Impact of the Pandemic on the Healthcare System: An In-depth Analysis of the Short-term Survival Rate Decline Among Cancer Patients

On February 6, *JAMA Oncology* published a federally funded study that, for the first time, quantified the impact of the COVID-19 pandemic on the short-term survival rates of cancer patients. The research team analyzed data from over 1 million newly diagnosed cancer patients between 2020 and 2021, finding that the one-year survival rate for patients diagnosed during the pandemic significantly declined compared to those diagnosed between 2015 and 2019. This phenomenon was observed across multiple cancer types, regardless of whether the diagnosis was at an early or advanced stage. Lead researcher Todd Bruce from the University of Kentucky noted that while the study could not attribute the findings entirely to a single factor, disruptions in the healthcare system were likely a key driver. This data provides empirical evidence for the concerns raised by experts early in the pandemic: delayed screenings, interrupted treatments, and strained medical resources ultimately left their mark on the survival curves of cancer patients.

The Survival Rate Gap Revealed by Data

This study utilized the National Cancer Registry Database, focusing on patients who were first diagnosed with malignant tumors in 2020 and 2021. The data shows that over 1 million people were diagnosed with cancer during these two years, among whom approximately 144,000 died within one year after diagnosis. The researchers calculated the 1-year survival rate for these patients and compared it with a cohort of patients diagnosed between 2015 and 2019.

The findings are alarming. Research indicates that when all cancer sites are combined, patients diagnosed during the pandemic had lower one-year survival rates, regardless of whether the diagnosis was early or late. The survival disparities were particularly significant for colorectal cancer, prostate cancer, and pancreatic cancer. Taking colorectal cancer as an example—it is the second leading cause of cancer death in the United States—its screening (such as colonoscopy) was largely suspended in the spring of 2020 due to the pandemic. Data from the American Cancer Society shows that from March to June 2020, colonoscopy volumes dropped by approximately 90% compared to expectations. This means a large number of polyps or early-stage tumors that could have been detected through early screening were missed. Patients did not seek medical attention until symptoms appeared, by which time the disease had often progressed to a more advanced and harder-to-treat stage.

The research team attempted to filter out cases where the primary cause of death was COVID-19 in their analysis to observe the effects of other factors. Bruce explained that their goal was to strip away the fatal threat posed by the SARS-CoV-2 virus itself to immunocompromised patients, thereby more clearly revealing the impact of systemic issues such as delays in diagnosis and treatment. Although the overall cancer mortality rate in the United States continued to decline during the pandemic—thanks to the prevention, diagnosis, and treatment systems built over many years not collapsing—the short-term survival deterioration among newly diagnosed patients revealed a hidden crisis: cracks in healthcare accessibility and treatment timeliness.

The Domino Effect of Healthcare System Disruption

The impact of the COVID-19 pandemic on cancer diagnosis and treatment is not a single event, but a series of chain reactions. In early 2020, as the novel coronavirus swept across the globe, the focus of the healthcare system shifted sharply toward addressing respiratory emergencies. Many hospitals suspended non-urgent surgeries and outpatient services, including routine cancer screenings. In March 2020, the American College of Radiology recommended postponing all non-urgent imaging examinations, which included low-dose CT scans used for lung cancer screening.

The impact of such interruptions is layered. First, there are screening delays. Researcher Resinda Sherman from the North American Association of Cancer Registries points out that screening is the first line of defense in cancer prevention and control, and its suspension directly leads to a large number of potential cases disappearing from the statistical radar. Taking breast cancer screening as an example, the National Cancer Institute estimates that in 2020, approximately 9.5 million women missed mammograms. These delays may mean tumors grew undetected for months.

Secondly, there is a delay in diagnosis and treatment. Even if patients develop symptoms, they may postpone seeking medical care due to fear of contracting COVID-19. A survey published in the Journal of Clinical Oncology found that during the peak of the pandemic, approximately 40% of cancer patients reported disruptions to their treatment plans. Surgeries were postponed, radiation therapy cycles were interrupted, and chemotherapy doses might have been adjusted due to poor blood counts in patients or strained hospital resources. For patients like Paul Murray—who was diagnosed with tonsil cancer in May 2021 due to a sore throat—time is of the essence. Fortunately, he quickly received advanced proton beam therapy at the University of Maryland's Greenebaum Comprehensive Cancer Center and preserved his vocal cords. However, not all patients can access such precise treatments in a timely manner.

