INTRODUCTION:
Cancer is a major cause of morbidity and mortality in low- and middle-income countries (LMICs) (1). The COVID-19 pandemic placed additional strain on health systems, which may have indirectly impacted cancer outcomes. This literature review examined the published scientific literature to determine whether cancer mortality burden increased or decreased during the COVID-19 period in LMICs.

METHODS:
A literature search was conducted in PubMed on 29 September 2025 using the terms “COVID-19”, “cancer”, and “low- and middle-income countries”. Titles and abstracts were screened for inclusion, followed by full-text review. Studies reporting cancer mortality, survival, or severe outcomes during the pandemic in LMICs were eligible for inclusion. Evidence from systematic reviews, meta-analyses, and observational studies was synthesised using a narrative approach.

RESULTS:
Preliminary results show that sixteen studies met the inclusion criteria. Most reported higher mortality or increased risk of death for cancer patients during the pandemic in LMICs, with many studies focused on paediatric populations. Several studies documented higher short-term mortality (30-day and 90-day) compared to higher income countries. Infection with COVID-19 was associated with poorer outcomes among cancer patients, particularly those with comorbidities, immunosuppression, or advanced / metastatic cancer. Factors contributing to changes in the cancer mortality burden included delays in diagnosis, interruptions to treatment, service disruptions, and late-stage presentation during the COVID-19 pandemic.

CONCLUSIONS:
The included studies indicate that the COVID-19 pandemic was associated with increased mortality among people with cancer in LMICs, due to disruptions to cancer care rather than direct effects of COVID-19 infection alone. These findings highlight the importance of protecting continuity of non-communicable disease services during public health emergencies, especially in resource-limited settings.