PURPOSE: Long-term follow-up (LTFU) care is essential to optimise health outcomes in childhood cancer survivors (CCS). We aimed to assess the impact of the COVID-19 pandemic on LTFU services and providers. METHODS: A COVID-19 working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) distributed a questionnaire to LTFU service providers in 37 countries across Europe, Asia, North America, Central/South America, and Australia. The questionnaire assessed how care delivery methods changed during the pandemic and respondents' level of worry about the pandemic's impact on LTFU care delivery, their finances, their health, and that of their family and friends. RESULTS: Among 226 institutions, providers from 178 (79%) responded. Shortly after the initial outbreak, 42% of LTFU clinics closed. Restrictions during the pandemic resulted in fewer in-person consultations and an increased use of telemedicine, telephone, and email consultations. The use of a risk assessment to prioritise the method of LTFU consultation for individual CCS increased from 12 to 47%. While respondents anticipated in-person consultations to remain the primary method for LTFU service delivery, they expected significantly increased use of telemedicine and telephone consultations after the pandemic. On average, respondents reported highest levels of worry about psychosocial well-being of survivors. CONCLUSIONS: The pandemic necessitated changes in LTFU service delivery, including greater use of virtual LTFU care and risk-stratification to identify CCS that need in-person evaluations. IMPLICATIONS FOR CANCER SURVIVORS: Increased utilisation of virtual LTFU care and risk stratification is likely to persist post-pandemic.

City of Hope Comprehensive Cancer Center Duarte CA USA

Danish Cancer Society Research Center Copenhagen Denmark

Department for Pediatric Hematology and Oncology CHU Nord University Hospital Saint Etienne Saint Priest en Jarez France

Department of Clinical Medicine Faculty of Health Aarhus University and University Hospital Aarhus Denmark

Department of Epidemiology and Cancer Control St Jude Children's Research Hospital Memphis TN USA

Department of Health Sciences and Medicine University of Lucerne Frohburgstrasse 3 PO Box 4466 6002 Lucerne Switzerland

Department of Oncology St Jude Children's Research Hospital Memphis TN USA

Department of Paediatric Bone Marrow Transplantation Oncology and Haematology Medical University of Wroclaw Wroclaw Poland

Department of Paediatrics Amsterdam UMC Amsterdam The Netherlands

Department of Paediatrics Skåne University Hospital Clinical Sciences Lund University Lund Sweden

Department of Pediatric Hematology and Oncology University Hospitals Leuven Leuven Belgium

Department of Pediatric Oncology Hospital Virgen del Rocío Sevilla Spain

Department of Pediatrics and Adolescent Medicine Kepler University Clinic Linz Austria

Department of Pediatrics at Emory University School of Medicine Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta Atlanta GA USA

Department of Pediatrics Clinical Hospital Centre Rijeka and School of Medicine of the University of Rijeka Rijeka Croatia

Department of Pediatrics Nippon Medical School Tokyo Japan

Division of Haematology Oncology The Hospital for Sick Children Toronto Canada

Dutch Childhood Cancer Parent Organization VOKK Netherlands Department VOX Survivors Nieuwegein The Netherlands

Epidemiology and Biostatistics Unit and DOPO Clinic IRCCS Istituto Giannina Gaslini Genova Italy

Faculty of Medicine University of Ljubljana Vrazov trg 2 Ljubljana Slovenia

Great North Children's Hospital and Translational and Clinical Research Institute Newcastle University Centre for Cancer Newcastle University Newcastle upon Tyne UK

Hospital Tunku Azizah Kuala Lumpur Malaysia

Leeds Institute of Medical Research University of Leeds Leeds LS2 9JT UK

Murdoch Childrens Research Institute Melbourne VIC Australia

Paediatric Integrated Cancer Centre Victoria Australia

Paediatric Oncology Tata Memorial Hospital Mumbai India

Pediatric Hematology and Oncology Hospital for Children and Adolescents University Hospital of Schleswig Holstein Campus Luebeck Luebeck Germany

Princess Máxima Center for Pediatric Oncology Heidelberglaan 25 3584 CS Utrecht the Netherlands

