In 2025, more than 2 million new cases of cancer are expected to be diagnosed in the United States, with the number of cancer survivors expected to increase from approximately 18 million in 2020 to 26 million by 2040. [1][2] But of course, being a cancer survivor doesn’t end the cancer story. As many as 20-40% of patients treated with surgery for one of the four most common solid tumor cancers—breast, colorectal, lung, and prostate—experience recurrence.[3]
This rise in cancer survivorship is happening as AI, digital pathology, and other technologies are revolutionizing cancer care. Call it The Cancer Paradox: As medical advances improve longevity, more patients than ever face the looming risk of cancer recurrence — and the anxieties and challenges that go with it.
Quest Diagnostics, in partnership with the Harris Poll, recently conducted a nationally representative survey of 250 oncologists to explore this paradox in more detail, and the findings have been illuminating.
Finding #1: Despite advances in cancer care, oncologists feel like they are seeing more advanced-stage cancers, much of which they attribute to delays, skips, or missing follow-up appointments.
Consider that among surveyed oncologists:
- 76% feel they are seeing more and more patients with advanced-stage cancer
- 75% feel they are seeing more patients with advanced-stage cancers, and believe the rise is due to screening barriers, potentially exacerbated by the pandemic
- 92% are concerned that patients who are economically disadvantaged or marginalized cannot get access to quality care
And these concerns are not limited to screening: Oncologists agree that identifying cancer recurrence in the earliest possible stage can improve outcomes. They also worry about patients skipping their monitoring appointments following surgery and treatment. Moreover, more than 75% of oncologists say they have seen some proportion of patients whose cancer recurrence was missed post-surgery and treatment (i.e., residual or recurring) at an earlier stage, with many of those saying patients missing/skipping/delaying follow-up care/monitoring appointments as the primary reason why cancer recurrence is typically missed.
An important step healthcare providers can take to address the challenge of these missed appointments is acknowledging the various “toxicities”, or burdens, at play. While financial toxicity requires no elucidation here, “logistic toxicity” of cancer care, defined in a recent study as everyday challenges of carrying out cancer care activities, often go underdiscussed. These include things like traveling for care, navigating the complex administrative and logistical challenges of healthcare visits, and many more.
These challenges are real and legitimate. The care team should take pains to make sure that appointments are consistently timed, communication is collaborative and transparent, and support groups are made available and readily apparent. While the care team may not be able to solve every logistical challenge (though many practices have ways to solve for some of them), what every practice and provider can do is visibly and vocally empathize. Research has shown that patient-centered communication, starting from a position of trust, is the key to improved outcomes. [6]
It is important to note that fear of recurrence can have long-term effects, including anxiety and depression. Some research suggests psychological interventions can alleviate some of this distress among patients with and survivors of cancer, [6][1] so be alert to signs a referral to a specialist is in order.
Listen closely, be patient, and empathetic. These are the keys to helping patients navigate the survivorship journey.
Finding #2: Oncologists report that certain tools like imaging tests are not definitively detecting recurrence early enough and value more sensitive tests like minimal residual disease (MRD) testing to reduce diagnostic delays.
The Quest-Harris Poll survey also revealed that limitations in conventional technology may be a factor in missed cancer detection. According to oncologists, among the primary reasons why recurrence was missed in an earlier stage:
- 50% cite imaging tests as not detecting recurrence early enough
- 30% cite current laboratory tests as not detecting recurrence early enough
Here, the oncologists suggest that MRD (minimal residual disease) testing, through the detection of circulating tumor DNA (ctDNA), could add considerable value.[5] Research has shown that, with only a simple blood draw, oncologists may be able to detect residual, recurrent, or resistant cancer cells earlier than traditional cancer detection methods.[9] Indeed, a recent study in The New England Journal of Medicine found that ctDNA testing, using Haystack MRD® from Quest Diagnostics, was a “reliable liquid biopsy surrogate” for treatment response that identified clinical complete response at a median of 1.4 months compared to over 6 months with traditional imaging. [9]
In fact:
- 96% of oncologists surveyed say that MRD testing has the potential to identify cancer recurrence earlier than other current methods
- 94% say that it could help reduce diagnosis delays in the detection of cancer recurrence
- 98% see at least one benefit of incorporating it into the care of their patients with cancer
Taken together, these data show that early detection modalities such as MRD could potentially be a valuable part of an oncologist’s armamentarium and are worthy of further study. At Quest, we’re committed to ensuring this and other next-gen technologies will provide reliable results, efficient processes, and world-class expertise across the cancer care continuum.
Conclusion
Oncologists and other cancer care providers will contend with a growing population of patients facing potential cancer recurrence in the years ahead. The tools we can use to fight back are limited, but potent. The first is acknowledgment of the logistical toxicity of cancer care – and then helping the patient overcome the many barriers to access. The utilization of next-gen testing techniques, like ctDNA MRD tests, can also be part of the solution. Allowing for serial blood-based monitoring in conjunction with imaging to help identify recurrence early, where treatment may have the most efficacy. If we’re to tackle this Cancer Paradox, both need to be at the center of the treatment paradigm.
Methodology: On behalf of Quest, The Harris Poll surveyed 250 oncologists (174 medical oncologists and 76 surgical oncologists) between August 6 and September 4, 2024, to gather insights into how they perceived and managed the challenges of cancer recurrence. Data were weighted where necessary by gender and age to bring them in line with their actual proportions in the population. For this research, we defined MRD testing as any laboratory test that uses a blood specimen to identify and measure levels of circulating tumor DNA (ctDNA) to aid in residual or recurring disease detection and treatment monitoring for solid tumor cancer, and not hematological cancers.
Reference
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[7] Elkefi S, Asan O. The Impact of Patient-Centered Care on Cancer Patients’ QOC, Self-Efficacy, and Trust Towards Doctors: Analysis of a National Survey. J Patient Exp. 2023 Jan 17;10:23743735231151533. doi: 10.1177/23743735231151533. PMID: 36698621; PMCID: PMC9869234.
[8] Zhu L, Xu R, Yang L, Shi W, Zhang Y, Liu J, Li X, Zhou J, Bing P. Minimal residual disease (MRD) detection in solid tumors using circulating tumor DNA: a systematic review. Front Genet. 2023 Aug 10;14:1172108. doi: 10.3389/fgene.2023.1172108. PMID: 37636270; PMCID: PMC10448395.
[9] Andrea Cercek, M.D., et al, Nonoperative Management of Mismatch Repair–Deficient Tumors Authors, April 27, 2025. N Engl J Med 2025;392:2297-2308. doi: 10.1056/NEJMoa240451
Featured image licensed under the Unsplash+ License and used with permission.
DOI:10.14229/onco.2025.09.20.001
