Cancer Care Disruptions During COVID-19 Led to Decreased Survival Rates

The COVID-19 pandemic disrupted cancer care across the United States, leading to delays in screening, diagnosis, and treatment. Health care systems implemented temporary changes to cancer care, such as pausing nonemergent screenings, expanding telehealth, and delaying surgeries, to reduce transmission risk and preserve hospital capacity.^1,2

Although data from previous studies have shown declines in cancer screening and diagnoses, less is known about how these disruptions affected short-term cancer outcomes, including survival. According to findings from a population-based cohort study published in JAMA Network Oncology, researchers aimed to examine 1-year cause-specific survival (CSS) rates among patients diagnosed with cancer in 2020 and 2021 using high-quality cancer registry data.¹

“I believe the most important takeaway for health systems from this study is the need to build health system resilience. This includes the ability to prevent, prepare, adapt, and respond to systemwide shocks. In our study we showed a failure in health system resilience in the US in that, while we were focused on preserving lives from a novel respiratory virus, we failed to maintain existing levels of care for individuals faced with a cancer diagnosis,” Todd Burus, PhD, co–study author and assistant professor of biomedical informatics at the University of Kentucky College of Medicine, said in an interview with Pharmacy Times.

Patient Selection and Cancer Survival Classification

Individuals included in the study were patients diagnosed with first primary malignant cancer using Surveillance, Epidemiology, and End Results (SEER) 21 Registries data, which covers approximately 41.9% of the US population. Cases identified only by death certificate or autopsy, or those that lacked survival time, in situ disease, or were of unknown stage, were excluded. Survival outcomes were assessed overall and stratified by sex, age (> 65 years vs < 65 years), race and ethnicity, urbanicity, and stage at diagnosis, with stage categorized as early (localized) or late (regional or distant).¹

The study analyzed 1-year CSS by cancer site, categorizing cancer as low-survival or high-incidence/high-survival. Low-survival cancers included pancreatic, liver, esophageal, lung, and brain, and high-incidence/high-survival cancers included breast, prostate, colorectal, uterine, and melanoma.¹

Impact of COVID-19 on Cancer Treatment and Outcomes

During 2020 and 2021, 1,008,012 individuals were diagnosed with cancer in the United States, with similar demographic distributions across both years. Compared with prepandemic trends, 1-year CSS declined significantly for both early- and late-stage cancers in 2020 and 2021, with larger reductions seen in late-stage disease. These survival declines were associated with an estimated 17,390 excess cancer-related deaths within 1 year of diagnosis during the first 2 years of the pandemic.¹

“We cannot definitively say from our study what drove worse 1-year survival rates among patients diagnosed during 2020 and 2021. Our study did isolate by stage at diagnosis in order to control for shifts from early- to late-stage disease. Given the remaining options and other studies on disruptions during that time, we suggested that health care disruptions were likely the primary reason for what we saw,” Burus said.

Further results showed that the largest survival losses occurred among older adults, in individuals of other non-Hispanic races and ethnicities, and in site-specific analyses for early-stage esophageal and colorectal cancers and late-stage prostate cancer.¹

“It did not surprise me that we saw survival decreases among both early- and late-stage diagnoses. Substantial disruptions to standard care for [patients with] cancer in the US during the COVID-19 pandemic have been well documented, so I anticipated we would also find significant changes in patient outcomes,” Burus noted.

What the Findings Reveal About Cancer Care During the Pandemic

The data suggest that patients diagnosed with cancer in 2020 and 2021 had worse short-term survival rates than those diagnosed from 2015 to 2016, highlighting the negative impact of cancer care disruptions during the first 2 years of the COVID-19 pandemic.¹

“I believe that our findings point to more than just delayed diagnoses as a factor in survival reductions. There was likely some impact from this—particularly if we consider within-stage variation in cases—but separating our analysis by stage at diagnosis helped mitigate most of these concerns. And since we know our available treatment options didn’t get worse between 2019 and 2020, that points to issues with treatment access/delivery as a potential contributing factor. And I believe it is important to say these delivery and access issues could have been either provider or patient initiated,” Burus concluded.

REFERENCES

1. Burus T, Damgacioglu H, Huang B, Tucker TC, Deshmukh AA, Lang Kuhs KA. Survival of patients diagnosed with cancer during the COVID-19 pandemic. JAMA Oncol. Published online February 5, 2026. doi:10.1001/jamaoncol.2025.6332

2. Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on cancer care: how the pandemic is delaying cancer diagnosis and treatment for American seniors. JCO Clin Cancer Inform. 2020;4:1059-1071. doi:10.1200/CCI.20.00134