Radiotherapy department Institute of Oncology Zaloska 2 1000 Ljubljana Slovenia

Republican Siauliai County Hospital Siauliai Lithuania

Royal Childrens Hospital Melbourne VIC Australia

St Anna Childrens Hospital Vienna Austria

U1059 Sainbiose University Jean Monnet Saint Etienne France

University Hospital Brno and International Clinical Research Center Masaryk University Brno Czech Republic

Vilnius University Siauliai Academy Siauliai Lithuania

Zobrazit více v PubMed

Turcotte LM, Liu Q, Yasui Y, et al. Chemotherapy and Risk of Subsequent Malignant Neoplasms in the Childhood Cancer Survivor Study Cohort. J Clin Oncol. 2019;37(34):3310–3319. doi: 10.1200/JCO.19.00129. PubMed DOI PMC

Leerink JM, De Baat EC, Feijen EAM, et al. Cardiac disease in childhood cancer survivors: Risk prediction, prevention and surveillance: JACC CardioOncology State-of-the-Art Review. J Am Coll Cardiol CardioOnc. 2020;2(3):363–378. PubMed PMC

Huang TT, Hudson MM, Stokes DC, Krasin MJ, Spunt SL, Ness KK. Pulmonary outcomes in survivors of childhood cancer: a systematic review. Chest 2011. 2011;140(4):881–901. PubMed PMC

Friedman DN, Tonorezos ES, Cohen P. Diabetes and Metabolic Syndrome in Survivors of Childhood Cancer. Horm Res Paediatr. 2019;91(2):118–127. doi: 10.1159/000495698. PubMed DOI PMC

Perkins JL, Chen Y, Harris A, et al. Infections among long-term survivors of childhood and adolescent cancer: a report from the Childhood Cancer Survivor Study. Cancer. 2014;120(16):2514–2521. doi: 10.1002/cncr.28763. PubMed DOI PMC

Frederiksen LE, Mader L, Feychting M, et al. Surviving childhood cancer: a systematic review of studies on risk and determinants of adverse socioeconomic outcomes. Int J Cancer. 2019;144(8):1796–1823. doi: 10.1002/ijc.31789. PubMed DOI

Verbruggen LC, Wang Y, Armenian SH, et al. Guidance regarding COVID-19 for survivors of childhood, adolescent, and young adult cancer: A statement from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Pediatr Blood Cancer. 2020;67(12):e28702. doi: 10.1002/pbc.28702. PubMed DOI PMC

Forster VJ, Schulte F. Unique needs of childhood cancer survivors during the COVID-19 pandemic. Support Care Cancer. 2021;29(1):17–19. doi: 10.1007/s00520-020-05824-z. PubMed DOI PMC

Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors. JCO Clin Cancer Inform. 2020;4:1059–1071. doi: 10.1200/CCI.20.00134. PubMed DOI PMC

Santoro GA, Grossi U, Murad-Regadas S, et al. DElayed COloRectal cancer care during COVID-19 Pandemic (DECOR-19): Global perspective from an international survey. Surgery. 2021;169(4):796–807. doi: 10.1016/j.surg.2020.11.008. PubMed DOI PMC

Mahl C, Melo LRS, Almeida MHA, et al. Delay in head and neck cancer care during the COVID-19 pandemic and its impact on health outcomes. Braz Oral Res. 2020;34:e126. doi: 10.1590/1807-3107bor-2020.vol34.0126. PubMed DOI

Papautsky EL, Hamlish T. Patient-reported treatment delays in breast cancer care during the COVID-19 pandemic. Breast Cancer Res Treat. 2020;184(1):249–254. doi: 10.1007/s10549-020-05828-7. PubMed DOI PMC

Saab R, Obeid A, Gachi F, et al. Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia region: A report from the Pediatric Oncology East and Mediterranean (POEM) group. Cancer. 2020;126(18):4235–4245. doi: 10.1002/cncr.33075. PubMed DOI PMC

