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01.
arXiv (CS.LG) 2026-06-11

SpaTeoGL: Spatiotemporal Graph Learning for Interpretable Seizure Onset Zone Analysis from Intracranial EEG

arXiv:2602.11801v2 Announce Type: replace Abstract: Accurate localization of the seizure onset zone (SOZ) from intracranial EEG (iEEG) is essential for epilepsy surgery but is challenged by complex spatiotemporal seizure dynamics. We propose SpaTeoGL, a spatiotemporal graph learning framework for interpretable seizure network analysis. SpaTeoGL jointly learns window-level spatial graphs capturing interactions among iEEG electrodes and a temporal graph linking time windows based on similarity of their spatial structure. The method is formulated within a smooth graph signal processing framework and solved via an alternating block coordinate descent algorithm with convergence guarantees. Experiments on a multicenter iEEG dataset with successful surgical outcomes show that SpaTeoGL is competitive with a baseline based on horizontal visibility graphs and logistic regression, while improving non-SOZ identification and providing interpretable insights into seizure onset and propagation dynamics.

02.
arXiv (CS.CL) 2026-06-11

When More Documents Hurt RAG: Mitigating Vector Search Dilution with Domain-Scoped, Model-Agnostic Retrieval

Retrieval-augmented generation degrades when scaled to large, heterogeneous document collections, where dense similarity loses discriminative power, and top-k retrieval increasingly returns semantically similar but contextually incorrect chunks. We refer to this failure mode as vector search dilution. Even when using hybrid dense+sparse retrieval, we observed this firsthand in a deployed Wyoming Department of Transportation corpus, where scaling from 54 to 1,128 documents (88,907 chunks) reduced accuracy from 75% to below 40%. To address this dilution, we propose MASDR-RAG ( Multi-Agent Scoped Domain Retrieval for RAG) and evaluate it on 200 expert-validated queries across five LLM backbones, six corpora, and two index stacks. Our results indicate that domain scoping using organizational metadata is the key fix, significantly improving P@10 from 0.77 to 0.86 ($p < 0.05$). Furthermore, our investigation of multi-agent orchestration revealed that a high degree of configuration dependence results –creating what we call the precision-faithfulness paradox. Based on these varied outcomes, our practical recommendation is simple: scope first, then perform a single synthesis call, reserving full multi-agent orchestration for genuinely multi-domain corpora paired with native-tool-call backbones. Code and Data will be made public upon acceptance.

03.
arXiv (CS.LG) 2026-06-11

SPADE: Split-and-Delay Embeddings for Autoregressive High-Granularity Calorimeter Simulation

arXiv:2606.11304v1 Announce Type: cross Abstract: We introduce SPADE (SPlit And Delay Embeddings), an autoregressive transformer for sequences whose tokens carry multiple features. Rather than embedding these features jointly, SPADE embeds them independently. Delaying each feature stream relative to the previous one allows intra-token correlations to be learned by the standard self-attention mechanism. Applied to point-cloud calorimeter shower generation in the highly granular ILD detector, SPADE is competitive with the state of the art AllShowers model on photon showers, and substantially outperforms its VQ-VAE-based predecessor OmniJet-$\alpha_C$. The mechanism is applicable to any generative task with multi-feature tokens, enabling LLM-style pretraining workflows for higher-dimensional data.

04.
arXiv (CS.AI) 2026-06-16

SCAN: A Decision-Making Framework for Effective Task Allocation with Generative AI

arXiv:2606.15601v1 Announce Type: cross Abstract: We introduce SCAN – a human-centric decision-making framework to facilitate learners for effective task allocation with Generative Artificial Intelligence (GenAI) based on Vygotsky's Zone of Proximal Development and Metacognition. In SCAN, we systematize and formalize AI-human interaction by introducing a task-identification approach with four "sub-zones": Substitute, Complement, Aid, and Non-negotiable. After describing the four sub-zones, we demonstrate how SCAN framework can be applied for knowledge workers in the workplace and students in education to metacognitively "scan" their use of Generative AI. We then discuss how such framework can be related to cognitive load theory, cognitive offloading, sycophancy, three decision-making modes in human-AI interactions (automation, augmentation, and collaboration), future of work such as upskilling and deskilling, and how it accounts for both human-human and human-AI learning. We propose that SCAN offers a great starting point before discussing whether GenAI complements or replaces our abilities when completing a task, with a general objective of sustaining lifelong learning, and a specific goal of reaching hybrid intelligence.

