Five years after COVID-19 first disrupted healthcare systems worldwide, oncology professionals continue to navigate the pandemic's lasting effects on cancer care. From telemedicine adoption to delayed diagnoses and clinical trial disruptions, the oncology landscape has been permanently altered, creating both new opportunities and persistent challenges.
The Telemedicine Revolution: Benefits and Limitations
The rapid expansion of telemedicine represents one of the most significant and enduring changes in cancer care delivery. According to a study published in The Cancer Journal, 87% of oncologists from the National Comprehensive Cancer Network viewed video-based clinical visits favorably, with 81% having never used telemedicine before the pandemic. Approximately 20% of cancer patients now prefer receiving future care entirely through telemedicine.
"The pandemic changed a lot of how we do things, mostly by doing so much telemedicine and being remote," notes Alan P. Venook, MD, the Madden Family Distinguished Professor in Medical Oncology and Translational Research at the University of California, San Francisco (UCSF). "We've lost ground in that regard—just the incidental contacts you have with faculty and researchers. A lot of new ideas and advances come from those spontaneous interactions, and we've lost almost all of that. But I don't see us coming back in person very soon, frankly, because patients like telemedicine."
For patients with complex conditions like hematologic malignancies, telemedicine offers practical benefits once they reach stability. Gregory Roloff, MD, a hematologist/oncologist at the University of Chicago Medicine, explains: "I do stem cell transplants approximately half the time, which is about as complex as it can get medically in the world of oncology... However, once they're doing well, it's very convenient for them and for us to work out some sort of partnership, ideally with a local doctor."
Telemedicine has also shown potential in addressing geographic disparities in cancer care. Rachel N. Grisham, MD, from Memorial Sloan Kettering Cancer Center, highlights this opportunity: "Telemedicine does provide an opportunity for us to be able to provide a similar standard of care across diverse geographic regions... [It is also a] potential opportunity to try to bring the research that has been predominantly centralized at academic institutions to a larger expanse of our population."
However, significant challenges remain. Kelly McCann, MD, PhD, from UCLA Health, shares concerns about the limitations of virtual visits: "I've had patients who, when we were doing video visits, came in for an in-person visit 6 months later stooped over from pain, which they had hidden from me on the telemedicine visit. Some things just don't translate well over telemedicine."
Financial sustainability also remains uncertain. "Right now, Medicare is still covering telemedicine, and other insurance companies are following suit. [However], the rules are supposed to change in April, and that's very concerning," McCann notes.
Delayed Diagnoses and Stage Migration
One of the pandemic's most concerning legacies is the persistent increase in advanced-stage cancer diagnoses resulting from disrupted screening programs and delayed medical care. A 2023 study in The Lancet Oncology reported significant declines in cancer screening services following the COVID-19 national emergency declaration, leading to underdiagnosis and a decrease in early-stage diagnoses during 2020.
While a 2025 JAMA study found that breast and colorectal cancer screening rates have rebounded between 2019 and 2023, cervical cancer screening declined by 14%. Moreover, improvements in breast and colorectal cancer screening were primarily limited to individuals with higher socioeconomic status, potentially exacerbating existing healthcare disparities.
"We're still seeing more advanced cervical cancer than before," emphasizes Stephanie V. Blank, MD, director of Gynecologic Oncology for the Mount Sinai Health System. "We're still seeing the lasting effects of the pandemic."
Beyond delayed screenings, the pandemic introduced new infection risks for cancer patients. Research published in Frontiers in Oncology found that nearly 25% of cancer patients who survived SARS-CoV-2 infection experienced "long COVID" symptoms lasting at least one year, with comorbidities increasing this risk.
Benjamin Herzberg, MD, from Columbia University Medical Center, raises concerns about potential connections between COVID-19 and lung cancer: "On an observational level, we've seen patients with long-term scarring or other abnormalities in their lungs from severe COVID-19 later presenting with lung cancers... Many cancers arise from chronic inflammation. This is a well-known concept, and we see people who have evidence of chronic inflammation in their lungs after COVID-19 and then we see cancers in those individuals."
Treatment Considerations in the Post-Pandemic Era
While vaccination and antiviral strategies have mitigated some early pandemic concerns, oncologists remain cautious about treatment decisions for immunocompromised patients.
