The Long-Term Impact of COVID-19 on Oncology Care: A Five-Year Retrospective

Alan P. Venook, MD

Five years after the onset of the COVID-19 pandemic, the oncology field continues to grapple with its repercussions. From fundamental shifts in patient management, including the introduction of telemedicine, to trial disruptions and workforce challenges, the pandemic has reshaped every aspect of oncology care. Although some of these adaptations offer unique benefits, others require strategic solutions, and the oncology community must continue to adapt and innovate to ensure optimal patient outcomes.

To better understand the long-term impact of the COVID-19 pandemic on these various aspects of cancer care, OncLive® spoke with 9 oncologists across multiple specialties, who shared perspectives on past shifts in treatment paradigms, current challenges, and future projections. Their unique insights have been highlighted below.

​​Shifting Treatment Paradigms: Is Telemedicine Here to Stay?

The expansion of telemedicine has been one of the most significant changes in cancer care during the COVID-19 pandemic, improving access for many patients across diverse geographic regions and socioeconomic backgrounds.

According to a study published in The Cancer Journal, among more than 1000 surveyed oncologists belonging to the National Comprehensive Cancer Network, 87% of respondents viewed video-based clinical visits favorably to very favorably and indicated that 46% of future oncology visits could be conducted via teleconsultation.1 Notably, 81% of these specialists had not been telemedicine users prior to the pandemic. Furthermore, patients with cancer have consistently reported high levels of satisfaction with telehealth, with approximately 20% in favor of 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,” Alan P. Venook, MD, noted about its impact on professional collaboration, a critical component of medical advancement in oncology. “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.”

Venook holds the Madden Family Distinguished Professorship in Medical Oncology and Translational Research and is a professor in the Department of Medicine (Hematology/Oncology) at the University of California, San Francisco (UCSF). He is also the Shorenstein Associate Director for Program Development at the UCSF Helen Diller Family Comprehensive Cancer Center.

Gregory Roloff, MD, a hematologist/oncologist at the University of Chicago Medicine in Illinois, highlighted the practical benefits of telemedicine for patients with hematologic malignancies once they reach a stable condition. “I do stem cell transplants approximately half the time, which is about as complex as it can get medically in the world of oncology, and understandably these patients need to be under my [watch] for a bit,” he stated. “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, to have them be seen if something were to arise; [we must] check in virtually as much as we can….”

Telemedicine not only facilitates patient management but also has the potential to address geographic disparities in cancer care. “Telemedicine does provide an opportunity for us to be able to provide a similar standard of care across diverse geographic regions,” Rachel N. Grisham, MD, an associate attending physician at Memorial Sloan Kettering Cancer Center (MSK), stated. “[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, through opportunities to, in some clinical trials, ship drugs to local providers. [We are] then able to centralize toxicity assessment through those with expertise in that particular type of cancer. [This opens up] many more ways for us to try to bring a quality of care across the country.” Grisham also serves as section head of Ovarian Cancer, and director of Gynecologic Medical Oncology, at MSK Westchester.

Although the wide-scale adoption of telehealth due to disruptions to in-person care highlighted the feasibility of this approach, challenges with its integration persist, including disparities in access to reliable technology or telehealth services.1 Likewise, many practitioners still harbor concerns about the effectiveness of remote monitoring considering certain pre-existing inequities.

Research published in Future Oncology elucidated that, despite telemedicine providing essential access to care during the pandemic, the absence of direct patient-oncologist interactions could negatively affect patient well-being and sense of security.2

Echoing these concerns, Kelly McCann, MD, PhD, an assistant professor and breast medical oncologist at UCLA Health’s David Geffen School of Medicine, in California, shares an illustrative example of telemedicine’s limitations and underscores the importance of balancing telemedicine with in-person care in light of these concerns: “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. I also like to take notes and draw diagrams for patients, which I can hand them at the end of an in-person visit. In general, [patients] are more engaged with you when you’re in person…and people retain more from an in-person visit than they did from that video visit.

Notably, current evidence attributes the widespread adoption of teleconsultations during the pandemic to the implementation of policies facilitating telehealth insurance coverage and reimbursement, along with state licensure facilitation—both long recognized as essential by telemedicine advocates—instead of infrastructure expansion, as available technologies remained largely unchanged pre- vs post-pandemic.1 Likewise, both McCann and Venook also shared their concerns about the future infrastructure and financial support of telemedicine.

“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 stated. “When we started with COVID-19, telemedicine was essential. Now it's become something that we are more used to and that is more convenient on some levels, especially for the patient. If I have a patient who is hours away, we’re going to do a telemedicine visit, but ultimately that in-person visit shouldn’t be completely lost either."

