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. 2025 Jun;19(3):1-17.
doi: 10.1007/s11764-023-01517-8. Epub 2024 Jan 6.

Physical late effects of treatment among survivors of childhood cancer in low- and middle-income countries: a systematic review

Kevin A Wong  1 , Alexandra Moskalewicz  2 , Paul C Nathan  2 , Sumit Gupta  2 , Avram Denburg  3
Affiliations

Physical late effects of treatment among survivors of childhood cancer in low- and middle-income countries: a systematic review

Kevin A Wong et al. J Cancer Surviv. 2025 Jun.

Abstract

Purpose: Physical late effects of treatment are well-documented among childhood cancer survivors in high-income countries, but whether prevalence and risk factors are comparable in low- and middle-income countries (LMICs) is unclear. We conducted a systematic review to assess physical late effect outcomes among childhood cancer survivors in LMICs.

Methods: Five health sciences databases were searched from inception to November 2022 in all languages. We included observational studies conducted in LMICs that evaluated physical late effects of treatment in childhood cancer survivors. Mean or median cohort follow-up must have been ≥ 5 years from original cancer diagnosis.

Results: Sixteen full articles and five conference abstracts were included. Studies were conducted in lower-middle (n = 12, 57%) or upper-middle income (n = 9, 43%) countries; nearly half (n = 9, 43%) were conducted in India. Five cohorts (24%) were comprised entirely of 5-year survivors. Subsequent malignant neoplasms were reported in 0-11% of survivors (n = 10 studies). Hypothyroidism and metabolic syndrome prevalence ranged from 2-49% (n = 4 studies) and 4-17% (n = 5 studies), respectively. Gonadal dysfunction ranged from 3-47% (n = 4 studies). Cardiac dysfunction ranged from 1-16% (n = 3 studies). Late effects of the musculoskeletal and urinary systems were least investigated.

Conclusions: Substantial knowledge gaps exist in LMIC childhood cancer survivorship. No low-income country data were found. In middle-income countries, late effects were defined and assessed variably and limited by selection bias and small sample sizes.

Implications for cancer survivors: Survivors in LMICs can experience physical late effects of treatment, though additionally systematically collected data from survivor cohorts are needed to fill knowledge gaps.

Keywords: Childhood cancer; Late effects of cancer treatment; Physical health; Survivorship.

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Conflict of interest statement

Declarations. Ethics approval: Ethics approval was not required as this was a systematic review. Consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: Paul C. Nathan is an associate editor for the Journal of Cancer Survivorship. All other authors have no relevant financial or non-financial interests to disclose.

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