Global Scholars: Dr. Joaquim Caetano de Aguirre Neto

Brazil's de Aguirre Neto Accelerates Latin American Kidney Tumors Network

Two things led Dr. Joaquim Caetano de Aguirre Neto to practice medicine: his mother and his mindset.

His mother had worked as a nurse, and she passed her love of the healthcare field on to her son, who knew at a young age that he wanted to be a doctor.

Around the age of 17, Dr. de Aguirre Neto also realized that he was motivated by the kinds of things that overwhelm most people. He set his sights on the challenges of getting into medical school, completing the rigorous training, and becoming a doctor in his native Brazil. Beyond enjoying the technical challenge, he reasoned that practicing medicine would give him the opportunity to interact with the people he helped, where other equally challenging professions might not.

“I like to have contact with other people — and try to help them,” he says. “And because it was very difficult, I said, ‘OK, let’s try that.’”

In medical school, he was invited to complete a clinical fellowship in general oncology at the Hospital Santa Casa de Belo Horizonte, treating both children and adults. “And, of course, nobody would like to work with children because it is overwhelming to see children suffering,” Dr. de Aguirre Neto remembers. “The cases are very difficult.”

Typically, he says, the pediatric oncology work would fall to the last person to join the fellowship. Again, he was drawn to the challenge — and, eventually, was surprised to discover that he had a knack for helping these patients and their parents. His sense of compassion trumped the fears that may have caused others to avoid pediatric oncology. It also fueled him to do the best job he could for those in his care.

While honing his ability to communicate with and treat this very specific population, Dr. de Aguirre Neto saw firsthand the need for oncologists who were trained specifically in pediatrics. As his education continued, he left the Hospital Santa Casa de Belo Horizonte to pursue a pediatric oncology residency in Sao Paulo. Ultimately, he returned to the hospital where he had completed his fellowship, becoming the first oncologist on staff to be fully trained in pediatrics. Dr. de Aguirre Neto was eventually joined by five other pediatric oncologists, and together, they treat more than 100 patients a year.

As Dr. de Aguirre Neto pursued his practice, one of the issues that drew his attention was the treatment of renal tumors in pediatric patients. Statistically, children with kidney tumors have a lower survival rate in Brazil than in many high-income countries. Dr. de Aguirre Neto noted that accurate diagnosis is a particularly key issue, along with challenges like a family’s access to specialty care.

With an eye toward addressing these challenges, Dr. de Aguirre Neto serves as a coordinator of the Brazilian Renal Tumor Group (GBTR), which has started to work in collaboration with the Latin American Group of Paediatric Oncology. In an attempt to improve the accuracy of diagnosis across the region, they began to explore creating a network among Latin American countries.

When he learned about the Global Scholars Program, he recognized it immediately as a sort of worldwide version of what they’d set out to do in the collaboration.

“When I saw the aim of the Global Scholars [program], I said, ‘Oh, I think that fits exactly what I’m trying to do, to accomplish,’ ” he says. “Not … only local in my hospital, but to expand to the national level, to the Latin America level, and to kind of a global level.”

So Dr. de Aguirre Neto applied to — and was accepted into — the St. Jude Global Scholars Program. He was drawn to methodologies around implementation science and quality improvement — and “how to transform the knowledge … to be implemented in the real world.” For his accompanying scholars project, he turned his attention back to the regional collaboration and the issues surrounding treating renal tumors in pediatric patients.

One issue he noted was that, in a given year, a center might see just four or five cases of Wilms tumors in young patients. This provides a limited sample size from which to draw inferences. So Dr. de Aguirre Neto’s project focuses on accelerating a regional kidney tumors network in Latin America, with the goal of creating opportunities for a multidisciplinary group to benefit from each other’s experiences.

Dr. de Aguirre Neto hopes the collaboration — which includes clinicians, surgeons, radiation oncologists, pathologists, radiologists, and more — can allow colleagues to discuss findings and observations from their cases, creating a fuller picture than just four or five cases a year would provide. “The group can discuss that number of cases in a single meeting, while also introducing relevant literature, sharing findings and experiences, and hearing from other experts from around the world. It's a way to learn how to manage the patient very fast,” he says. “And when you put together all this knowledge, you have a very, very robust, nice collaboration that benefits the patient.”

As part of his project, Dr. de Aguirre Neto is working to make the collaboration more efficient, to improve the dynamics of the multidisciplinary gatherings, and to “normalize the evidence-based decision care.” The Global Scholars Program has provided him with new skills and new frameworks for tackling challenges, he says. And he’s also found a sense of global community and developed friendships with people doing similar work thousands of miles away.

The program, he concludes, has opened his mind to a new, beautiful way of seeing the world. “You are not competing for knowledge, competing for titles. … Everyone is looking for solutions, trying to innovate, in how to bring better care, better survival, better outcomes for children worldwide.”