Coordinating Cancer Care Between Cuba and the U.S.: A Guide for Patients and Oncologists

The Dual-Team Care Model

American cancer patients who travel to Cuba for immunotherapy enter a dual-team care model — they continue to be managed by their U.S. oncologist while receiving Cuban immunotherapy that is not available in the United States. This model is increasingly common in international medical travel, but it requires deliberate coordination to be safe and effective.

The principle is straightforward: Cuban immunotherapy (CIMAvax-EGF, Vaxira, CIMAher) is complementary to — not a replacement for — standard U.S. oncology care. The Cuban treatment is added to the patient's existing care plan, not substituted for it. This means the patient's U.S. oncologist remains the primary treating physician, and the Cuban oncology team serves as a specialized consulting team providing access to treatments unavailable in the U.S.

For this model to work safely, three coordination pillars must be in place: 1. Pre-treatment coordination — The Cuban team reviews the patient's complete medical records before travel to confirm eligibility and design a treatment plan. 2. During-treatment communication — The Cuban team shares treatment progress with the U.S. oncologist and the patient receives coordinated care. 3. Post-treatment continuity — A comprehensive treatment report, telemedicine follow-up, and a maintenance therapy plan ensure that the U.S. oncologist can continue coordinated care after the patient returns home.

SMC Salud's coordinators facilitate all three pillars, serving as the communication bridge between the Cuban and U.S. medical teams. This guide explains how the coordination works and what American patients and their oncologists can expect.

Pre-Treatment: Medical Record Review and Eligibility

Before an American patient travels to Cuba, the Cuban oncology team conducts a comprehensive medical record review to determine eligibility and design a personalized treatment plan. This pre-treatment coordination is essential — it ensures that the patient is a suitable candidate for Cuban immunotherapy and that the treatment plan is appropriate for their specific cancer.

Required documentation from the U.S. oncologist: • Pathology report — Confirming cancer type and histological subtype (e.g., non-small cell lung cancer — adenocarcinoma vs. squamous cell carcinoma). • Staging documentation — CT, MRI, and/or PET scan reports showing the current extent of disease. • Treatment history — Complete record of all prior treatments, including: - Chemotherapy regimens (specific drugs, doses, dates, and response assessment) - Radiation therapy (sites, doses, dates) - Surgery (procedures, dates, pathology) - Immunotherapy or targeted therapy (drugs, dates, response, side effects) • Molecular profiling — EGFR mutation status, ALK rearrangement, ROS1, PD-L1 expression, and other relevant biomarkers (increasingly standard in U.S. NSCLC care). • Tumor markers — Including EGF blood levels if available (relevant for CIMAvax-EGF). • Current imaging — Recent CT or PET scans (preferably within the last 4-6 weeks) on CD or via secure upload. • Current medications and overall health status — Complete medication list, comorbidities, performance status (ECOG score), and recent blood work (CBC, comprehensive metabolic panel). • Treating oncologist's contact information — Name, practice, phone, and email for direct coordination.

The review process: 1. Document submission — The patient or family submits all medical records through SMC Salud's secure consultation portal. SMC Salud's medical coordination team reviews the documents for completeness and assists with translation if needed. 2. Oncology team review — Cuba's oncology specialists at CIM and partner hospitals review the case, typically within 24-48 hours of complete documentation. 3. Eligibility determination — The team determines whether the patient meets criteria for CIMAvax-EGF, Vaxira, or CIMAher, based on cancer type, stage, prior treatment response, overall health, and biomarker status. 4. Treatment proposal — If eligible, a personalized treatment proposal is issued with timeline, treatment plan, and transparent cost breakdown. 5. U.S. oncologist communication — With the patient's consent, SMC Salud can share the Cuban treatment proposal with the U.S. oncologist for their input and to ensure coordinated care.

If the patient is not a suitable candidate — for example, if the cancer type is not appropriate, if first-line treatment has not been completed, or if there are contraindications — the Cuban team provides an honest assessment and does not recommend treatment. This integrity is fundamental to SMC Salud's approach.

