Childhood cancer survivors are at risk for developing late effects from their cancer treatment. Due to barriers such as lack of awareness, financial hardship, lack of access, and competing priorities, only one-third of survivors report receiving survivor-focused follow-up care, and even fewer receive appropriate risk-reduction counseling and screening. During the COVID-19 pandemic, many hospitals and clinics began to offer telehealth services, including the Texas Children's Cancer Center Long-Term Survivor Clinic. In the past several years, significant advances have been made in the field of telemedicine, so that it is now possible to conduct elements of a physical exam remotely, including h...

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Childhood cancer survivors are at risk for developing late effects from their cancer treatment. Due to barriers such as lack of awareness, financial hardship, lack of access, and competing priorities, only one-third of survivors report receiving survivor-focused follow-up care, and even fewer receive appropriate risk-reduction counseling and screening. During the COVID-19 pandemic, many hospitals and clinics began to offer telehealth services, including the Texas Children's Cancer Center Long-Term Survivor Clinic. In the past several years, significant advances have been made in the field of telemedicine, so that it is now possible to conduct elements of a physical exam remotely, including heart and breath sounds, temperature, and heart and respiratory rate. Although best practices for telehealth are available through national professional organizations, no standards of practice for delivering survivorship services via telehealth exist, nor is there guidance regarding determining survivor eligibility for telehealth vs. an in-person visit. This application addresses these gaps by assessing telehealth readiness and financial distress in adult survivors, among other factors contributing to eligibility and appropriateness for telehealth survivorship care. We will develop a survivor and clinician-informed standard of practice for telehealth delivery of survivorship services that leverages Passport for Care, which creates a personalized, guidelines-informed Survivorship Care Plan, and will incorporate innovative digital health solutions for conducting a remote physical exam. Last, we will conduct a pilot study in 50 adult survivors to assess feasibility, acceptability, and appropriateness. We anticipate that the scalability of this framework will support future expansion of high-quality and innovative survivorship services and improve access to care for survivors across the state of Texas, especially those living in medically-underserved regions of the state.

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