“Looking forward, it’s hard for me to stay upbeat and optimistic that we’ll be back with ‘guns a blazing’ very soon,” Venook added. “The issues with clinical research aren’t just pandemic-related anymore—now you layer on what’s happening with the NIH and in Washington, DC. There are many issues to overcome.”

Regardless of these obstacles, telemedicine remains a valuable tool in oncology. In fact, although video or audio visits are often perceived as less effective for patient-physician connections, data from a palliative care program showed that, with proper training, telemedicine can successfully facilitate goals-of-care conversations.1

“[Telemedicine is] not a substitution for an inpatient visit, but it’s a great supplement, especially for individuals who have reached a point of inertia in their treatment and are doing well,” Roloff confirmed. “Perhaps if they’re a bit older [or] live a distance from the tertiary care center, it’s a wonderful option that allows them to not have their lives uprooted and overly medicalized by what might otherwise be a quick visit in. I believe it’s here to stay, but I’m curious to see how we can be smarter with this tool in the future.”

Delayed Cancer Diagnoses and Stage Migration

Although the rise of telemedicine due to the COVID-19 pandemic has undoubtedly improved access to routine care, significant disruptions in cancer screenings and routine check-ups have led to delayed diagnoses and a shift toward more advanced disease stages at presentation. Findings published in The Lancet Oncology in 2023 reported rapid declines in screening services for nearly all cancer types in the USA following the declaration of the COVID-19 national emergency, as well as a significant underdiagnosis of cancer and a decrease in the proportion of early-stage diagnoses during 2020.3

Interestingly, a 2025 study published in JAMA found that both breast and colorectal cancer (CRC) screening rates rebounded between 2019 and 2023 from declines observed during the COVID-19 pandemic in the United States; however, cervical cancer screening declined by 14%, and the observed improvements in breast and CRC screening rates were mostly restricted to individuals with higher socioeconomic status.4

These reductions have raised concerns about increased late-stage cancer diagnoses and associated mortality rates.​ Accordingly, many oncologists have observed a persistent increase in late-stage disease diagnoses across tumor types.

“We’re still seeing more advanced cervical cancer than before,” Stephanie V. Blank, MD, the director of Gynecologic Oncology for the Mount Sinai Health System in New York, emphasized to OncLive. “We’re still seeing the lasting effects of the pandemic.” Blank is also the director of Women’s Health at The Blavatnik Family – Chelsea Medical Center at Mount Sinai, and a professor of obstetrics, gynecology, and reproductive science.

Beyond delayed screenings, the pandemic introduced new infection risks for patients with cancer. ​According to research shared in Frontiers in Oncology, nearly a quarter of patients with cancer who survived SARS-CoV-2 infection experienced “long COVID” symptoms lasting at least 1 year, and patients with comorbidities were at a higher risk of developing “long COVID.”5 ​

Benjamin Herzberg, MD, an assistant professor of medicine at Columbia University Medical Center and an oncologist at Herbert Irving Comprehensive Cancer Center in New York, highlighted concerns about long-term pulmonary inflammation following severe COVID-19 infections potentially contributing to lung cancer diagnoses. “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. It’s very hard to tell [if patients are] presenting with lung cancer [because] they didn’t go for a screening test during COVID-19 and [thus] are presenting with lung cancer later. There could just be a delay effect, and we can’t rule that out. That said, there are lots of tumors caused by inflammation in organs. 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. It’s hard to tell [if] this is just a shift because of shifting clinical patterns [or if] this is a new phenomenon."

Effects of COVID-19 on Cancer Outcomes, Treatment Considerations

The long-term impact of COVID-19 on cancer outcomes extends beyond stage migration and delayed diagnoses. Although vaccination and antiviral strategies have mitigated some of the early pandemic concerns, survival outcomes for patients have been significantly impacted due to interruptions in care and increased vulnerability among immunocompromised patients, experts asserted.

“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,” Herzberg stated regarding this shift in risk perception. “The major success story has been vaccination and antivirals. COVID-19 has gone from something terrifying to something manageable, much like other respiratory viruses. That’s an incredible achievement in itself.”

Roloff emphasized the need for caution when initiating immunosuppressive therapies, particularly in patients with chronic lymphocytic leukemia (CLL). “The patients who I believe were hit hardest by COVID-19, as a leukemia doctor, were those with CLL. When patients with CLL are going to transition from a stage of being clinically monitored—which is typically the [approach] upfront—to being treated, the decision to initiate treatment will vary [from] patient to patient based on their counts and symptom experiences. A lot of times, if patients are not feeling great [and] there may be a reasonable indication to start [treatment], we will. This often includes therapies that are quite immunosuppressive. …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 that [circulate] seasonally and probably renders them not overly responsive to vaccines that would typically allow protection.”

