COVID-19 Left Lasting Scars on Breast Cancer Survivors, Major Review Finds

When the COVID-19 pandemic swept through hospitals in early 2020, few groups felt the disruption more acutely than women who had just finished treatment for breast cancer. A sweeping new scoping review, published in Supportive Care in Cancer, has now pulled together the global evidence on what those years of lockdowns, cancelled appointments and fear of infection actually did to breast cancer survivors, and the picture that emerges is one of measurable psychological harm, fragmented follow-up care and an unexpected silver lining in the form of virtual medicine. The review, led by Ethan Goonaratne and Jashmira Bhinder with senior authors Muna Alkhaifi and Henry C. Y. Wong, synthesised forty primary studies published between January 2020 and February 2025, offering the most comprehensive account to date of how the pandemic reshaped survivorship for one of the world’s largest cancer populations.

The methodological architecture of the review matters, because scoping reviews occupy a distinctive niche in the evidence hierarchy. Rather than pooling effect sizes statistically, as a meta-analysis would, a scoping review maps the breadth of available research, identifying patterns, gaps and recurring themes across heterogeneous study designs. The team searched four major databases, Embase, MEDLINE, CINAHL and Web of Science, using a meticulously documented strategy that combined controlled vocabulary terms for COVID-19, cancer survivors and breast neoplasms with extensive free-text synonyms, from ductal carcinoma to mammary malignant neoplasms. The search was limited to human studies published from 2019 onward and reported in English. Adherence to the PRISMA reporting guidelines lends the review a transparency that allows other researchers to reproduce or update the search as new evidence accumulates.

The forty included studies were dominated by cross-sectional surveys, which accounted for fourteen of the total, followed by ten prospective cohort studies and seven qualitative investigations. Four randomised controlled trials also made the cut, a notable detail because intervention trials are the strongest design for establishing that a telehealth programme or home-based exercise regimen actually caused an improvement rather than merely coinciding with one. Thirty-five of the forty studies examined quality of life outcomes specifically, making psychological well-being the single most intensively studied dimension of pandemic-era survivorship. That concentration reflects a genuine clinical concern: breast cancer survivors, many of whom had recently completed chemotherapy, radiation or surgery, faced a novel pathogen about which little was known, in a health system suddenly rationing in-person contact.

The psychological findings are the review’s most sobering thread. Twenty studies reported worsened mental health among survivors, with elevated stress, anxiety, depression and loneliness documented across multiple countries and healthcare systems. The stressors were specific and identifiable rather than diffuse: survivors described fear of being exposed to COVID-19 during in-person hospital visits, and parallel anxiety about the disruption or cancellation of the very services they needed to stay well. Research on older women with breast cancer tracked longitudinal changes in sleep disturbance that tracked with depressive and anxiety symptoms, while controlled comparisons found that survivors’ psychological distress exceeded that of matched women without a cancer history. Qualitative work added texture to the numbers, documenting women who felt they were negotiating cancer largely alone, and others who drew on spirituality, self-compassion and personal resilience as coping resources. Notably, three studies published after 2023 reported that these effects persisted: lingering anxiety, reduced access to healthcare and declines in functional well-being were still measurable well after the acute phase of the pandemic had passed.

Follow-up care, the backbone of survivorship medicine, was the second major casualty. Fifteen studies documented interruptions to routine surveillance, including cancelled appointments, delayed imaging and reduced access to the periodic clinical assessments that normally reassure both patient and physician that the cancer has not returned. The clinical stakes of such gaps are not trivial. Modelling studies cited in the review’s bibliography estimated that pandemic-related delays in cancer diagnosis in England alone could translate into additional cancer deaths, and separate work has examined the effect of health disruptions on breast cancer mortality among older women using semi-Markov modelling. For survivors already past active treatment, the concern is subtler than missed diagnosis: it is the erosion of a structured safety net, and the psychological cost of waiting months for a mammogram or an oncology review while imagining the worst.

