Dos Anjos Gustavo Rodrigues, Machado Guilherme Falcao, de Barros Cassiano Pereira, de Andrade Victor Piana, Maciel Rui Monteiro de Barros, Cunha Lucas Leite
Emergency and Evidence-Based Medicine Unit, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Front Public Health. 2025 Jul 16;13:1601483. doi: 10.3389/fpubh.2025.1601483. eCollection 2025.
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 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.
癌症生存已成为一个关键的全球健康问题，在高收入国家（HICs）和低收入及中等收入国家（LMICs），生存率都在上升。癌症幸存者，从确诊起就涵盖了各类人群，面临着独特而复杂的健康挑战，需要量身定制的护理。在高收入国家，由于诊断和治疗的进步，生存率有所提高，促使开展了强有力的生存计划，以应对后期影响和长期生活质量问题。然而，在低收入及中等收入国家，医疗保健可及性、基础设施和支持系统方面的差距阻碍了生存护理方面取得类似进展，尤其是在城市以外地区。低收入及中等收入国家的幸存者常常面临经济障碍、后续护理机会有限以及严重的心理社会和康复差距。专门的生存中心很少见，应对后期影响的资源也很有限，影响了幸存者的长期福祉。主要来自中等收入国家的新兴研究发现了内分泌和代谢紊乱等后期影响，不过全面、详尽的数据仍然稀缺。对于儿童癌症幸存者，慢性病毒感染和认知障碍等后期影响已有记录，但系统的随访仍然有限。为了弥合这些差距，低收入及中等收入国家需要创新护理模式，例如非营利性伙伴关系和基于社区的干预措施，以满足幸存者的复杂需求。在巴西，我们重点介绍了一些成功的项目，包括提高护理能力项目和作为示范登记处的统一医疗系统数据库（DATA - SUS）。本综述综合了低收入及中等收入国家癌症生存方面的现有文献，评估了不同地区的挑战和成功做法。满足这些需求对于改善生存护理至关重要，特别是在社会经济差距加剧癌症后康复挑战的地区。
