Development of an Evidence-Based Clinical Tool for Childhood Cancer Survivorship Care in Tanzania

Three in every four childhood cancer survivors experience late effects from treatment. As childhood cancer outcomes improve globally, it is important for providers to screen for these potential late effects to reduce morbidity. The present study aims to increase survivorship care capacity in low-resource settings by developing a digital clinical tool that integrates patient diagnosis and treatment exposure with evidenced-based surveillance recommendations to provide comprehensive childhood cancer follow-up guidelines. Surveys with key stakeholders at each of the four childhood cancer treatment centers in Tanzania were completed to determine the current capacity to provide off-therapy surveillance. This informed the selection of late-effect screening tests by the International Late Effects of Childhood Cancer Guideline Harmonization Group's 2023 guidelines that were both evidenced-based and feasible in our setting. Qualtrics software was utilized to create a provider-facing digital survey to enter patient diagnosis, treatment exposures, and cumulative dosing. The clinical tool was successfully created and implemented in our setting. In addition to entering patient demographic data, the survey burden for providers is anywhere from 5 to 11 questions in length. Using entered treatment exposures, the clinical tool uses a programmed algorithm to determine the late effect risk category, cardiovascular risk score, and personalized screening recommendations. Recommendations include both screening tests and frequency, to improve provider compliance with current best practice guidelines. This tool can be adapted for other settings based on current capacity and provides personalized surveillance recommendations. This can help standardize treatment guidelines by increasing provider capacity and knowledge, with the potential to improve adherence to follow-up guidelines among childhood cancer survivors in LMICs, like Tanzania.