"Nowadays, with essentially everyone having had COVID-19 or a vaccination for it, our biggest concern is that transmissibility still interrupts operations and trials…but [it does so] no more so than the flu," notes Herzberg. "The major success story has been vaccination and antivirals. COVID-19 has gone from something terrifying to something manageable, much like other respiratory viruses."
For patients with certain conditions like chronic lymphocytic leukemia (CLL), the decision to initiate immunosuppressive therapy requires careful consideration. Roloff explains: "The patients who I believe were hit hardest by COVID-19, as a leukemia doctor, were those with CLL... I've had to think long and hard before committing these patients to immunosuppressive therapies. To take out the CLL, we lose normal B cells as well. [Therefore], it leaves patients quite vulnerable to COVID-19 and other upper respiratory illnesses."
Clinical Trial Disruptions and Research Challenges
The pandemic severely disrupted clinical trial operations, with effects still reverberating through the research ecosystem. A report in JCO Oncology Practice documented a significant drop in enrollment to cancer clinical treatment trials during the initial COVID-19 wave, attributed to patient safety concerns and resource constraints.
"We tried to minimize face-to-face contact during the pandemic, and of course, it's hard to do research if you're not seeing patients. That affected clinical trial enrollment [and the ability to conduct studies]," Venook explains. "It's impacted the finances, as you need people to do the work [and many left during COVID-19]. In many cases, patients are now less inclined to come in person."
Some institutions, however, found ways to adapt. Raajit K. Rampal, MD, MPH, from Memorial Sloan Kettering, notes: "At MSK, we're fortunate that we have a network and facilities that are beyond just Manhattan... We were able to do more clinical trials there and use telemedicine as part of our clinical trial assessments. That has allowed us to have a little [more reach] than we did before."
Despite some recovery, lingering effects remain. "During COVID-19, we had massive disruptions to clinical research across the cancer center," Herzberg states. "In some ways, that made us leaner and more productive once the worst of it passed. But in other respects, we're still feeling the effects years later, especially from having to shut down and compress our portfolio so deeply."
Workforce Challenges and Oncologist Burnout
Many clinical trial disruptions stem from staffing shortages and worsening oncologist burnout. According to data from JCO Oncology Practice, burnout among oncologists in patient care roles increased from 45% in 2013 to 59% in 2023, exacerbated by increased workloads and staffing shortages. A survey of 328 practicing oncologists by ASCO found that 59% demonstrated one or more burnout symptoms in 2023 compared to 34% in 2013.
"Oncologist burnout is real," Blank emphasizes. "We've had a lot of trouble with clinical trial staff, and staff in general has been more of an issue. People feel less loyal to the institution, and I think that's a huge thing."
Edward S. Kim, MD, MBA, from City of Hope National Medical Center, highlights the need for systemic changes: "This crisis highlighted the importance of addressing EHR interoperability issues and the excessive documentation requirements that our providers face. We need to continue to find solutions for these challenges so our physicians and staff can focus on what's most important: caring for patients."
Ramez N. Eskander, MD, from the University of California San Diego Health, notes the specific impact on clinical trials: "The biggest impact of COVID-19 was on staff. To run clinical trials appropriately, you need the staff not only to care for patients but also to manage the trials themselves. There was a real depletion of staff in clinical trial organizations during COVID-19 due to attrition and job transitions, and it took time to rebuild."
Looking Forward: Adaptation and Resilience
Despite ongoing challenges, many oncologists express optimism about the field's ability to adapt and recover. "Thankfully, many institutions have been able to rebuild…and staff up appropriately," Eskander notes. "We're still seeing some degree of that legacy from the staffing changes that happened. [However], I'm very optimistic."
Marwan G. Fakih, MD, from City of Hope Comprehensive Cancer Center, emphasizes the balanced approach needed for virtual care: "[COVID-19] opened the door for virtual medicine, which allowed access to patients who are far from cancer centers who would have otherwise had difficulties getting second opinions... There's a happy medium where one should still see the patient for a physical exam and not overdo virtual visits."
Scarlett Lin Gomez, PhD, MPH, from UCSF, highlights broader lessons: "What came out of the pandemic was this recognition of the importance of these upstream structural and social drivers of health, as we recognize that there were populations right here in our country that were more impacted than others."
As the oncology field continues to navigate these challenges, the focus remains on leveraging pandemic-driven innovations while addressing persistent disparities and workforce issues to ensure optimal patient care. The resilience demonstrated by the oncology community during this unprecedented crisis provides a foundation for continued adaptation and improvement in cancer care delivery.
