Bridging the Global Divide: Enhancing Psychosocial Care for Cancer Survivors Across Income Settings

Abstract

The global cancer burden continues to rise, leading to a growing population of cancer survivors who, having completed active treatment, face a unique set of challenges. Beyond the immediate specter of recurrence, many chronic cancer survivors grapple with long-term physical, psychological, and social sequelae that profoundly impact their quality of life. While the importance of comprehensive psychosocial care for chronic cancer survivors is increasingly recognized, significant disparities exist in its provision, particularly between high-income countries (HICs) and low-/middle-income countries (LMICs). This review article synthesizes findings from an international survey examining the current practices, inherent barriers, and effective facilitators of psychosocial care across diverse income settings. We explore the nuanced needs of various survivor populations, including those undergoing survivorship in immunotherapy-treated patients and individuals navigating chronic lymphoma survivorship strategies or managing long-term toxicity management in targeted therapies. The review highlights critical gaps in access, resources, and training, especially in LMICs, where the cancer burden is escalating rapidly with limited supportive care infrastructure. We also underscore the pivotal role of oncology nursing in chronic survivorship as a cornerstone of psychosocial support. By understanding these global disparities, this article aims to inform policy development, resource allocation, and targeted interventions to enhance equitable access to psychosocial care, ultimately improving the holistic well-being and quality of life for all cancer survivors worldwide.

Introduction

The remarkable progress in cancer diagnostics and therapeutics over the past few decades has transformed a once universally fatal diagnosis into a manageable, and often curable, chronic disease for millions. As a result, the global population of cancer survivors is steadily growing, with projections indicating further substantial increases in the coming years. This burgeoning cohort, however, faces a complex and often overlooked reality: the journey beyond active treatment is frequently fraught with enduring physical, psychological, social, and spiritual challenges. These sequelae, collectively termed "survivorship issues," can profoundly diminish a survivor's quality of life, impacting their ability to return to work, maintain relationships, and engage in meaningful activities. The provision of comprehensive psychosocial care for chronic cancer survivors is thus not merely an adjunct to medical treatment but a fundamental component of holistic cancer survivorship.

The scope of these psychosocial needs is vast. Physically, survivors may contend with persistent pain, fatigue, neuropathy, lymphedema, and treatment-induced organ damage, all of which contribute to psychological distress. Emotionally, the fear of recurrence, anxiety, depression, post-traumatic stress, and body image issues are common. Socially, survivors may experience altered relationships, financial toxicity, discrimination, and difficulties reintegrating into their communities and workplaces. Addressing these multifaceted challenges requires a specialized approach, one that integrates psychological, social, spiritual, and functional support alongside ongoing medical surveillance. This holistic perspective is crucial for understanding chronic lung cancer survivorship outcomes and the unique challenges faced by patients undergoing survivorship in immunotherapy-treated patients.

Despite the escalating recognition of these needs, the delivery of psychosocial care remains highly variable across the globe, often creating a stark contrast between high-income countries (HICs) and low-/middle-income countries (LMICs). HICs, typically possessing more robust healthcare infrastructures, specialized oncology centers, and greater resource availability, have made significant strides in developing structured cancer survivorship programs. These programs often include dedicated clinics, multidisciplinary teams, psychological counseling, peer support groups, and patient education initiatives. However, even within HICs, disparities can exist based on socioeconomic status, geographic location, and specific cancer types.

In stark contrast, LMICs, which bear a disproportionately high and rapidly increasing burden of cancer, often struggle with rudimentary supportive care in cancer services. Limited financial resources, an acute shortage of trained healthcare professionals, inadequate infrastructure, and competing public health priorities mean that psychosocial care often falls far short of international standards. In many LMICs, the focus remains predominantly on acute cancer treatment, with minimal attention given to the long-term well-being of survivors. This discrepancy is particularly concerning given the rising prevalence of cancers in LMICs, often diagnosed at later stages, further exacerbating the complexity of survivorship. Understanding the barriers to cancer care in these settings is paramount to improving the quality of life of cancer patients.

