Childhood Cancer Survivorship Globally: A Systematic Review

Area of Science:

• Global Health
• Oncology
• Epidemiology

Background:

• Childhood cancer survival rates are increasing globally, creating a growing population of survivors at higher risk of long-term health issues.
• Existing childhood cancer survivorship research lacks a global summary, particularly comparing high-income countries (HICs) and low- and middle-income countries (LMICs).

Purpose of the Study:

• To systematically review and describe the global distribution of childhood cancer survivorship research.
• To analyze research by country of origin, study focus, and survivorship domains, comparing HICs and LMICs.

Main Methods:

• A systematic review of studies published between 1980 and 2021 was conducted using multiple databases (Global Index Medicus, CAB Direct, Embase, PubMed).
• Studies were included if they focused on childhood cancer survivors (diagnosed before age 20) and assessed survivorship outcomes or multimorbidity.
• Data were categorized by country income group, WHO region, and survivorship domains (mental, physical, psychosocial health, recurrences, new cancers, health promotion).

Main Results:

• 1558 studies from 43 countries were included, with a disproportionate representation from HICs (95.2%) and WHO American/European regions (92.5%).
• The proportion of research from LMICs increased over time.
• Physical effects were the predominant survivorship domain studied, especially in LMICs compared to HICs. Studies in HICs had larger sample sizes and broader data sources.

Conclusions:

• The current body of childhood cancer survivorship research does not adequately represent the global survivor population.
• Equitable long-term outcomes for all childhood cancer survivors worldwide require enhanced support for research in underrepresented regions and diverse study areas.