Models of Care for Survivors of Childhood Cancer From Across the Globe: Advancing Survivorship Care in the Next Decade

Abstract

With improvements in cancer treatment and supportive care, a growing population of survivors of childhood cancer at risk for significant and potentially life-threatening late effects has been identified. To provide a current snapshot of the models of care from countries with varying levels of resources and health care systems, stakeholders in childhood cancer survivorship clinical care and research were identified from 18 countries across five continents. Stakeholders responded to a survey and provided a brief narrative regarding the current state of survivorship care. Findings indicate that among pediatric-age survivors of childhood cancer (allowing for differences in age cutoffs across countries), resources are generally available, and a large proportion of survivors are seen by a physician familiar with late effects in most countries. After survivors transition to adulthood, only a minority are seen by a physician familiar with late effects. Despite the need to improve communication between pediatric oncology and primary care, only a few countries have existing national efforts to educate primary care physicians, although many more reported that educational programs are in development. These data highlight common challenges and potential solutions for the lifelong care of survivors of childhood cancer. Combining risk-based and patient-oriented solutions for this population is likely to benefit both providers and patients.

Childhood cancer survivorship and late effects: The landscape in India in 2020

“…The burgeoning number of childhood cancer survivors in high‐income countries with their morbidity burden necessitated steady and sustained efforts in developing services for their needs. Although there is variation in provision of these services, there is universal agreement on their need 34,35 …”

Re-Engage: A Novel Nurse-Led Program for Survivors of Childhood Cancer Who Are Disengaged From Cancer-Related Care

“…Median length of the first consultation was 68 minutes (IQR, 45-90 minutes [SD,29]), rated by 92% of survivors as "just right" (n523/25). Median length of the second consultation was 11 minutes (range, 7-15 minutes [SD,5]), which all survivors rated as "just right." We did not observe any evidence of a difference in consultation length over the course of the study (P5.420) or by diagnosis (P5.185).…”

“…2 Ideally, survivorship care should be personalized and risk-based 3,4 ; however, the optimal delivery of childhood cancer survivorship care is greatly debated. 5 Current models of survivorship care are inadequate. In many hospitals, the increasing number of survivors outweigh current service capacity, which relies primarily on oncologists.…”

“…In many hospitals, the increasing number of survivors outweigh current service capacity, which relies primarily on oncologists. 5,6 Many pediatric cancer centers are limited to major cities and do not offer lifelong survivorship care, necessitating transition to nonspecialized and adult services, a critical point at which many survivors disengage from care. 6 These factors necessitate new models of care that empower survivors as guardians of their healthcare, ideally with healthcare coordination support.…”

Follow-Up Care for Breast and Colorectal Cancer Across the Globe: Survey Findings From 27 Countries

“… 11 A recent review on the state of survivorship care for childhood-onset cancers across 18 countries highlighted challenges in communication and coordination, particularly in the transition between pediatric and adult care and among low-resource settings. 12 …”