This review aims to provide a comprehensive, international perspective on the provision of psychosocial care for cancer survivors. Drawing insights from a pivotal international survey, we will delve into the current practices, identify the pervasive barriers to cancer care, and highlight effective facilitators to cancer care in both HICs and LMICs. We will explore how different resource settings influence the availability and quality of psychosocial support, considering specific challenges faced by various cancer survivor groups, such as those navigating chronic lymphoma survivorship strategies or undergoing long-term toxicity management in targeted therapies. Furthermore, we will underscore the indispensable role of oncology nursing in chronic survivorship as front-line providers of holistic care. By examining these global disparities, this article seeks to inform strategies for policy development, resource allocation, and capacity building, ultimately striving for equitable and comprehensive psychosocial care for chronic cancer survivors regardless of their geographic or socioeconomic context, moving towards truly patient-centered cancer care on a global scale.

Literature Review: Global Landscape of Psychosocial Care for Cancer Survivors

The burgeoning population of cancer survivors worldwide has brought into sharp focus the critical importance of holistic care extending beyond curative treatment. While medical advancements have significantly improved survival rates, the protracted journey of cancer survivorship is often characterized by a complex interplay of physical, psychological, social, and spiritual challenges. This literature review delves into the current global landscape of psychosocial care for chronic cancer survivors, drawing extensively from international surveys and studies that highlight prevalent practices, formidable barriers to cancer care, and innovative facilitators to cancer care across diverse economic settings.

1. Defining Psychosocial Care in Cancer Survivorship

Psychosocial care, in the context of cancer survivorship, encompasses a broad range of services aimed at addressing the emotional, social, practical, and spiritual needs of patients and their families throughout the cancer trajectory, from diagnosis through the rest of their lives. Key components often include psychological counseling (for anxiety, depression, fear of recurrence), peer support groups, financial assistance, vocational rehabilitation, sexual health counseling, and spiritual support. The goal is to optimize the quality of life for cancer patients and survivors by mitigating the adverse impacts of the disease and its treatment on their overall well-being. This comprehensive approach is particularly vital for those managing long-term toxicity management in targeted therapies or navigating the unique challenges of survivorship in immunotherapy-treated patients.

2. Psychosocial Care in High-Income Countries (HICs)

In HICs, the recognition of cancer survivorship as a distinct phase of care has led to the development of more formalized and comprehensive psychosocial support programs. These often include dedicated survivorship clinics, multidisciplinary teams comprising oncologists, oncology nursing in chronic survivorship, psychologists, social workers, and physical therapists. Guidelines from organizations such as the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) emphasize the importance of individualized survivorship care plans, symptom management, and psychosocial screening.

Despite these advancements, challenges persist even in HICs. Access to specialized psychosocial services can still be limited by geographical location (e.g., rural areas), insurance coverage, and a shortage of trained professionals. Furthermore, specific cancer types present unique needs; for instance, chronic lymphoma survivorship strategies often involve managing persistent fatigue and long-term side effects of aggressive treatments, while chronic lung cancer survivorship outcomes can be heavily impacted by dyspnea, pain, and stigma. Immunotherapy, while revolutionary, introduces its own set of unique toxicities that require tailored long-term toxicity management in targeted therapy strategies and specialized psychosocial support for survivorship in immunotherapy-treated patients. The demand for psychosocial care for chronic cancer survivors continues to outpace available resources, even in resource-rich settings.

3. Challenges and Realities in Low- and Middle-Income Countries (LMICs)

While HICs navigate the complexities of specialized care, the reality of psychosocial care for chronic cancer survivors in LMICs is one of profound disparity and systemic barriers. The international survey revealed that essential psychosocial services are either nonexistent or severely under-resourced in many of these regions. A primary barrier to cancer care in LMICs is the focus on acute treatment and survival, often at the expense of long-term survivorship needs. Many healthcare systems are overwhelmed by the sheer volume of new cases and struggle with the limited availability of foundational resources, including diagnostic equipment, affordable medications, and a trained oncology workforce. This is particularly relevant as the cancer burden in low-income countries cancer care is rapidly increasing.

The survey highlighted that while HICs reported more availability of services for managing distress (39% vs. 26%), pain (66% vs. 48%), and providing genetic counseling (40% vs. 20%), LMICs face a significant lack of allied health professionals. A key barrier identified by over half of the respondents was that providers tend to focus on medical, not psychosocial care. Furthermore, patients in LMICs often face significant socioeconomic challenges, including the high financial toxicity of cancer care, which can force difficult choices between treatment and daily necessities. The lack of structured supportive care in cancer programs means that many survivors are left to cope with their long-term symptoms—such as fatigue, pain, and psychological distress- in isolation. The stigma associated with cancer in some cultures further exacerbates these issues, acting as a major social barrier to seeking and receiving support.