06.
arXiv (quant-ph) 2026-06-19

Matrix-product state skeletons in Onsager-integrable quantum chains

arXiv:2511.07212v2 Announce Type: replace Abstract: Matrix-product state (MPS) skeletons are connected networks of Hamiltonians with exact MPS ground states that underlie a phase diagram. Such skeletons have previously been found in classes of free-fermion models. For the translation-invariant BDI and AIII free-fermion classes, it has been shown that the underlying skeleton is dense, giving an analytic approach to MPS approximation of ground states anywhere in the class. In this paper, we partially expose the skeleton in certain interacting spin chains: the $N$-state Onsager-integrable chiral clock families. We construct MPS that form a dense MPS skeleton in the gapped regions surrounding a sequence of fixed-point Hamiltonians (the generators of the Onsager algebra). Outside these gapped regions, these MPS remain eigenstates, but no longer give the many-body ground state. Rather, they are ground states in particular sectors of the spectrum. Our methods also allow us to find further MPS eigenstates; these correspond to low-lying excited states within the aforementioned gapped regions. This set of MPS excited states goes beyond the previous analysis of ground states on the $N=2$ free-fermion MPS skeleton. As an application of our results, we find a closed form for the disorder parameter in a family of interacting models. Finally, we remark that many of our results use only the Onsager algebra and are not specific to the chiral clock model representation.

07.
medRxiv (Medicine) 2026-06-17

Investigating shared genetic overlap of immune-mediated inflammatory diseases and cardiometabolic diseases

Abstract Background: Immune-mediated inflammatory diseases (IMIDs) are associated with increased risk of cardiometabolic diseases. Investigating genetic overlap among these conditions can provide insights into their clinical management. Methods: Genetic correlation was assessed using linkage disequilibrium score regression (LDSC). Then, a meta-analysis was conducted using Association Analysis Based on SubSETs (ASSET) to pinpoint independent single nucleotide polymorphisms (SNPs) shared across the diseases. Each independent SNP was then used to define a genomic window (+/-500KB) for colocalisation analysis and Local Analysis of [co]Variant Association (LAVA) to offer multiple layers of regional pleiotropic evidence. Over-representation analysis was then run to identify enriched biological pathways, which then were used for drug target analysis. Results: The LDSC analysis showed a significant global genetic correlation for rheumatoid arthritis (RA) and cardiometabolic diseases including hypertension, coronary artery disease (CAD), heart failure (HF), stroke, atrial fibrillation (AF), and type two diabetes mellitus (T2DM) ranging from rg = 0.09 to 0.24. ASSET meta-analysis identified 164 independent SNPs shared across RA and the cardiometabolic diseases with P < 5 x 10- in the overall one-sided meta-analysis P-value, FDR < 0.05 in both individual GWASs, and TRUE phenotype matrix. Colocalisation analysis revealed multiple loci with strong evidence (Posterior probabilities [&ge;] 80) of single causal SNPs between the trait pairs. LAVA analysis was then used as an additional layer of confirmation for the findings generated by ASSET and colocalisation and thus several loci were highlighted. Over-representation analysis showed significant enriched immune-related pathways across RA-hypertension, RA-CAD, RA-AF, and RA-T2DM trait pairs. Drug target analysis highlighted several drugs which could be further tested for their effectiveness in RA and its common comorbidities. Conclusion: The findings revealed a shared genetic architecture and key immune-related biological pathways underlying RA and its associated cardiometabolic comorbidities. The identified genes and drugs provide opportunities for further therapeutic assessment which could improve clinical management strategies.

