A new law in Chile’s national health system offers a centralised approach to paediatric cancer treatment. Securing national healthcare policies in legal mandates can help ensure long-term improvements in outcomes.
Securing national healthcare policies in legal mandates can help ensure long-term improvements in cancer treatment and outcomes. Photo: Alejandra De Lucca V
Chile has made remarkable progress in childhood and adolescent cancer, driven by a collaborative effort between the government, healthcare teams, and civil society. Over the years, these partnerships have been pivotal in establishing public policies that aim to control cancer in children and adolescents, with universal healthcare coverage playing a crucial role in improving outcomes.
Chile’s journey towards better cancer care for children began with the creation of the Group of Pediatric Oncologists of Chile (GOPECh) in 1978. This group marked the start of a nationwide effort to improve paediatric oncology. In 1989, the establishment of the Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), or the National Children’s Program for Antineoplastic Drugs, further solidified these efforts, setting up standardised protocols for childhood cancer treatment. However, it wasn’t until 2004 that cancer treatment for individuals under 15 years of age was fully integrated into Chile’s national health system through the GES Law No. 19,966 (Explicit Health Guarantees Regime).
This law was a milestone in childhood cancer care. It guarantees financial protection, access, and timely care for both public and private healthcare beneficiaries. Under this system, approximately 80% of the population, primarily those in the public health sector, benefits from a comprehensive package of services covering diagnosis, treatment, follow-up care (up to 10 years post-discharge or until the patient turns 18), and palliative care. These health packages are not static; they are reviewed and updated every three years to incorporate advancements in medical evidence, emerging healthcare technologies, and improvements in treatment protocols.
Over time, this structured approach to childhood cancer care has led to notable improvements in survival rates. According to Chile’s latest epidemiological report for 2017–2019, the five-year survival rate for childhood cancer stands at 78.4%. This achievement reflects the significant impact that universal healthcare coverage and well-defined treatment packages have had on childhood cancer outcomes in Chile.
Implementation of the National Cancer Control Plan
Chile has become the first country in South America to implement a National Cancer Control Plan exclusively for children and adolescents under the National Cancer Law No. 21,258. This pioneering plan is structured around the four pillars (centres of excellence, universal coverage, treatment regimens, and evaluation and monitoring) and the three enablers (governance, funding, and advocacy) of the cure-all framework.
Our focus is on early diagnosis, equitable access to diverse treatment options (including innovative therapies), and comprehensive, ongoing care from diagnosis to follow-up. This includes strengthening primary healthcare teams through national training and education programs, community awareness campaigns, increased coverage for adolescents aged 15 to 19, and updated health packages and clinical practice guidelines.
The importance of having legislation that directly supports cancer care cannot be overstated. It ensures that national policies are grounded in legal mandates, holding the government accountable for providing necessary healthcare services. By enshrining cancer care in law, Chile has taken a crucial step toward securing long-term improvements in cancer treatment and outcomes.
There remain pressing issues that any national plan should address age-specific health packages for adolescents and specialised healthcare teams trained in adolescent care will be critical, as will the inclusion of new treatments and technologies like immunotherapy, targeted therapies, and personalised medicine. Chile’s healthcare system must remain flexible to incorporate new health technologies and ensure that its cancer care is aligned with global best practices.
The National Cancer Law No. 21,258 provides a comprehensive framework to centralise and improve cancer care across the country, including childhood and adolescent cancers. A National Cancer Control Plan under this law must focus on ensuring equitable access to care across all regions, reducing disparities in treatment and ensuring that the latest medical advancements reach all patients. This plan should also prioritise strengthening palliative care services, offering psychological support, and providing long-term follow-up for survivors.
The role of civil society is also crucial in maintaining the government’s commitment to childhood and adolescent cancer care. Civil society organisations, patient advocacy groups, and healthcare professionals must continue to push for improved policies and hold the government accountable for ensuring that cancer care remains a national priority. For example, in 2017 parents of children with cancer successfully lobbied for mandatory insurance for working parents of children affected by a serious health condition; similar advocacy will be instrumental in ensuring that the National Cancer Control Plan is implemented efficiently and that the needs of children and adolescents with cancer are met.
Chile’s progress in childhood cancer care, driven by universal healthcare coverage and well-structured public policy, has resulted in substantial improvements in survival rates and patient outcomes. With a five-year survival rate of 78.4%, the country is making great strides in providing equitable cancer care to its youngest citizens. To sustain these achievements and ensure further progress, it is crucial to address the gaps in care for adolescents, expand GES coverage, continue developing specialised care teams, and support patient advocacy.
As Chile implements its National Cancer Control Plan under the new Cancer Law, the nation has an opportunity to lead the way in Latin America in providing comprehensive, equitable cancer care for children and adolescents. By focusing on these future challenges, Chile can continue to build on its successes and further improve outcomes for all young cancer patients.
The opinions expressed are those of the authors and do not necessarily reflect the position of Re:solve Global Health.
Julia Palma Behnke; MD is a paediatric hemato-oncologist with training in hematopoietic stem cell transplantation in Barcelona. She is Assistant Professor of Pediatrics at the University of Chile, National Coordinator of the Pediatric Oncology Group (PINDA), and cancer advisor at the Ministry of Health of Chile.
Orietta Candia, MSc is a dentist with a master’s degree in public health from the University of Chile who works on the childhood and adolescent cancer team at Chile's Ministry of Health.
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