in general hospitals.
What did you feel you could bring from your experience to INEN?
Increases in the rate of economic growth mean that we need immediate results in the population, either in health or education. Both are very important issues that we must lead. That is why the Ministry of Health is implementing health reform and for cancer control we succeeded through our successful support focus in impoverished people providing full access to prevention and oncology treatments. We decreased out-of-pocket expenses significantly for the poor population, which is important because 75 percent of INEN patients are classified as the poor population of Peru. The change has been drastic, improving their health and lives.
Peruvian financial policies are promoting investment in health and education; now the cancer control budget creates a special way to afford cancer control and is very unique worldwide. In 2009, the national cancer budget amounted to 100 million soles; today it is 650 million soles. That is real investment in cancer control actions. We have generated a very positive response in our country in favor of global cancer control. We also promote multi-sectorial integration. We believe that the unique way to improve cancer control is by working together. We have a good cancer control policy with technical regulation, so interaction between stakeholders can happen easily.
Plan Esperanza has made an unprecedented change in access to comprehensive oncology healthcare on time, opening full coverage for the protection of cancer patients, which is free for the poorest population affiliated at the Comprehensive Health Insurance: SIS-FISSAL (Public Government Insurance), having served freely in two years more than 105,000 people with cancer in poverty around the country. 88,000 of them are INEN patients, being consistent with data of affiliated increments to SIS, at INEN, from 17 percent in 2009 to 65 percent in 2014, which consequently decreases out-of-pocket expenses from 58 percent in 2009 to 7 percent in 2014. This protects patients from Metropolitan Lima (50 percent) and different regions of Peru (50 percent).
We are operating, monitoring, evaluating and following up prevention and cancer control actions by interacting mainly between the Ministry of Health, INEN, the Ministry of Economy, SIS-FISSAL and others. INEN is leading technical support and translating the Plan Esperanza model knowhow by accompanying the implementation and dissemination process into the different levels of government through articulated routes with an independent and intangible cancer budget.
What competitive advantages does INEN offer compared to similar institutes in the Americas?
The quality of our institute is most evident in our professional training. Our strict procedures and high standard healthcare delivery service, education and research allow us to pursue the best oncology practices for public health and this has been fundamental for INEN’s development. We work collaboratively; it is critical to share knowledge, innovation and health technology with other academic science and global health institutions worldwide. Scientist interchanges with initiatives and new ideas are important to the development of the most innovative universal healthcare models and improve technology for health, wellness and life. Furthermore, investment in Plan Esperanza by the Peruvian government to improve INEN’s modernization and innovation has been fruitful. Laboratories and health technology have improved dramatically, particularly considering that cancer requires a cellular/molecular approach working with advanced and complex technology. That is way providing the best technology for all Peruvians despite age, location or socio economical status is very important. For that, INEN serves as oncology platform for the whole country, and it is fundamental that our standards are replicated throughout the health system in the country. By repeating what we do in Lima in the various regions of Peru, we can better promote good oncology practices for everybody. That is why we invest significantly in education and research; people can improve in professional competitiveness and build capacities and competences step-by-step for a productive system and a high quality oncology health network.
One of the big trends in cancer research today is personalized medicine. How actively does INEN engage in this?
We are doing a lot of work in this area. INEN belongs to a number of academic science networks and collaborative groups for cancer research; many of them focus on molecular oncology for genomics, translational research and clinical trials. LATAM countries need to be involved in research for oncology development and translate science to evidence-based public health actions. Personalized medicine based on genetics and genomics are related to the wide demographics and epidemiologic data associated with bio-molecular concepts for each country. That is why we started this project a long time ago, and INEN is now producing data on this subject. Molecular oncology is a key focus in research and oncology healthcare services implementation in our institute, and we are expanding similarly in the new cancer institute network. We are expanding our capacity for cancer institutes in the north and south of Peru (La Libertad and Arequipa), and we are going to build in the Andean mountains (Junín) and the Amazon jungle (Loreto). These institutes must be developed in education and research, translating knowledge, innovation and technology for the Peruvian macro-regions. INEN is also building an outpatient tower for minimal invasive procedures and personalized and precision medicine into our campus. We believe that if we continue with this approach, our close future is promising, our health professionals and scientists around the country will be better trained and they will have the opportunity to exchange experiences outside the country. INEN is part of MDACC sister institutions academic program, NCI US-LCNR and another important academic science networks mainly in the US, Europe and Latin America. We often send Peruvian scientists, medical doctors and molecular biologists, to these institutions to collaborate with the world’s best. Our scientists are going primarily to the US, Spain, Brazil, Mexico, France, UK, and Japan; but we are always open for any academic science opportunity worldwide to learn from each other and we are promoting south-south cooperation too. It is part of our protocol for a new science initiative or new health technology implementation. In just a few years we will have implementing groundbreaking health technology in areas like 3D and 4D conformal radiation (VMAT, IGMRT), high dose rate brachytherapy, intraoperatory radiation, radiation surgery, bone marrow transplant, molecular diagnostic, automated labs, digital radiology, informatic solutions, surgery and clinical advance technology. We do this in tandem with the implementation of molecular techniques for early detection, precision medicine, diagnostic, personalized treatment and complementary support. The INEN organization is unique in Peru and in the world; that is why we think it is crucial for us to share experiences between peers for cloning the best practices to keep building a good health oncology delivery system. This will be according to each reality in a global network for universal patient safety, called by us molecular management for improving global public health quality. As chief of INEN I must share with everybody our oncology global public health experiences for the continuity of these actions and actively maintain our INEN School. That is why we work together with various oncology and global heath institutions, with the civil society organizations and different cancer control stakeholders and must work together in multidisciplinary teams to joint actions with the whole health sector in Peru, in UNASUR National Cancer Institutes Network (RINC), in the US and European oncology science and cancer control networks and in any global initiative for prevention and cancer control worldwide.
What would you like to achieve by 2020?
I want to see Peru free of advanced cancer, with universal coverage and comprehensive cancer healthcare, delivering oncology services throughout the whole country. That is the INEN mission and the main vision of the Plan Esperanza to build a strong health delivery oncology system step-by-step, throughout the country improving protection for people health and cancer patients’ lives.