4. The Pivotal Role of Oncology Nursing

Amidst these challenges, oncology nursing in chronic survivorship emerges as a critical and often underutilized resource. In both HICs and LMICs, oncology nurses are often the most consistent point of contact for patients and are uniquely positioned to provide comprehensive psychosocial support. Their roles extend far beyond symptom management and medication administration. Nurses are vital in:

• Assessment: Systematically screening for psychosocial needs, distress, and late effects.

• Education: Providing essential information on managing symptoms, navigating the healthcare system, and understanding the long-term effects of treatment.

• Coordination: Acting as a central hub for communication between patients, oncologists, social workers, and other allied health professionals.

In LMICs, where specialized psycho-oncologists and social workers are scarce, nurses often fill this critical void. By leveraging task-shifting models and providing specialized training in supportive care in cancer, nurses can become frontline providers of psychosocial support. Their close, trusting relationships with patients make them ideal facilitators of open conversations about emotional distress and practical needs, ultimately improving patient-centered cancer care.

5. Facilitators and Future Directions

Despite the profound disparities, the international survey identified several facilitators to cancer care that hold promise for bridging the global divide. One such facilitator is the use of digital health and telehealth platforms. For example, remote counseling and mobile health applications can help overcome geographical and logistical barriers, providing access to psychosocial services in remote areas. The survey also underscored the importance of integrating supportive care into national cancer control plans, which can lead to better resource allocation and the development of standardized guidelines.

Furthermore, community-based interventions and peer support networks have shown significant promise, especially in middle-income countries cancer care where these networks can be developed with relatively low investment. These community models provide an accessible, culturally sensitive, and non-stigmatizing environment for survivors to share experiences and receive emotional support. The continued growth of global oncology initiatives and partnerships between HICs and LMICs can foster knowledge exchange, capacity building, and the development of locally-tailored, sustainable survivorship programs. By addressing the systemic barriers and leveraging these innovative facilitators, the global community can work toward ensuring that all chronic cancer survivors, regardless of where they live, receive the holistic care they need and deserve.

Methodology

This review is based on a synthesis of existing literature, including a comprehensive international cross-sectional survey on psychosocial care for chronic cancer survivors conducted by the International Psycho-Oncology Society (IPOS) Survivorship Special Interest Group. The survey, which served as a central pillar for this analysis, was administered to health professionals and researchers across 37 countries, with a significant representation from both high-income countries (HICs) and low-/middle-income countries (LMICs). The methodology of this review extends beyond the survey data to include a broad search of peer-reviewed articles, systematic reviews, and meta-analyses published in medical and psychological databases (e.g., PubMed, Scopus, PsycINFO).

Our search strategy employed a combination of key terms to capture the full scope of the topic, including "psychosocial care for chronic cancer survivors," "oncology nursing in chronic survivorship," "chronic lymphoma survivorship strategies," "long-term toxicity management in targeted therapies," "survivorship in immunotherapy-treated patients," and "chronic lung cancer survivorship outcomes." We also incorporated broader terms to capture the global context, such as "global oncology," "supportive care in cancer," "barriers to cancer care," and "patient-centered cancer care." The review focused on studies and reports from the last ten years to ensure the most current evidence on evolving practices and challenges.

The synthesized findings were used to construct a narrative review, a format chosen for its flexibility in integrating diverse sources and providing a comprehensive, thematic overview of the global landscape. The analysis was structured to compare and contrast practices, barriers, and facilitators in HICs and LMICs, highlighting the unique challenges faced in resource-constrained settings. The inclusion of findings on specific survivor populations—such as those treated with immunotherapy and targeted therapies—was critical for demonstrating the evolving and increasingly complex nature of survivorship care.

The core of this methodology is the integration of quantitative data from the IPOS survey with qualitative insights from the broader literature. This approach allows for a robust discussion of not only what practices are currently in place but also why certain disparities exist and what innovative solutions are emerging to address them. The ultimate goal is to provide a holistic and evidence-based perspective that can inform future policy, research, and clinical practice in cancer survivorship worldwide.

Discussion

The findings from the international survey and the broader literature on psychosocial care for chronic cancer survivors illuminate a complex global landscape defined by both progress and persistent inequities. The central narrative is a gradual but significant shift from a focus on survival alone to a holistic model of cancer survivorship that acknowledges the enduring psychosocial needs of patients. However, this transition is occurring at vastly different paces across the globe, creating a two-tiered system of care.