The deeper issue lies in the crowding and reallocation of medical resources. Oncologists and nurses are being transferred to COVID-19 wards, radiotherapy equipment may see reduced patient capacity due to extended disinfection procedures, and clinical trial recruitment has been forced to pause. These structural disruptions have altered the pathways and speed at which patients access care. Bluestein admits: We haven't forgotten how to do these things, but the disruptions may have changed accessibility and potentially altered the speed at which people receive treatment.

Differential Impacts and Long-term Concerns Across Various Cancer Types.

Research indicates that not all cancers are affected equally. The survival rates for colorectal cancer, prostate cancer, and pancreatic cancer have declined particularly significantly, which has underlying reasons related to their pathology and diagnostic-treatment pathways.

Colorectal cancer and prostate cancer are both highly reliant on regular screening for early detection. The interruption of prostate-specific antigen testing and colonoscopy directly leads to more cases being diagnosed only after metastatic symptoms appear. Pancreatic cancer, due to its insidious nature and rapid progression, is extremely sensitive to the timing of treatment. Any delay in diagnosis or treatment may completely close the already limited window of opportunity for surgery.

In comparison, cancers that can be partially managed through telemedicine, or diseases with relatively flexible treatment approaches, may experience less impact. However, this does not mean they are immune to systemic disruptions. Hyuna Sung, a senior principal scientist and cancer epidemiologist at the American Cancer Society, reminds us that further research is needed to determine whether such effects are temporary or long-lasting. A short-term decline in survival rates that recovers quickly may have little impact on long-term mortality trends. But if disruptions lead to irreversible disease progression, the consequences could be profound.

A key paradox lies in: Why did the overall cancer mortality rate in the United States continue to decline during the pandemic, while the short-term survival of new patients worsened? Bruce believes this reflects that cancer prevention and control is a long-term, multi-faceted endeavor. The effects of public health measures (such as smoking cessation and HPV vaccination) and therapeutic advancements (such as targeted drugs and immunotherapy), which have been driving down mortality rates for years, are still being realized, buffering the macro-level impact of the pandemic. However, on the more sensitive frontline indicator of new cases, the system's vulnerabilities are fully exposed. It is akin to a battle: rear reserves are still holding the line, but the immediate casualty rate on the front has risen.

Public Health Lessons Learned from Crises.

The significance of this study extends beyond confirming a known hypothesis. As the first research to document pandemic-related, cause-specific survival rates, it provides an indispensable roadmap for addressing future public health crises. Reshinda Sherman emphasizes: The more we understand the impact of COVID-19, the better prepared we will be for the next crisis.

First, it highlights the extreme importance of maintaining the continuity of key medical services for non-communicable diseases such as cancer. Future emergency plans must classify cancer screening, diagnosis, and treatment as essential medical services, establishing safe pathways to ensure their provision even during peak pandemic periods. This requires advance planning for resource allocation, developing clear priority protocols, and establishing backup facilities and personnel reserves.

Secondly, the study highlights the value of real-time data monitoring. The national cancer registration system played a central role in this analysis. Enhancing the timeliness and granularity of such monitoring systems, enabling them to detect delays in diagnosis and treatment as well as changes in survival rates in near real-time, will help decision-makers take corrective actions more swiftly.

Furthermore, the pandemic has accelerated certain changes, such as the widespread adoption of telemedicine, which may offer more flexible options for follow-up and management for some cancer patients. The key lies in how to systematize and standardize these temporary measures while ensuring they do not exacerbate healthcare inequalities.

Todd Bruce and his team have opened a window for us to see a silent secondary disaster beneath the global health crisis. The 144,000 lives lost within a year of diagnosis—each number represents a story like Paul Murray's, only with a different ending. This pandemic has tested not only humanity's resistance to a virus but also society's ability to maintain systemic resilience and humanistic care in the face of multiple health threats. The chain of cancer diagnosis and treatment is long, from screening, diagnosis, treatment to follow-up. Any weak link in this chain can be amplified by a storm into a decline in survival rates. Rebuilding this resilience will be one of the most enduring challenges in public health in the post-pandemic era.