{"entity":{"id":"rejuv-access-survivorship-care-lmic","kind":"technology","name":"After treatment in low and middle income countries: mostly nothing","aka":[],"tldr":"Most people in the world who survive cancer are offered no survivorship care at all. Specialist centres are rare, follow-up is limited, late effects are poorly documented, and the household pays. This is the largest gap in recovery care anywhere, and the one with the thinnest evidence base.","summary":"Survival after cancer is rising in low and middle income countries, which means the number of people living with the consequences of treatment is rising too. What exists to meet them is very little, and the literature describing it is correspondingly thin, which is itself part of the finding.\n\nWhat the published review states. A synthesis of the available literature on cancer survivorship in low and middle income countries describes disparities in healthcare access, infrastructure and support systems that hinder comparable progress in survivorship care, particularly outside urban areas, with survivors contending with financial barriers, limited access to follow-up care and significant psychosocial and rehabilitative gaps. It states directly that specialised survivorship centres are rare and resources for addressing late effects are constrained. On the evidence base itself: emerging studies, mostly from middle-income countries, identify late effects such as endocrine and metabolic disorders, but \"robust, comprehensive data remain scarce\", and for childhood cancer survivors late effects including chronic viral infections and cognitive impairment are documented while \"systematic follow-up remains limited\".\n\nWhy this matters for everything else on this front. Nearly every number elsewhere in this file, every minimally important difference, every late-effect incidence, every randomised trial of symptom monitoring, comes from high-income countries. The epidemiology of late effects after treatment differs where treatment protocols, supportive care, infection burden, nutrition and comorbidity differ, so those numbers cannot simply be transported. When this corpus quotes a figure for a late effect, the population it came from is part of the figure.\n\nWhat is being tried. The review points to non-profit partnerships and community-based interventions as the models being attempted, and names Brazilian examples including workforce expansion programmes and the national health system data infrastructure used as a registry model. Task-shifting to nurses and community health workers, which is the general answer to workforce shortage in these settings, applies here too.\n\nWhat would change the picture, in order of what is missing. A count: how many people are alive after cancer treatment, where, and with what. Registries capable of following them. Late-effects data generated locally rather than borrowed. And some version of the cheapest things on this page, a treatment summary the person keeps, a named contact, and the functional measures that need nothing but a corridor and a dynamometer.\n\nThis record deliberately carries fewer numbers than the others in this section. That is the honest representation of the evidence, and the gap is the finding.","status":"emerging","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Global_health","links":[{"label":"dos Anjos et al., Cancer survivorship in low- and middle-income countries: challenges, needs, and emerging support strategies (Front Public Health 2025)","url":"https://doi.org/10.3389/fpubh.2025.1601483"},{"label":"Nekhlyudov et al., Developing a quality of cancer survivorship care framework: implications for clinical care, research, and policy (JNCI 2019)","url":"https://doi.org/10.1093/jnci/djz089"}],"tags":["rejuvenation","survivorship","measurement","access","global"],"related":["rejuv-access-what-it-costs-elsewhere","rejuv-paed-chronic-disease-burden"],"cancers":["cervical","breast-hr-positive","all-leukemia","hodgkin-lymphoma"],"sections":["rejuvenation","supportive-care"],"technologies":["global-oncology-access","survivorship-care-plan","rejuv-access-who-misses-out","oncology-nursing","rejuv-measure-functional-tests"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects","quality-of-life","financial-toxicity"],"trials":[],"people":[],"bottlenecks":["b-global-access","b-survivorship","b-rare-cancers"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Survivorship care is the part of cancer care that is cut first when resources are scarce, because its benefits are diffuse, delayed and measured in outcomes nobody is counting. Where there is no register of survivors, there is no denominator, and without a denominator there is no accountability for what they are offered.","strengths":["The gap is now described in the literature rather than ignored","The cheapest interventions on this front need no equipment and could be deployed","Task-shifting and community-based models are being attempted and reported"],"limitations":["Specialised survivorship services are rare and concentrated in cities","Comprehensive late-effects data are scarce, so high-income figures are being borrowed","Systematic follow-up of childhood cancer survivors is limited","Household out-of-pocket costs fall on the family","This record carries few numbers because few exist"]},"route":"/technologies/rejuv-access-survivorship-care-lmic/","neighbours":{"technology":[{"id":"global-oncology-access","kind":"technology","name":"Global oncology and access in low- and middle-income countries","route":"/technologies/global-oncology-access/"},{"id":"rejuv-paed-chronic-disease-burden","kind":"technology","name":"How much illness childhood cancer survivors carry, and at what age","route":"/technologies/rejuv-paed-chronic-disease-burden/"},{"id":"oncology-nursing","kind":"technology","name":"Oncology nursing and nurse-led care","route":"/technologies/oncology-nursing/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"rejuv-measure-missing-data-and-who-is-not-asked","kind":"technology","name":"The questionnaires that were never returned, and the people never asked","route":"/technologies/rejuv-measure-missing-data-and-who-is-not-asked/"},{"id":"rejuv-measure-functional-tests","kind":"technology","name":"Walking, gripping and standing up: the tests that take five minutes","route":"/technologies/rejuv-measure-functional-tests/"},{"id":"rejuv-access-what-it-costs-elsewhere","kind":"technology","name":"What recovery costs in the rest of the world","route":"/technologies/rejuv-access-what-it-costs-elsewhere/"},{"id":"rejuv-access-who-misses-out","kind":"technology","name":"Who misses out on recovery care, measured","route":"/technologies/rejuv-access-who-misses-out/"}],"cancer":[{"id":"all-leukemia","kind":"cancer","name":"Acute lymphoblastic leukaemia","route":"/cancers/all-leukemia/"},{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"term":[{"id":"financial-toxicity","kind":"term","name":"Financial toxicity","route":"/terms/financial-toxicity/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-rare-cancers","kind":"bottleneck","name":"Rare and paediatric cancers without markets","route":"/bottlenecks/b-rare-cancers/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}]}}