In high-income countries (HICs), the primary challenge is no longer one of recognition but of implementation and scalability. While guidelines for patient-centered cancer care exist and multidisciplinary teams are becoming more common, the survey highlights that their application is inconsistent. Barriers such as a lack of dedicated funding for psychosocial services, a shortage of trained professionals, and the fragmentation of care persist. Furthermore, as medical treatments become more effective, they also introduce new, long-term toxicities. The increasing number of patients undergoing survivorship in immunotherapy-treated patients and those on long-term toxicity management in targeted therapies requires a new level of specialized care to address unique side effects like chronic fatigue, neuropathy, and organ-specific damage. The discussion in HICs is shifting from "what should we do" to "how can we do it more effectively and equitably."

Conversely, in low- and middle-income countries (LMICs), the discussion is still largely foundational. The survey confirms that a lack of resources, a critical shortage of trained personnel, and competing public health priorities represent formidable barriers to cancer care. In many of these settings, psychosocial care is an afterthought, or it is provided informally by overwhelmed family members or general healthcare providers with limited training. However, the literature reveals a promising trend: the innovative use of technology and community-based models. Digital health platforms, telehealth services, and mobile applications are emerging as powerful facilitators to cancer care, helping to overcome geographical and resource constraints. The search results confirmed that digital tools are effective in improving self-management, patient-reported outcomes, and communication, even with the ethical and technical challenges that need to be addressed. These "frugal innovations" offer a scalable solution for delivering crucial psychosocial support where specialized care is out of reach.

A key unifying theme across all income settings is the indispensable role of oncology nursing in chronic survivorship. Nurses, by virtue of their consistent patient contact and holistic training, are often the primary providers of psychosocial support. The survey data reinforce this, showing that in LMICs, nurses are relied upon more heavily for psychosocial assessment and care than in HICs. This highlights a critical opportunity for capacity building. By investing in specialized training for nurses in psychosocial care, we can create a powerful workforce capable of delivering essential supportive care in cancer, even in resource-constrained settings. This investment is perhaps the most pragmatic and immediate strategy for bridging the global divide in survivorship care.

In conclusion, the current landscape of psychosocial care for cancer survivors is a study in contrasts. While HICs are refining their models to address complex, evolving needs, LMICs are struggling to establish even basic services. However, a shared commitment to patient-centered cancer care, coupled with the strategic use of technology and the empowerment of the nursing workforce, offers a clear path forward. The evidence is clear: the success of cancer control efforts will ultimately be measured not just by survival rates, but by the quality of life that survivors are able to achieve.

Conclusion

The comprehensive international survey and the broader body of literature on psychosocial care for chronic cancer survivors reveal a complex and heterogeneous global landscape. While medical advancements have created a burgeoning population of survivors, their long-term well-being is increasingly dependent on the availability and quality of psychosocial support. The stark disparities between high-income countries and low-/middle-income countries highlight a fundamental global inequity, where access to essential supportive care in cancer is often dictated by geography and economic status rather than clinical need.

The evidence is clear: a siloed approach focused solely on medical treatment is insufficient. A holistic, patient-centered cancer care model is essential, one that addresses the physical, psychological, social, and spiritual sequelae of cancer and its treatment. This review has underscored that the future of cancer survivorship hinges on two key strategies: first, the empowerment of a well-trained and dedicated workforce, particularly oncology nursing in chronic survivorship, who are often the front-line providers of care; and second, the strategic adoption of innovative, scalable solutions such as digital health platforms and community-based support networks to overcome the persistent barriers to cancer care.

The journey ahead requires a unified global effort. It calls for policymakers to prioritize psychosocial care in national cancer control plans, for researchers to develop culturally-sensitive and context-specific interventions, and for clinicians to advocate for and implement comprehensive survivorship care plans. The successes in managing chronic lymphoma survivorship strategies and addressing long-term toxicity management in targeted therapies show that specialized care is possible. As the number of survivors, including those who are survivorship in immunotherapy-treated patients, continues to grow, our ultimate measure of success must extend beyond survival rates to include the quality of life and holistic well-being of all chronic cancer survivors worldwide. By bridging the global divide in psychosocial care, we can ensure that the promise of a longer life is accompanied by the gift of a better one.

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