Bridging Gaps in Survivorship Care in LMICs: A Multicenter Study on Healthcare Providers’ Perceptions of Late Effects in Pediatric Cancer in Thailand

Abstract

Purpose: In low- and middle-income countries, including Thailand, pediatric cancer survivorship care is limited by resource constraints, lack of structured programs, and an overemphasis on recurrence surveillance. Understanding healthcare provider (HCP) perceptions is a key first step toward developing sustainable multidisciplinary survivorship guidelines. Methods: The Doctor Assessment in Late-Effects Treatment (DALET) survey was used to assess HCPs’ perceptions of late-effect care. The survey was distributed nationwide to physicians involved in childhood cancer care using a targeted dissemination strategy guided by local experts. Results: A total of 114 physicians from 37 centers participated, with only 3 centers (8.1%) having dedicated late-effect clinics. Most respondents (69.3%) reported prior training in late-effect care, and 81.6% provided post-treatment follow-up. Overall knowledge showed good alignment with the Children's Oncology Group Long-Term Follow-Up Guidelines (mean score, 71.7%), with prior training independently associated with higher alignment (p = 0.034). Confidence in managing physical late effects was significantly associated with physician expertise (p < 0.001), hospital type (p = 0.036), and prior training (p < 0.001), while access to consultation varied by expertise and hospital type. Main barriers to late-effect clinics were a lack of one-stop multidisciplinary services (80.7%) and time constraints (78.9%). Conclusions: Gaps in training and confidence persist across specialties and institutions, highlighting the need for national policies that strengthen education, capacity building, multidisciplinary collaboration, and standardized guidelines to ensure equitable late-effect care for pediatric cancer survivors in Thailand.