At the forefront of oncological care in Brazil, members of A.C.Camargo Cancer Center’s management team inform us of the institution’s latest projects, programs, partnerships, and investment plans.
THE BEST OF BRAZILIAN ONCOLOGY
Brazil is a country of continental proportions, with more than 200 million inhabitants and upwards of 6,400 public, private, and philanthropic hospitals.
There are circa 12.5 million hospital admissions per year in Brazil, where the public healthcare sector is responsible for most medical-hospital procedures performed.
The private sector in Brazil, meanwhile, has experienced an aggressive movement of mergers and acquisitions in recent years, whilst large healthcare groups have expanded their own networks of hospitals and clinics with the aim of reducing operating costs and expanding capillarity.
However, there are many challenges to overcome, such as financing the public and private health system, the cost of acquiring technologies, the high tax burden on payrolls, and charges on inputs and equipment.
The challenges are even greater in oncology, the study of cancer, where the focus of A.C.Camargo Cancer Center (A.C.Camargo) lies.
“The aging population and introduction of new technologies are cost drivers that compromise the sector’s sustainability,” observes Victor Andrade, CEO of A.C.Camargo.
“The system today is fragmented and inefficient, which makes A.C.Camargo stand out even more in terms of its patient services.”
A.C.Camargo is a freestanding Cancer Center offering everything a patient may need for any type of cancer over the last 70 years. The legacy of A.C.Camargo in South America goes beyond patient care, as many oncologists from different countries and all Brazilian states were educated there. A.C.Camargo has also developed clinical trials, and collected over 100,000 tumor samples for biobank and research projects in genomics. Since the Ludwig Institute from New York joined A.C.Camargo in 1983, genomics has helped to develop diagnosis and treatment locally.
TREATING COMPLEX CASES
A.C. Camargo is the only centralized, specialized and integrated private center for cancer diagnosis, treatment, rehabilitation, teaching, and research that operates under the Cancer Center model in Brazil.
Across 100,000 square meters, three hospitals, one outpatient clinic and one day hospital, as well as research and administrative units, the entire A.C.Camargo complex comprises 449 beds, 184 offices, four surgical centers and four diagnostic centers, including a world class surgical pathology and genomics laboratory.
12 disease centers offering integrated care with over 700 professionals, supported by nurse navigators and tumor boards, are at the forefront of medicine and obtain outcomes comparable or even superior to the very best cancer centers in the US and Europe.
Survival curves for each tumor in almost 99,000 cancer patients treated in the last 20 years are available at the Cancer Observatory, published in January 2023.
“We described all new cases of cancer treated at our institution (including the sociodemographic, epidemiological, clinical patterns of patients and five-year percentage of survival). We are proud of the improvements of survival percentages in each tumor we achieved within the last 20 years,” says Pedreira.
“We treat complex cases, both local and referred, from all over Brazil using minimally invasive surgeries, reconstructions, interventional radiology, liver and bone marrow transplants, CAR-T cell therapy, including the opportunity for patients to be part of phase I to phase III clinical trials.” outlines Andrade.
Since 2013, 4,000 robotic oncological surgeries were performed by A.C.Camargo until December 2022, the most in Latin America, complementing an impressive portfolio of annual data in all areas including 300,000 outpatient visits, 270,000 imaging tests, almost 30,000 infusion sessions, and 20,000 surgical procedures.
“This year, the center carried out its first CAR-T infusion and we pioneered in phase I CART cell clinical trials as well. We are the technical reference for this technology in Latin America and have had several other technological innovation projects within the pharmaceutical industry, including risk sharing and the design of bundle payments.”
In the last 20 years A.C.Camargo has evolved from a cancer hospital to a Cancer Center and is now endeavoring to become an oncology platform that will welcome BioTech, DeepTech, and EdTech, while taking 70 years of accumulated knowledge in oncology to partners and sharing best practices and efficiencies carried by the Cancer Center format.
A.C.Camargo hopes to develop new business at the same time, helping to improve the Brazilian oncology ecosystem.
“Brazilian citizens and payers deserve more outcome data and less waste in healthcare, and we believe we can help,” says Andrade.
Since 2021, the center has also added an immunization service and completely rebuilt the Emergency Room, Endoscopy Center, Pediatric Tumor Unit (both outpatient and inpatient clinics), and the Rehabilitation Unit.
Last year, A.C.Camargo also kickstarted its R$279 million (USD$60 million) investment plan to expand its triple A inpatient and outpatient units, acquire robots, linear accelerators, MRI, CT scans, digital pathology scanners, and update its technological infrastructure, including preparation for the demands on artificial intelligence (AI) and a 5G environment. A new data center, high performance computers, and Data Science team are in place to transform efficiency and the patient experience.
“We have been investing in pertinent and safe care, removing barriers to a more efficient pathway. Even though the NPS index was 90.6 last year, new protocols focusing on a better patient experience are on the way to meet expectations even for premium patients,” says Pedreira.