Jammu AS, Chasen MR, Lofters AK, Bhargava R. Systematic rapid living review of the impact of the COVID-19 pandemic on cancer survivors: update to August 27, 2020. Support Care Cancer. 2020;29(6):2841–2850. doi: 10.1007/s00520-020-05908-w. PubMed DOI PMC

Costello AG, Nugent BD, Conover N, Moore A, Dempsey K, Tersak JM. Shared Care of Childhood Cancer Survivors: A Telemedicine Feasibility Study. J Adolesc Young Adult Oncol. 2017;6(4):535–541. doi: 10.1089/jayao.2017.0013. PubMed DOI PMC

Kenney LB, Vrooman LM, Lind ED, et al. Virtual visits as long-term follow-up care for childhood cancer survivors: Patient and provider satisfaction during the COVID-19 pandemic. Pediatr Blood Cancer 2021; Published online February 8, 2021. doi: 10.1002/pbc.28927 PubMed PMC

Curtis ME, Clingan SE, Guo H, Zhu Y, Mooney LK, Hser YI. Disparities in digital access among American rural and urban households and implications for telemedicine-based services. J Rural Health 2021; Published online August 6, 2021. doi: 10.1111/jrh.12614. PubMed PMC

Friend AJ, Feltbower RG, Hughes EJ, Dye KP, Glaser AW. Mental health of long-term survivors of childhood and young adult cancer: A systematic review. Int J Cancer. 2018;143(6):1279–1286. doi: 10.1002/ijc.31337. PubMed DOI

Zeltzer LK, Recklitis C, Buchbinder D, et al. Psychological status in childhood cancer survivors: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27(14):2396–2404. doi: 10.1200/JCO.2008.21.1433. PubMed DOI PMC

Burghardt J, Klein E, Brähler E, et al. Prevalence of mental distress among adult survivors of childhood cancer in Germany-Compared to the general population. Cancer Med. 2019;8(4):1865–1874. doi: 10.1002/cam4.1936. PubMed DOI PMC

Michel G, Rebholz CE, Von der Weid NX, Bergstraesser E, Kuehni CE. Psychological distress in adult survivors of childhood cancer: the Swiss Childhood Cancer Survivor study. J Clin Oncol. 2010;28(10):1740–1748. doi: 10.1200/JCO.2009.23.4534. PubMed DOI

Fidler MM, Ziff EJ, Wang S, et al. Aspects of mental health dysfunction among survivors of childhood cancer. Br J Cancer. 2015;113(7):1121–1132. doi: 10.1038/bjc.2015.310. PubMed DOI PMC

Hudson MM, Oeffinger KC, Jones K, et al. Age-dependent changes in health status in the Childhood Cancer Survivor cohort. J Clin Oncol. 2015;33(5):479–491. doi: 10.1200/JCO.2014.57.4863. PubMed DOI PMC

Pahl DA, Wieder MS, Steinberg DM. Social isolation and connection in adolescents with cancer and survivors of childhood cancer: A systematic review. J Adolesc. 2021;87:15–27. doi: 10.1016/j.adolescence.2020.12.010. PubMed DOI

Hanghøj S, Pappot N, Hjerming M, Taarnhoj GA, Boisen KA, Pappot H. Experiences of Social Isolation During the COVID-19 Lockdown Among Adolescents and Young Adult Cancer Patients and Survivors. J Adolesc Young Adult Oncol. Published online February 18, 2021. doi: 10.1089/jayao.2020.0202 PubMed

European Centre for Disease Prevention and Control. Rapid increase of a SARS-CoV-2 variant with multiple spike protein mutations observed in the United Kingdom. December 20, 2020.

Priesemann V, Balling R, Brinkmann MM, et al. An action plan for pan-European defence against new SARS-CoV-2 variants. Lancet. 2021;397(10273):469–470. doi: 10.1016/S0140-6736(21)00150-1. PubMed DOI PMC

Van Oosterhout C, Hall N, Ly H, Tyler KM. COVID-19 evolution during the pandemic - Implications of new SARS-CoV-2 variants on disease control and public health policies. Virulence. 2021;12(1):507–508. doi: 10.1080/21505594.2021.1877066. PubMed DOI PMC