Trajectories and Risk Factors of Poor Physical and Mental Health Among Cancer Survivors Before, During, and After the COVID-19 Pandemic.

BACKGROUND

The COVID-19 pandemic severely disrupted healthcare and socioeconomic systems linked to worse health outcomes. However, its association with health-related quality of life (HRQoL) among cancer survivors remains less well defined.

AIM: To evaluate pandemic-related changes in HRQoL among cancer survivors.

METHODS

Cancer survivors aged ≥ 18 years were identified in the 2017-2024 Behavioral Risk Factor Surveillance System (BRFSS). Periods were categorized as pre-pandemic (2017-2019), pandemic (2020-2021), and post-pandemic (2022-2024). Outcomes included poor physical health (PPH) and poor mental health (PMH; ≥ 14 days/month). Multivariable Poisson regression generated adjusted incidence rate ratios (aIRRs). Interrupted time series analyses (ITSA) assessed level and slope changes.

RESULTS

Among 194,144 cancer survivors, 35.6% (n = 69,174) were surveyed pre-pandemic, 20.6% (n = 40,040) during the pandemic, and 43.7% (n = 84,930) post-pandemic. Most were female (63.1%) and White (79.0%). Compared with pre-pandemic, the pandemic period was associated with lower adjusted rates of PPH (aIRR 0.91, 95% CI 0.88-0.95) but higher adjusted rates of PMH (aIRR 1.14, 95% CI 1.09-1.20; both p < 0.001). ITSA demonstrated an immediate 14.63% decline in PPH at pandemic onset (95% CI -22.08 to -7.18), whereas PMH demonstrated a pandemic-era upward trend (7.72%/year, 95% CI 3.05-12.40).

CONCLUSION

Among cancer survivors, COVID-19 pandemic was associated with an immediate decrease in the prevalence of poor physical health, followed by a steady increase in the prevalence of poor mental health during the pandemic. Routine mental health screening and scalable psychosocial support are encouraged within survivorship care, particularly during periods of system-wide disruption.