Cancer survivorship in low- and middle-income countries: challenges, needs, and emerging support strategies

Abstract

Cancer survivorship has become a critical global health issue, with survival rates on the rise in both high-income countries (HICs) and low- and middle-income countries (LMICs). Cancer survivors, encompassing individuals from diagnosis onward, face unique and complex health challenges that necessitate tailored care. In HICs, survival rates have increased due to advances in diagnosis and treatment, prompting robust survivorship programs addressing late effects and long-term quality of life. In LMICs, however, disparities in healthcare access, infrastructure, and support systems hinder comparable progress in survivorship care, particularly outside urban areas. LMIC survivors often contend with financial barriers, limited access to follow-up care, and significant psychosocial and rehabilitative gaps. Specialized survivorship centers are rare, and resources for addressing late effects are constrained, impacting survivors' long-term wellbeing. Emerging studies, primarily from middle-income nations, identify late effects such as endocrine and metabolic disorders, though robust, comprehensive data remain scarce. For childhood cancer survivors, late effects like chronic viral infections and cognitive impairments are documented, yet systematic follow-up remains limited. To bridge these gaps, LMICs require innovative care models, such as non-profit partnerships and community-based interventions, to meet the complex needs of survivors. In Brazil, we've highlighted successful programs including the Mais Médicos program for increased care capacity and DATA-SUS as a model registry. This review synthesizes available literature on cancer survivorship in LMICs, evaluating challenges and successful practices across diverse regions. Addressing these needs is crucial for improving survivorship care, particularly in regions where socioeconomic disparities amplify the challenges of post-cancer recovery.

Keywords: cancer survivorship; health disparities; late effects; low-and middle-income countries (LMICs); quality of life.

Figure 1

Global map with pie-charts presenting the most incident types of cancer by region (–83). It's important to note that regions with higher Human Development Index (HDI) and high-income countries (HIC), such as Northern America, Europe and Oceania, have a predominance of lifestyle related malignancies (lung and colorectum cancer, for example); whereas regions with lower HDI and low- and middle-income countries (LMIC), such as Africa, Asia, Latin America and the Caribbean, have more infection-related malignancies (cervix uteri and liver cancer, in particular).

Figure 2

A conceptual diagram which summarizes the most important Challenges faced by cancer survivors in LMICs and the possible interventions that may improve care provided for patients.