During Treatment: Coordinated Care in Cuba

While the patient is receiving treatment in Cuba, the Cuban oncology team manages the immunotherapy program and coordinates with the patient's U.S. oncologist as needed. The treatment program follows a structured protocol:

Phase 1 — Arrival & Oncology Evaluation (3-5 days): • Comprehensive review of all medical records, imaging, and pathology • Physical examination by Cuban oncologist • Blood tests including EGF levels (for CIMAvax-EGF), tumor markers, CBC, and metabolic panel • Treatment plan confirmation and informed consent • Baseline assessments documented for progress tracking

Phase 2 — Induction (2-4 weeks): • Initial immunotherapy doses administered in the clinical facility • Medical monitoring for immune response (antibody titers for CIMAvax-EGF) and side effects • Supportive care and symptom management • Regular progress assessments documented

Phase 3 — Maintenance Planning: • The Cuban team designs a maintenance therapy plan (ongoing doses) • Some patients continue maintenance during return visits to Cuba • For others, the maintenance plan is coordinated with the U.S. oncologist for local administration or monitoring

Communication during treatment: • SMC Salud's English-speaking coordinators provide regular updates to the patient and family. • With the patient's consent, the Cuban team can communicate with the U.S. oncologist during the treatment period if clinical questions arise. • If any significant clinical events occur (adverse reactions, disease progression, new findings), the Cuban team communicates with the U.S. oncologist to ensure coordinated decision-making. • The patient's U.S. oncologist remains the primary treating physician — the Cuban team does not make changes to the patient's U.S. treatment plan without coordination.

Accommodation and support: • Accommodation for the patient and an accompanying family member near the treatment facility. • English-speaking coordinators available throughout the stay. • Airport pickup and all logistical coordination handled by SMC Salud. • Cultural and dietary accommodations for American patients.

The goal during treatment is to provide the Cuban immunotherapy safely and effectively while maintaining continuity with the patient's U.S. care. The Cuban team does not replace the U.S. oncologist — they provide specialized immunotherapy access that complements U.S. care.

Post-Treatment: Continuity of Care and Telemedicine

After the patient completes the induction phase in Cuba and returns to the United States, the continuity-of-care process ensures that the U.S. oncologist has all the information needed to continue coordinated care. This is the most critical phase of the dual-team model, as the patient will receive ongoing care from their U.S. oncologist while maintaining connection with the Cuban team.

Comprehensive medical report: • The Cuban oncology team provides a detailed treatment report documenting: - All assessments performed (physical exam, blood work, imaging, biomarker testing) - Immunotherapy administered (drug, doses, dates, route) - Immune response data (anti-EGF antibody titers for CIMAvax-EGF) - Treatment tolerance and any adverse events - Clinical status at discharge - Recommendations for maintenance therapy and follow-up - Restaging imaging recommendations (when to repeat CT/PET) • This report is designed to be shared directly with the patient's U.S. oncologist. • SMC Salud provides the report in a format suitable for U.S. medical records and can provide English translation.

Maintenance therapy coordination: • For CIMAvax-EGF and Vaxira, maintenance doses are typically administered periodically (monthly or as determined by the oncology team). • Some patients return to Cuba for maintenance doses; others coordinate with their U.S. oncologist for local monitoring. • The Cuban team provides a clear maintenance schedule and protocol. • SMC Salud's coordinators facilitate scheduling of return visits if needed.

Telemedicine follow-up: • Remote consultations with the Cuban oncology team allow ongoing monitoring and communication. • Telemedicine is particularly valuable for: - Reviewing follow-up imaging and blood work - Adjusting the maintenance therapy schedule - Answering questions from the patient or U.S. oncologist - Monitoring for disease progression or treatment response - Coordinating with the U.S. oncologist on any changes to the treatment plan • These consultations are scheduled through SMC Salud's coordinators, who provide interpretation and logistical support.

Restaging and monitoring: • The Cuban team provides recommendations for when to repeat imaging (CT/PET) and tumor markers. • These restaging studies are typically performed in the U.S. (covered by U.S. insurance) and shared with the Cuban team via telemedicine. • This allows both teams to assess treatment response and make coordinated decisions about ongoing care.

The U.S. oncologist's role: • Remains the primary treating physician throughout the process. • Continues to manage all aspects of the patient's cancer care not related to Cuban immunotherapy. • Receives the comprehensive treatment report and maintenance recommendations from the Cuban team. • Participates in telemedicine consultations if clinical questions arise. • Makes decisions about ongoing U.S. treatments (chemotherapy, radiation, other immunotherapy) in coordination with the Cuban team's input.

This dual-team model, when well-coordinated, provides American patients with access to Cuban immunotherapy while maintaining the continuity and safety of their U.S. oncology care. SMC Salud's coordinators are the essential bridge that makes this coordination possible — facilitating communication, documentation, and care planning across the two medical systems.