08.
arXiv (CS.AI) 2026-06-18

Mechanism-Guided Selective Unlearning for RLVR-Induced Reasoning

arXiv:2606.19222v1 Announce Type: cross Abstract: We propose MAST (Mechanism-Aligned Selective Targeting), a mechanism-guided method for unlearning RLVR-induced reasoning with substantially lower collateral damage than standard full-parameter updates. In matched SFT/RLVR checkpoints on Qwen2.5-Math-1.5B and Qwen3-1.7B-Base, the SFT-to-RLVR increment differs sharply from the SFT update in token-level delta-log-probability, and full-parameter gradient ascent forgets only by damaging retain MATH and GSM8K. MAST ranks attention-projection tensors by off-principal energy, update magnitude, and forget-gradient coupling magnitude, then updates only the top-ranked subset. On the primary model, MAST induces statistically significant target forgetting (MATH forget 45/150 to 37/150; McNemar p=0.0078) while preserving GSM8K (+0.8 pp) and MATH retain (-0.5 pp). The advantage reproduces across seeds, NPO/SimNPO objectives, and Qwen3, where MAST preserves GSM8K while full-parameter unlearning collapses it.

09.
arXiv (CS.AI) 2026-06-19

Evaluating and Enhancing Negation Comprehension in Remote Sensing MLLMs

arXiv:2606.20177v1 Announce Type: cross Abstract: Multimodal Large Language Models (MLLMs) have demonstrated remarkable success in various Remote Sensing (RS) tasks. However, their ability to comprehend negation remains underexplored, limiting deployment in real-world applications where models must explicitly identify what is false or absent, e.g., emergency responders need to locate non-flooded routes for evacuation. To comprehensively study this limitation, we introduce RS-Neg, the first benchmark to evaluate negation understanding across region-level to scene-level tasks. Specifically, we design an automated data generation pipeline for RS imagery, using LLMs to synthesize diverse negation queries, and introduce a dynamic visual focus module for verification. Our evaluation reveals that advanced RS MLLMs struggle with negation, exhibiting hallucinations and substantial performance degradation. To close this gap, we propose NeFo, a novel test-time learning method that explicitly incorporates the logical role of negation into the model optimization. Remarkably, using about 5\% unlabeled test samples, NeFo significantly improves the negation understanding of models and shows strong generalization to unseen tasks. Code and data will be released upon acceptance.

10.
arXiv (CS.CV) 2026-06-18

Optimizing Incomplete, Large-Scale and Sparse Multi-Graph Matching in Bioimaging

Multi-graph matching is a fundamental problem in computer vision. Our work is motivated by a challenging application in bioimaging, where dozens or even hundreds of 3D microscopy images of worms must be brought into correspondence. Existing datasets do not cover this large-scale regime, and virtually all existing methods are inapplicable because they assume a complete or dense problem setting. To support further research, our first contribution is a new large-scale dataset based on problem instances from bioimaging. Our second contribution is a comprehensive analysis of the two main multi-graph matching paradigms: direct and permutation synchronization-based formulations. We argue, in part by proof, that practical large-scale methods must explicitly address problem sparsity and incompleteness. Since standard permutation synchronization approaches fail in this setting, we further introduce a sparse permutation synchronization paradigm. Our final contribution is GREEDA, a general method for sparse and incomplete problems that can be instantiated across cost orders and paradigms. While our paper focuses on objective functions up to quadratic order, GREEDA is inherently generalizable to arbitrary orders. On larger, sparse instances, GREEDA outperforms competing methods in both objective value and runtime. For example, for moderately-sized problems based on 30 worm images GREEDA produces a high-quality solution within 2 minutes, whereas competitors require at least half an hour and yield far worse results. On smaller dense problems, GREEDA remains on par with leading methods while being an order of magnitude faster.

