Understanding Childhood Cancer Survivorship: A Qualitative Study on Global Care Approaches

Survival rates for childhood cancer have improved substantially worldwide. Although survivorship begins at cancer diagnosis, the concept of survivorship care often begins 2-5 years from cancer diagnosis. Despite the availability of evidence-based survivorship guidelines, their implementation remains inconsistent, particularly in low- and middle-income countries. This study aimed to characterize clinicians' survivorship care practices, goals, perceived barriers, and tools/needs across variably resourced global settings to inform strategies for sustainable, equitable survivorship care.

We conducted semistructured interviews with physicians, psychologists, and nurses responsible for childhood cancer survivorship care across diverse health care settings. Participants were recruited across all six WHO regions and represented a range of clinical disciplines and survivorship program maturity levels. Interviews explored care delivery models, survivorship goals, institutional support, and barriers to implementation. Rapid qualitative analysis was performed using a structured matrix approach. Findings were stratified by country income classifications to contextualize resource-related differences.

Thirty-one clinicians from 26 countries participated, representing low- (70.9%), middle- (6.5%), and high-income (22.6%) settings. Survivorship care models varied, ranging from structured, multidisciplinary programs to informal follow-up. Regardless of setting, clinicians shared a common goal of monitoring survivors to optimize long-term health and quality of life. Key barriers included limited funding, workforce shortages, inadequate institutional support, challenges with patient access and follow-up, and difficulties implementing complex survivorship guidelines. Clinicians from lower-resourced settings emphasized the need for adaptable care models and simplified, context-appropriate guidelines, whereas those from higher-income settings reported competing priorities and workforce constraints.

Global childhood cancer survivorship care is highly variable but united by shared goals. Overcoming barriers requires context-adapted guidelines, strengthened institutional support, workforce development, and patient-centered tools. Prioritizing survivorship care everywhere is essential to achieving equitable long-term outcomes for childhood cancer survivors worldwide.