# Survival of Patients Diagnosed With Cancer During the COVID-19 Pandemic

## TL;DR

Cancer patients diagnosed during the early years of the COVID-19 pandemic had worse survival rates compared to those diagnosed before the pandemic, with an estimated 13% more deaths within a year.

## Contribution

This study is the first to show that pandemic-related disruptions in cancer care led to measurable declines in short-term survival rates for cancer patients in the US.

## Key findings

- Patients diagnosed in 2020 and 2021 had significant reductions in 1-year survival rates compared to pre-pandemic years.
- The survival decline was observed for both early- and late-stage cancer diagnoses, with late-stage cases showing larger drops.
- The study estimates 17,390 more cancer-related deaths within a year of diagnosis during the pandemic's first two years.

## Abstract

Were the survival rates of patients diagnosed with cancer in the US in 2020 and 2021 different than in the years before the COVID-19 pandemic?

This population-based cohort study of more than 1 million US individuals found that patients diagnosed with cancer in 2020 and 2021 (compared with 2015 to 2019) had significant reductions in survival when diagnosed at both early and late stages, resulting in an estimated 17 390 more deaths (13.1%) within 1 year of diagnosis than expected.

Individuals diagnosed with cancer in the US during 2020 and 2021 experienced worse survival during the first year after their diagnosis than those diagnosed before the COVID-19 pandemic.

This cohort study investigates the association of the COVID-19 pandemic with short-term survival among patients diagnosed with cancer in 2020 and 2021 using US population-based cancer registry data.

The effects of COVID-19 pandemic–related disruptions on cancer diagnosis in the US have been widely observed, but their impact on short-term survival has not been assessed.

To examine 1-year cause-specific survival (CSS) rates among patients diagnosed with cancer during 2020 and 2021 using high-quality cancer registry data.

This population-based cohort study of cancer survival between 2015 and 2021 used the Surveillance, Epidemiology, and End Results 21 Registries (SEER-21) database. The population included individuals with an invasive cancer diagnosis and complete follow-up reported to registries included in SEER-21 between January 1, 2015, and December 31, 2021. Data were analyzed from May 13 to May 27, 2025.

COVID-19 pandemic.

The primary outcome was 1-year CSS rates by stage at diagnosis for patients diagnosed with cancer in 2020 and 2021 compared with trends in 1-year CSS rates among patients diagnosed between 2015 and 2019. Additional site-specific analyses were performed on common cancer sites identified as having low survival (5-year relative survival <33%) or high incidence and high survival (incidence >20.0 per 100 000 and 5-year relative survival ≥66%).

A total of 1 008 012 individuals were diagnosed with cancer during the first 2 years of the COVID-19 pandemic, including 473 781 in 2020 (50.1% female; 51.0% diagnosed at ≥65 years; 11.5% Black, 15.8% Hispanic, 64.1% White, and 7.4% other race) and 534 231 in 2021 (50.3% female; 51.9% diagnosed at ≥65 years; 51.9% diagnosed at ≥65 years; 11.7% Black, 16.2% Hispanic, 62.9% White, and 7.9% other race). Compared with prepandemic trends, significant absolute reductions in 1-year CSS rates occurred for early-stage diagnoses in 2020 (−0.44 [95% CI, −0.54 to −0.34] percentage points) and 2021 (−0.27 [95% CI, −0.37 to −0.16] percentage points) and late-stage diagnoses in 2020 (−1.34 [95% CI, −1.75 to −0.93] percentage points) and 2021 (−1.20 [95% CI, −1.69 to −0.71] percentage points). Survival reductions resulted in an estimated 17 390 more cancer-related deaths (13.1%) within 1 year of diagnosis than expected during the first 2 years of the COVID-19 pandemic. Absolute survival reductions greater than 1.00 percentage point occurred in both years for late-stage diagnoses among individuals of other non-Hispanic race and ethnicity (ie, American Indian and Alaska Native, Asian or Pacific Islander, or unknown race) and individuals aged 65 years or older. Significant site-specific survival reductions also existed in both 2020 and 2021, respectively, for early-stage diagnoses of esophageal cancer (−3.89 and −3.67 percentage points) and colorectal cancer (−1.08 and −0.78 percentage points) and late-stage diagnoses of prostate cancer (−0.64 and −0.77 percentage points).

This cohort study found that individuals diagnosed with cancer in 2020 and 2021 experienced worse short-term survival than those diagnosed between 2015 and 2019, suggesting substantial harms associated with cancer care disruptions during the first 2 years of the COVID-19 pandemic.