A.C.Camargo is also investing in digital transformation for faster and more intelligent processes that will save time for patients, doctors and employees.
The center is investing to make its clinical trials unit three times larges to accommodate the number of studies it is expecting from the industry in the coming years. This has positively impacted the number of people treated by A.C.Camargo and will benefit both public and private patients.
SUPPORTING A CANCER NETWORK
A.C.Camargo believes that cancer care requires a high level of integration between providers to match patient complexity with the proficiency of providers. Less complex cases can be treated locally, whereas complex cases deserve to be treated at cancer centers.
A.C.Camargo is building a cancer network to offer the best care as close to a patient’s house as possible. The center started partnering with Sabará Children’s Hospital in São Paulo, a large private not-for-profit pediatric hospital with dozens of cases of cancer diagnosed at the emergency room annually. Despite its specialization and superb infrastructure, cancer is a rare disease at that hospital and A.C.Camargo is now integrating its staff and protocols to better treat each patient, with most complex cancer cases referred to the center.
Recently, A.C.Camargo also signed referral partnerships with Grupo Santa Joana, an OB-GYN specialized hospital in the city of São Paulo and, Hospital Santa Rita, a tertiary general hospital 1,000 kilometers north of São Paulo, as well as several other members of A.C.Camargo’s private cancer network.
It plans to organize and support a solid cancer network formed by a diagnostic laboratory running prevention tests, outpatient clinics, general hospitals, and specialized non-oncologic hospitals and hospices to build a high quality, low waste ecosystem.
STRATEGY AND PROJECTS
In order to understand its value in society and mission for the future, A.C.Camargo last year delved into measuring the epidemiological cancer trends in Brazil. Its clear that oncology in Brazil is a fast-growing market and many new entrants would like to invest. The current challenges point to a higher frequency of oncological cases, rising costs above inflation, and a strangulation of paying resources.
“A.C.Camargo’s 2023-25 strategy is to take advantage of its 70-year knowledge and credibility to help organize the players in a more sustainable way, while enhancing the A.C.Camargo brand as a protagonist in national oncology,” says Andrade.
“We understand the potential of A.C. Camargo to increase the efficiency by addressing cancer in the Brazilian population through education, training, access to prevention, treatment, rehabilitation, and well-being after cancer,” he continues.
For this reason, the center has reformulated its A.C.Camargo Social Impact Program, aiming to increase geographic coverage and the number of beneficiaries, via multiple public-private partnerships.
This innovative program aims to contribute with technical and management assistance from prevention to rehabilitation, supporting municipalities that present major challenges in their oncology services.
“In addition, short- and long-term outcomes, costs and pertinence indicators have been shared with payers hoping we will progress to a value-based payment models,” shares Pedreira.
CANCER SPECIALIZATION FOR THE WHOLE COUNTRY
A.C.Camargo’s priority is to provide patients with the best treatments and protocols available worldwide, which is why the center encourages its physicians and researchers to keep updated on international forums and congresses.
“We are formal partners with cancer centers abroad, such as the Princess Margaret Hospital in Toronto and the Institute Curie in Paris, and the exchange of innovations and best practices is continuous, bringing Brazilians closer to the best oncology in the world,” emphasizes Andrade.
A.C.Camargo has trained doctors in different specialities from various Latin American countries and all Brazilian states since 1953, and is responsible for the specialization and postgraduation of a large proportion of current Brazilian oncologists.
Now, the center plans to move into an open platform of oncology education to reach graduate students and senior professionals, offering life-long learning for everyone interested in oncology in the country. In the first half of 2023, A.C.Camargo announced a partnership with Cogna, the largest education group in Brazil, to expand training opportunities for health professionals in the multidisciplinary treatment of cancer, taking knowledge to all regions of the country.
There is a demand for trained professionals in oncology, and this partnership will enhance A.C.Camargo’s protagonism in the field of education throughout Brazil.
“We just launched three courses, but our intention is to provide dozens of virtual and face-to-face courses in the upcoming years,” reveals Andrade.
“We have different teaching and training tools, from face-to-face training and classes to online courses aimed at all our professional staff.”
One of A.C.Camargo’s objectives is to present the best balance between outcomes and cost for the patient and payers, bringing a sustainable model to healthcare in Brazil.
“For this, we need to continue developing our internal models, and always seek medical, technical, and personal improvement,” says Pedreira.
In addition to these internal objectives, A.C.Camargo wants to work on prevention and early diagnosis, partnering with private companies to educate them on how to take good care of their employees.
With the pharmaceutical industry, A.C.Camargo is working on risk-sharing and market sustainability projects, finding innovative ways to pay more for drugs that work better for the patient and pay less or even nothing for ineffective drugs.
Each of these objectives is evaluated so that, in future, they can serve as a benchmark for the entire health sector.
“We are also advancing other ways of sharing expertise, with a consulting area specialized in oncology,” concludes Pedreira.
As such, it seeks to continue sharing the concepts, knowledge, and skills that it has acquired in 70 years as a Cancer Center with the healthcare market in Brazil and Latin America.