SURVIVE-CARE: Digital survivorship care for preventing and managing chronic health conditions in children and young people after cancer treatment

V.A. Fanarjyan National Center of Oncology (NCO) is a leading oncology hospital in Armenia with experience in clinical research and the conduct of clinical trials, as well as expertise in clinical data management and cancer registry coordination. We are seeking European and international partners to develop a collaborative proposal for the Horizon Europe call HORIZON-HLTH-2027-01-DISEASE-10 on prevention and management of chronic non-communicable diseases in children and young people.

The proposed project will focus on adolescents and young adults who have survived childhood cancer, initially with a particular focus on survivors of acute lymphoblastic leukaemia (ALL). Childhood cancer survivors represent a well-defined population requiring long-term health monitoring, but the transition from cancer treatment to long-term survivorship and adult healthcare can be fragmented. Important opportunities for prevention, early detection and management of chronic health conditions may therefore be missed.

The project will implement and evaluate an evidence-based, patient-centred survivorship care pathway supported by clinical registry and digital health infrastructure. Existing clinical and registry information will be used to develop individualised survivorship profiles and identify recommended preventive measures, screening and follow-up according to the young person's previous treatment, current health status and risk factors.

The proposed digital pathway may support:

• identification of young people requiring specific preventive or screening interventions;

• personalised survivorship care plans;

• reminders for recommended assessments and follow-up;

• monitoring of cardiovascular, metabolic, endocrine, psychological and other relevant chronic health risks;

• communication between paediatric oncology, primary care and adult healthcare;

• structured transition from paediatric to adult services;

• longitudinal monitoring of care delivery and health outcomes.

The project will not focus on testing a new medicine. Instead, it will investigate how evidence-based chronic disease prevention and survivorship care can be effectively implemented in routine healthcare settings. A hybrid implementation-effectiveness approach could be used to assess both patient outcomes and implementation outcomes such as reach, adoption, acceptability, feasibility, fidelity, equity, cost-effectiveness and sustainability.

A key component will be the development and harmonisation of a minimum survivorship dataset and the use of longitudinal clinical registry data to evaluate whether recommended preventive and screening services are actually delivered. Young people, families, healthcare professionals, policymakers and other stakeholders will be involved in co-designing and adapting the care pathway to local healthcare contexts.

The National Competitiveness Council (NCO) of Armenia can contribute expertise in childhood cancer registry coordination, clinical data management, longitudinal data collection and real-world implementation. NCO also has experience and infrastructure related to clinical research and can contribute to implementation and evaluation activities in Armenia.

We are particularly interested in partners with expertise in:

• paediatric oncology and childhood cancer survivorship;

• implementation science;

• clinical trials and hybrid implementation-effectiveness studies;

• digital health and clinical decision-support systems;

• health data, registries and interoperability;

• primary and adult healthcare/transition of care;

• epidemiology and biostatistics;

• health economics and health inequalities;

• social sciences and behavioural research;

• patient and young survivor engagement.

We are interested in establishing a multidisciplinary consortium with complementary expertise and implementation sites in different healthcare settings. The ultimate goal is to develop an evidence-based and scalable model that can improve long-term prevention, screening and management of chronic health conditions among young cancer survivors and support sustainable integration of survivorship care into routine health systems.