Estimates of transition burden, geographic distribution, and risk-stratified care for adolescent and young adult cancer survivors: A multi-centre analysis from a low- and middle-income country

BackgroundImproved survival in low- and middle-income countries is generating a rapidly expanding population of childhood cancer survivors (CCS) who will transition to adult care. In India, the capacity and geographic distribution of long-term survivorship care remain poorly characterized.MethodsWe synthesized survivorship data from three tertiary pediatric oncology centres in North India. Transition-eligible survivors were those diagnosed before age 18 years, who completed cancer-directed therapy between January 2016 and December 2025 and had attained age >18 years by December 2025. We quantified the transition-eligible cohort, projected the transition burden through 2030, mapped adolescent and young adult (AYA) survivors by geographic distance from their treating centre, and risk-stratified survivors for survivorship care planning as per published diagnosis and exposure based criteria.ResultsAmong 3,060 survivors, 398 (13.0%) were transition-eligible; 288 (72.4%) were male. Lymphomas (34.1%), solid tumors (29.1%), and acute lymphoblastic leukemia (27.8%) were the predominant diagnoses. The transition-eligible cohort is projected to increase to 1,071 by 2030 (+169.1%). Approximately 58% lived >50 km from their treating centre. Overall, 387 (97.2%) were classified as moderate (44.9%) or high risk (52.3%). Transition processes were absent (56%) or informal (33%); barriers included perceived lack of need (78%), unawareness of late effects (67%) and farther distance from treating centre (56%).ConclusionThis study estimates that the transition-eligible CCS population is projected to nearly triple by 2030 and is predominantly composed of moderate- and high-risk survivors. A risk-stratified, geographically distributed survivorship model incorporating tele-support and shared care closer to home is urgently required.