Understanding Childhood Cancer Survivorship: A Qualitative Study on Global Care Approaches.
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PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.