Against that backdrop, the review’s findings on fear of cancer recurrence are quietly reassuring. Five studies specifically addressed whether the pandemic and its care disruptions led to more actual recurrences, and none observed an increase. What did rise, however, was the fear itself, a well-recognised phenomenon in psycho-oncology in which uncertainty about surveillance amplifies catastrophic thinking. The distinction matters clinically: heightened recurrence fear is a supportive care need that can be addressed with counselling, reassurance and restored access to monitoring, whereas a genuine spike in recurrences would have demanded a fundamentally different kind of remediation, including backlog-clearing diagnostic programmes and revised surveillance intervals.

The third strand of the review documents how care models bent rather than broke. Eighteen studies described broader changes to survivorship care delivery, with telemedicine and virtual interventions emerging as the dominant adaptation. Five studies evaluated at-home programmes in detail, and two reported positive patient experiences with phone-based follow-up, including one institution that used electronic medical record-assisted telephone reviews to keep survivors connected to their care team. The intervention literature was surprisingly rich: randomised trials tested clinical decision support systems for lifestyle modification and internet-delivered mindfulness-based stress reduction, while feasibility studies evaluated online home-based exercise programmes, telerehabilitation for daily functioning, activity tracker-based counselling during Italy’s lockdown, and a national SMS text message wellness programme for survivors. One home-based lifestyle intervention even reported an unexpected improvement in quality of life during the first pandemic year, suggesting that for some patients, structured remote support partially compensated for what in-person care had lost.

Not every adaptation succeeded equally, and the review is careful about the limits of the evidence. Virtual cardiovascular rehabilitation, for example, required survivors to transition mid-programme, and the qualitative accounts reveal both enthusiasm and friction around technology, privacy and the loss of face-to-face coaching. Studies focused on racially and ethnically diverse populations, including African American, Black, Hispanic and Asian American survivors, highlighted that digital divides, differing cultural coping resources and pre-existing inequities in healthcare access shaped who benefited from the pivot to virtual care. A technology-based intervention tailored to Asian American survivors showed efficacy across five dimensions of need for help, but the broader lesson is that remote care is not automatically equitable care, and implementation must account for connectivity, digital literacy and language.

The review’s conclusion is measured but pointed: COVID-19 negatively affected both the quality of life and the care delivery experienced by breast cancer survivors, yet virtual follow-up and virtual interventions were well received and may reasonably be recommended as alternatives to in-person care where appropriate. That recommendation aligns with a wider literature on telemedicine in post-treatment cancer survivorship, which has identified both the efficacy of remote models and the practical challenges of scaling them. The authors also flag the longer-term signal from post-2023 studies as a priority for continued surveillance, since persistent anxiety and reduced healthcare access years after the acute pandemic suggest that the survivorship community should not treat 2020 as a closed chapter.

For clinicians and policymakers, the practical takeaways are concrete. Survivorship services should build in routine psychological screening that can detect pandemic-amplified distress, protect surveillance capacity during future health system shocks, and design hybrid care pathways that reserve in-person visits for what genuinely requires physical examination while delivering education, lifestyle support and low-acuity follow-up remotely. For the millions of women living after breast cancer, the review validates an experience that was easy to dismiss at the time: the pandemic did not merely postpone appointments, it measurably strained mental health and continuity of care, and the health systems that emerge from it will be judged by how well they repair both.

Subject of Research: The impact of the COVID-19 pandemic on quality of life, follow-up care and supportive care interventions among breast cancer survivors

Article Title: The impact of the COVID-19 pandemic on breast cancer survivorship: a scoping review

Article References: Goonaratne, E., Bhinder, J., McGrath, K., Astray, D., Sharma, K., Sferrazza, D., Botea, A., Tse, S. S. W., Lee, S. F., Chan, A. W., Jefford, M., Chan, R. J., Chow, E., Alkhaifi, M., & Wong, H. C. Y. (2026). The impact of the COVID-19 pandemic on breast cancer survivorship: a scoping review. Supportive Care in Cancer, 34(11), Article 1075. https://doi.org/10.1007/s00520-026-11309-2

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11309-2

Keywords: breast cancer, cancer survivors, COVID-19, quality of life, telemedicine, survivorship care, psychological distress, fear of cancer recurrence, scoping review, virtual care, supportive care, follow-up care