11.
arXiv (CS.AI) 2026-06-17

Understanding LLMs in Title-Abstract Screening: From Disagreements to Recommendations

arXiv:2606.17588v1 Announce Type: cross Abstract: Several studies have examined the use of large language models (LLMs) for title-abstract screening in systematic reviews (SRs), reporting mixed accuracy. However, questions of reliability remain largely unaddressed. In this study, we go beyond quantitative LLM-human agreement metrics and qualitatively investigate how and why LLMs fail. We also propose actionable recommendations. We analyzed disagreements between LLMs and researchers across six software engineering SRs and over 1,000 primary study papers. For each SR, papers were screened independently by human experts and LLMs in zero-shot mode, resulting in Kappa values ranging from 0.52 to 0.77. Qualitative analysis suggests that human-LLM disagreement results from recurring, identifiable causes, such as boundary ambiguity in key terms, keyword overemphasization, and incorrect topic inference. Based on these findings, we propose recommendations such as validating semantic understanding before deployment, running multiple LLMs, and focusing validation efforts on borderline cases. Future studies are needed to validate the impact of our recommendations, and community efforts are needed to develop normative guidelines on LLM usage in SRs.

12.
arXiv (CS.CL) 2026-06-16

Connecting Speech to Words through Images

How can we learn the mapping between written words and their spoken counterparts in the absence of explicit textual supervision? We present a visually grounded method for building a vocabulary of spoken words using only images and their spoken descriptions. First, image captioning systems are used to build a vocabulary of written words representing salient visual concepts in the images. For each word, we then find utterances whose image captions contain that word. Then we use an unsupervised word discovery technique to align these utterances to locate instances of the target word. The result is spoken word segments that are linked to written words – all accomplished without any text supervision. In spoken word retrieval and keyword spotting experiments, the proposed approach outperforms a strong neural baseline while being more interpretable. These results demonstrate the feasibility of the approach in English and motivate future work on low-resource languages without transcripts.

14.
arXiv (CS.CL) 2026-06-16

ttda704 at SemEval-2026 Task 4: Modeling Narrative Structures via Pseudonymization and Multi-View Sentence Alignment

We present our approach to SemEval 2026 Task 4: Narrative Story Similarity and Narrative Representation Learning. Our solution uses contrastive learning with fine-tuned sentence transformers to capture narrative similarity across abstract themes, course of action, and outcomes. We develop two pipelines: (Track A) a single-view method that encodes full narratives with smart layer freezing to reduce overfitting, and (Track B) a multi-view method that models theme, plot, and outcome with view-specific projection heads and self-supervised alignment. Both pipelines build on sentence-transformers models and are trained with contrastive loss on synthetic data. The code is available at the following GitHub repository: https://github.com/dinhthienan33/SemEval2026-Task4-ttda704.

15.
arXiv (CS.LG) 2026-06-11

Bootstrapped Monitoring: Leveraging Transparent Reasoning to Oversee Stronger AI Agents

arXiv:2606.11998v1 Announce Type: new Abstract: Trusted monitoring is a cornerstone of AI control. However, as frontier models grow more capable, the increasing capabilities gap between trusted and untrusted models may render trusted models unreliable monitors. We introduce bootstrapped monitoring, a protocol that addresses this by inserting a stronger, intermediate untrusted model with transparent chain-of-thought reasoning into the oversight chain. The untrusted monitor ($U_m$) evaluates the agent's actions, while a weaker trusted model ($T$) oversees $U_m$'s reasoning to detect collusion. We evaluate bootstrapped monitoring on multi-turn software engineering tasks (BashArena) across multiple agents and monitors. Bootstrapped monitoring substantially improves catch rates over trusted-only monitoring, even when the untrusted monitor actively colludes with the agent, provided we have access to its raw chain-of-thought. Our results suggest that bootstrapped monitoring can extend the useful lifetime of trusted models in control as AI capabilities advance.

17.
arXiv (CS.CV) 2026-06-11

DAM-VLA: Decoupled Asynchronous Multimodal Vision Language Action model

Vision-language-action (VLA) models inherit a shared synchronous clock from vision-language pretraining, processing every input at one rate. This is misaligned with physical interaction, where a high-frequency modality changes at hundreds of hertz, vision evolves more slowly, and language stays constant across an episode. A synchronous VLA oversamples slow modalities, undersamples fast ones, and caps action generation at the lowest effective frequency. We hypothesize that decoupling temporal processing per modality, letting each update and retain information at its own sensor rate, yields stronger representations and more robust control. We present DAM-VLA, which maintains per-modality latent buffers refreshed at sensor rates and read continuously by the action head, integrating new high-frequency modalities through gated cross-attention that leaves the pretrained backbone intact. Across seven contact-rich real-world manipulation tasks, DAM-VLA more than doubles the average success rate of the strongest synchronous baseline (95.2\% vs.\ 40.95\%) while sustaining smooth, reactive 100\,Hz control. Project website: \href{https://intuitive-robots.github.io/DAM-VLA/}{intuitive-robots.github.io/DAM-VLA/}