Clinical Trial Disruptions, Enrollment Challenges, and Oncologist Burnout

One of the biggest impacts of the pandemic was on clinical trial operations, leading to decreased patient enrollment and logistical challenges. An article published in JCO Oncology Practice noted a significant drop in enrollment to cancer clinical treatment trials during the initial wave of COVID-19, partially attributed to increasing patient safety concerns and resource constraints for academic and community centers.6 Furthermore, a report by the Office of the Assistant Secretary for Planning and Evaluation detailed widespread disruptions across all clinical trial activities, from initiation and recruitment to execution and monitoring.7 These interruptions have had lasting effects on the progress of oncology research.

“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 stated. “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. For a while, we were even making extra efforts to keep patients away. It has thrown the whole field off our game.”

Conversely, Raajit K. Rampal, MD, MPH, director of the Center for Hematologic Malignancies and Myeloproliferative Neoplasms Program at MSK, noted that his institution’s adaptations to the pandemic unexpectedly expanded the reach of their clinical trials: “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. I would actually say that, if there are any positives that came out of the pandemic, that might be one [of them].”

Although clinical trial operations have rebounded in some ways, lingering effects remain, Herzberg asserted. “During COVID-19, we had massive disruptions to clinical research across the cancer center. 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. That takes many years to work its way through the system, and we’re just starting to get there.”

Many of these logistical challenges can also be attributed to staffing shortages and worsening oncologist burnout post-pandemic, as many institutions struggled to retain personnel, straining an already burdened system. In the same NCBI report, experts identified clinical staffing, fatigue, and shortages as a major contributor to disrupted clinical trial operations.7

The prevalence of burnout among oncologists in patient care roles increased from 45% in 2013 to 59% in 2023, as per data from JCO Oncology Practice, and was exacerbated by increased workloads, staffing shortages, and emotional fatigue.8 Furthermore, a survey of 328 practicing oncologists in the United States conducted by ASCO found that 59% of respondents demonstrated 1 or more symptoms of burnout in 2023 vs 34% in 2013.9

“Oncologist burnout is real,” Blank emphasized. “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."

“Our priority during the pandemic was caring for the patients who needed us and supporting our health care work force,” Edward S. Kim, MD, MBA, vice physician-in-chief at City of Hope National Medical Center and physician-in-chief for City of Hope Orange County in Duarte, California, noted. “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, a gynecologic oncologist and assistant professor of obstetrics, gynecology, and reproductive sciences at the University of California San Diego (UCSD) Health, also observed the impact of workforce shortages on clinical trial operations: “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.”

In an internal survey of 15 oncologists conducted by OncLive, several experts noted a disparity in the recovery of academic vs community practices post-pandemic. They added that many large academic hospitals, with more resources and infrastructure, have demonstrated a quicker rebound in both workforce stability and the ability to continue research initiatives compared with smaller community practices.

Despite the ongoing strain on health care systems and clinical research funding due to COVID-19, many oncologists express hope that clinical trial staffing will improve, especially as the industry adapts to new funding models and strategies to address workforce shortages.

“Thankfully, many institutions have been able to rebuild…and staff up appropriately,” Eskander concluded. “…We’re still seeing some degree of that legacy from the staffing changes that happened. [However], I’m very optimistic. [USCD Health] has rebuilt in a dramatic way, and we’re in a great position right now, I feel like that’s occurring at many institutions, but we need to continue to drive this message.”

References

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4. Breast and colorectal cancer screening rebound from pandemic-related declines, but cervical cancer screening yet to return, new ACS study finds. News release. American Cancer Society. March 5, 2025. Accessed March 26, 2025. https://pressroom.cancer.org/PostPandemicScreening
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6. Unger JM, Stires H, Levit LA, et al. Sponsor perspectives on the impact of the COVID-19 pandemic on interventional cancer clinical trial protocols and data quality. JCO Oncol Pract. 2023;19(10):907-916. doi:10.1200/OP.23.00185
7. Stern AD, Trusheim M. Transformation of the clinical trial enterprise: lessons learned from the COVID-19 pandemic: final report. Washington (DC): Office of the Assistant Secretary for Planning and Evaluation (ASPE); February 9, 2024. Accessed March 26, 2025.
8. Schenkel C, Levit LA, Kirkwood K, Shanafelt T, Subbiah IM. Ten-year trends in clinician well-being and burnout among oncology fellows in training: an ASCO state of cancer care in America study. JCO Oncol Pract. Published online January 29, 2025. doi:10.1200/OP.24.00200
9. Schenkel C, Levit LA, Kirkwood K, et al. State of Professional Well-Being, Satisfaction, and Career Plans Among US Oncologists in 2023. JCO Oncol Adv. 2025;2(1):e2400010. Published 2025 Jan 29. doi:10.1200/OA.24.00010