TABLE 3.

Table of representative quotes from categories and themes of cancer care in select Latin American countries.

Category	Themes	Example Quote (Participant ID)
Barriers	Financial barriers	“For example, I have young patients who have the financial power to buy a cellphone, a computer, pay for Internet connection, food, and other necessary things. They can even get medications that the public health system doesn't have […] There's a difference between those patients who have resources and the ones who don't, right?” (15) “I wish all [AYA] could have access to healthcare […] No child should remain without the right to obtain care for cancer because, cancer can be cured with these steps I've just mentioned.” (27)
	Language barriers	“We always try to have a translator of their language, but Guatemala has 23 or 24 languages. Sometimes, we do not have translators of all the Mayan languages.” (5) “So, depending on what part of the country they [AYAs] come from, sometimes we have to face this limitation, that they don't speak Spanish as their first language or that they don't know Spanish at all.” (7)
	Poor access to technology	“So, as you say, if we had to turn off the camera during a zoom session because of a connectivity issue then imagine what it's like outside the city where the signal is worse.” (12) “[…] it would be great to have an app that would remind patients when their appointment is, when they have to do a certain exam […]” (18)
	Traveling to receive treatment	“Another barrier, as well, is like, in my country […] the distances that they have to go to, to get to the hospital because many times they are long distances” (19) “They need to travel all the way to the capital to receive treatment.” (23)
	Religious barriers	“We have had patients who have a good socio‐economic standard of living and a good education but are very rooted in their religious beliefs and decide to abandon treatment.” (7) “Many of our families are prone to magical thinking, religious discourses. We validate those things but we [emphasize] that medicine is important.” (8)
	Conflicts between parents and providers	“And the part that I don't like sometimes is family interventions because sometimes they can be behavioral and they involve bad habits, lack of rules, complicated dynamics […]” (9) “[Parents] have a very strong will to overprotect their children.” (15)
	Limited medical literacy	“When they hear the word cancer it immediately translates to death. So, many patients take a long time to understand the illness's natural process and in understanding that there are many types of cancer and that not all of them lead to death, right?” (32) “For example, enteral nutrition and gastric tubes are very limited for these children because they believe it's more aggressive [treatment] for the patients.” (34)
	Caring for other children besides patient	“So, it's very difficult for them [AYA] to adhere to treatment because of the distance, because they [parents] have other small children at home [and] because they don't have anyone to help them with the children if they have to stay at the hospital for a long time […]” (10) “[…] both parents work, and they can't devote the necessary time [to come to the hospital] because they have several children.” (12)
	Difficulty in providing psychosocial support	“We also provide emotional support through our service of oncological psychologists, who are the psychologists who come here to support us. And we [the foundation] have to pay for their services.” (13) “The medical insurance plans don't cover psychological support. So, the patients have to pay it out of pocket.” (35)
	Continuing education for staff	“There aren't trainings for the staff. There aren't opportunities for internal or external graduate programs. There isn't any orientation in oncology… We earn very little money to be able to pay for a graduate program or keep studying.” (20) “I think that these constant training and education courses could also improve our teamwork abilities.” (23)
	Costs to hospital for treating patients with cancer	“The aspect that maybe isn't as pleasant is our limited ability to generate funds and the support that we receive from the state to achieve the foundation's necessary [inaudible].” (13) “[Treatments] cost thousands and thousands of dollars. I mean, it's practically inaccessible for most people.” (23)
	Structural barriers	“[…] we need more staff so we can provide better and more personalized care.” (10) “So, everything is like far away. So, if I have to go to the mental health department, we're on the 8th floor. Medical oncology is on the 8th floor. And if I want to go to the mental health ward, I have to walk for about 15 minutes.” (23)
	Limited treatment options	“We would love to have high‐quality medication. Even when we have very good medication, we have to go for a middle ground that is accessible for everyone.” (21) “[…] there are treatment methods and medications that haven't been updated in 20 years.” (34)
Facilitators	Educating patients and families	“In the case of adolescents, we orient the mother and the child about their self‐care and the family members about home care and alarming signs.” (25) “But I think that the way we offer them information is what makes the difference. Telling a child and telling a teenager are very different” (30)
	Multidisciplinary services	“We have a team called Integral Medicine and it's formed by the doctors in palliative care, social care, psychology, and child life, who are the psychologists who treat children and teenagers.” (10) “We have the psychology service, social workers, hemato‐oncology service, and nursing services too. We also have a school that had been closed during the pandemic but a month ago it was reopened.” (36)
	Comprehensive intake assessment	“Well, here in social work we provide care since the beginning […] We conduct an interview that allows us to learn more about their family context, their family situation, where they live, [and] their family dynamic. And based on that we determine the risk of treatment abandonment, right?” (8) “[…] when the patients first come here, my role is to see the parents, conduct a brief interview and collect information from the family and the [AYA] patient.” (10)
Strategies to Improve Care	Providing education for patients	“I think that there should be virtual platforms in our public health system where teenagers can access information about certain specific pathologies.” (15) “I have always fought about how they don't inform us about what is going on. Something that is lacking is education both [for the public] and professional.” (32)
	Providing more services for patients	“Another problem that patients have here is the lack of shelter when they come from distant places. The number of shelters [for AYA and a parent] that are available to them is very limited.” (6) “Evidently, no transportation, with the exception of some occasions in which [the foundation] supports them with half of the fare.” (29)
	Advocacy	“Well, I think that we could involve or raise awareness and sensitize people at schools, communities, right? About the importance of seeking treatment.” (9) “Yes, having campaigns where people visit communities to talk about childhood cancer and the types of childhood cancer that exist. That way people or families can catch it early on instead of realizing it when it's too late.” (10)
	Increase social support	“It's essential to be able to receive support from their family, as well as from their social network, the people who live around them, their church as well. When the person [AYA with cancer] doesn't belong to any such network, then, they may have all these complications during treatment.” (3) “So, what we want is for some relatives [of the AYA with cancer] to get to know each other and create a support network.” (37)
	Increasing funding and volunteers	“Although we receive public funds and donor funds, they do not give us enough to receive the entire [AYA] population.” (5) “Volunteers are what allow us to carry on with our work. The volunteers and I do everything.” (13)
	Need more medical resources within the hospital for providers	“[…] the financial resources are not enough to have a permanent translator here at the hospital.” (7) “Well, basically, for adolescents, we have patients with osteosarcomas. So, the majority of them required magnetic resonance and […] we don't have it in the unit.” (29)
	Need more staff and support for staff	“I think that we should have more staff to spend more time caring for the emotional side of patients. Sometimes we don't have enough time to talk or provide psychological attention.” (24) “Maybe, creating a support group for the staff who are dealing directly with these types of patients [AYA]. In personal experience, since I've been here so many years treating children and teenagers, there comes a time in which despite you not wanting it to, it affects you emotionally.” (29)

Note: Countries and roles of participants are not provided to maintain confidentiality.