Rehabilitation for Children With Cancer: Global Opportunities and Need for Systems-Aligned Interventions.

INTRODUCTION

Rehabilitation can improve function and quality of life for children with cancer, yet access remains limited and variable across settings. Understanding how rehabilitation is integrated within pediatric oncology care is important to identify opportunities to strengthen access and quality.

METHODS

We conducted a cross-sectional survey of medical and rehabilitation professionals caring for children with cancer. The survey assessed rehabilitation service availability, referral practices, care coordination, financing, workforce knowledge and training, and monitoring of quality indicators. Findings were organized using the Health Systems Plus framework.

RESULTS

Responses from 59 professionals representing 32 countries were analyzed, including 44 (74.6%) from low- and middle-income countries. Rehabilitation availability varied across disciplines, settings, and phases of care. Medical providers reported rarely or never referring patients to rehabilitation during inpatient (28%, n = 7/25), outpatient (36%, n = 9/25), and survivorship care (40%, n = 10/25). Referrals typically relied on provider identification of need (85%, n = 50/59) rather than standardized pathways. Assistive product availability varied, with lower availability of hearing (n = 19/59, 32%) and vision (n = 15/59, 25%) products. Family payment for rehabilitation services and assistive products was frequently reported. Workforce challenges included limited rehabilitation knowledge among medical providers and limited training opportunities for rehabilitation providers. Among rehabilitation respondents, 44% (15/34) reported monitoring functional outcomes. Qualitative findings highlighted barriers related to workforce, awareness, financial, infrastructure, geographic, and referral-system challenges.

CONCLUSIONS

This survey highlights opportunities to improve access to rehabilitation and assistive products through strengthening referral pathways, workforce capacity, financing, care coordination, and monitoring. These components are interdependent and require coordinated system-level action.