18.
arXiv (CS.CL) 2026-06-17

A Framework for Evaluating Agentic Skills at Scale

Agent skills – structured, reusable knowledge artifacts that augment LLM agent capabilities – have been rapidly adopted in industry, yet their cross-domain impact and use across commercial and open-source models remain under-studied, and no reusable methodology exists for evaluating an individual skill. In this work, we present an evaluation framework that lets a skill author construct realistic tasks to rigorously assess the aspects of a skill that matter most to them, and that estimates skill utility by solving those tasks. Further, we apply our evaluation approach at scale to 500 real-world skills, generating 1,000 tasks derived from the skills' content, along with instruction-following and goal-completion scoring rubrics. Using these metrics, we evaluate how 19 agent-model configurations, both proprietary and open-source, perform on the tasks. Our results show that models vary widely in how closely they adhere to the instructions encoded in skills, leading to substantial differences in their performance gains. Furthermore, we show that access to a skill significantly changes model behavior compared to the no-skill setup, providing an essential mechanism for encoding opinionated workflows into LLM agents. We release our evaluation dataset to support future work on agent skills.

19.
arXiv (math.PR) 2026-06-15

Stationary measures for higher spin vertex models on a strip

作者:

arXiv:2309.04897v2 Announce Type: replace-cross Abstract: We introduce a higher spin vertex model on a strip with fused vertex weights. This model can be regarded as a generalization of both the unfused six-vertex model on a strip arXiv:2212.09111 and an 'integrable two-step Floquet dynamics' model introduced in arXiv:1711.08884. We solve for the stationary measure using a fused version of the matrix product ansatz and then characterize it in terms of the Askey-Wilson process. Using this characterization, we obtain the limits of the mean density along an arbitrary down-right path. It turns out that all these models share a common phase diagram, which, after an appropriate mapping, matches the phase diagram of open ASEP. This provides evidence for the universality of this phase diagram.

20.
arXiv (CS.CV) 2026-06-12

VLADriveBench: Evaluating CoT-Action Relationship in VLA for Autonomous Driving

Vision-language-action (VLA) models generate chain-of-thought (CoT) reasoning alongside driving trajectories, but existing benchmarks evaluate only trajectory quality and do not assess whether the CoT is relevant, consistent, or causally connected to the driving action. We introduce VLADriveBench, a framework that combines observational metrics (mentioning, hallucination, contradiction, action alignment) with a CoT intervention protocol to provide complementary views of the CoT-action relationship. Applying VLADriveBench to three models across two architectures, we find that the two analyses can diverge sharply: ORION scores highest on observational alignment yet its CoT is epiphenomenal, while Alpamayo v1.5 scores lower yet its CoT is strongly causal, with visual salience gating the extent of CoT influence.

21.
Nature (Science) 2026-06-10

Diverse binding poses of agonistic neurotoxins on human Na<sub>v</sub>1.6

作者:

Voltage-gated sodium (Nav) channels are key targets of various venomous toxins. Deciphering the binding poses and mechanisms of action of representative toxins will help to dissect the functional mechanism of the channels and facilitate therapeutic development targeting Nav channels1,2. Here we present cryo-electron microscopy&nbsp;(cryo-EM) structures of distinct binding poses of three agonistic peptide toxins on the human Nav1.6–β1 channel complex. The globular β-scorpion toxin Cn2 nestles between the extracellular segment of voltage-sensing domain (VSD)&nbsp;in the second repeat of the Nav1.6 core α-unit (VSDII) and the pore extracellular loops in the third repeat of the Nav1.6 core α-unit (ECLIII), where it is stabilized by interactions with both protein regions and the branched N1372-glycan. Cone&nbsp;snail ι-conotoxin RXIA adopts an elongated conformation, spanning VSDI and VSDIV to wrap around the shoulder of the pore domain (PD). The bullet&nbsp;ant-derived toxin δ-paraponeritoxin-Pc1a exists as a transmembrane helix that stands between VSDII and PDIII. Our findings, corroborated by functional characterizations, illustrate the diversity in peptide toxin binding poses and mechanisms of action, link stabilization of the up state of VSDI or VSDII to channel activation, and provide clues to the rational design of selective Nav channel modulators. Structures of the distinct binding poses of three agonistic peptide toxins—bullet-ant-derived toxin δ-paraponeritoxin-Pc1a, cone&nbsp;snail ι-conotoxin RXIA and the globular β-scorpion toxin Cn2—on the human Nav1.6–β1 channel complex illustrate a diversity in binding poses and mechanisms of action.

22.
arXiv (CS.CV) 2026-06-11

SceneMiner: Identity-Preserving Multi-Task Fine-Tuning for Unified BEV Scene Mining

Mining hard, safety-critical scenes from driving logs is bottlenecked by the absence of difficulty labels, and no single proxy, collision risk, trajectory ambiguity, or semantic rarity suffices to find such scenes on its own. We present SceneMiner, a unified, camera-only bird's-eye-view pipeline that emits complementary mining signals from a frozen vision-language backbone in a single forward pass, with no LiDAR or radar: a retrieval embedding for text-prompted scenario search, a multi-label scene-tag distribution, and a continuous physics-based risk score (a motion forecast is a byproduct, not a contribution). Building such a multi-head model exposes our central finding, a failure mode we term cross-task interference: adding or upgrading one head shifts a shared activation stream and degrades weight-frozen sibling heads, so freezing parameters alone is insufficient. Our contribution, identity-preserving multi-task fine-tuning, removes this interference by zero-initializing every new sub-module and freezing every parameter that feeds the shared stream. The mining heads are thereby preserved bit-identically while training only ~102k parameters. The tagging head reaches mAP 0.4614 (micro-F1 0.5557) on 20 scene tags by pooling each scene into 32 visual tokens, and the embedding head supports text-prompted retrieval, validated qualitatively. Code is available at: https://anonymous.4open.science/r/sceneminer_anonymous-64E5

23.
medRxiv (Medicine) 2026-06-16

Reporting patterns of adverse drug withdrawal events using individual case safety reports in United States and European databases

Introduction: Adverse drug withdrawal events (ADWEs) are a key safety concern with deprescribing but are infrequently reported in trials. Although pharmacovigilance systems have advanced our understanding of medication-related harms, it is unclear how extensively these systems have been used for ADWEs. Objectives: To examine the reporting patterns of ADWEs for all drugs recorded in United States and European pharmacovigilance databases between 2004 and 2023. Methods: A retrospective study was conducted using two pharmacovigilance databases, the publicly available FDA-FAERS dataset and EMA-EV Level 2A (individual-level) dataset. ADWE cases were identified using relevant MedDRA preferred terms. Data on patient characteristics, reporter type, drugs, indication, ADWE outcomes, dechallenge/rechallenge, seriousness criteria, time to onset, duration, and causality were summarised. Results: A total of 158,505 ADWE reports were analysed (FDA-FAERS: 145,514; EMA-EV: 12,987), with mean ages of 46.1 (FDA; 55.3% female) and 45.5 years (EMA; 57.1% female). The frequently reported drug classes were opioids (FDA: oxycodone, 29.8%; EMA: buprenorphine, 19%), antidepressants (FDA: duloxetine, 32%; EMA: venlafaxine, 25.9%) and gabapentinoids (FDA: pregabalin, 6.7%; EMA: pregabalin, 6.0%). The most common adverse outcomes were other serious medical conditions (FDA=63.9%; EMA=46.0%), hospitalisation (FDA=15.9%; EMA=28.3%), and disability (FDA=13.3%; EMA=6.2%) and these outcomes varied significantly based on sex and age group (p

24.
arXiv (CS.AI) 2026-06-11

LSTM-Based Detection of Structural Breaks in Property Insurance Loss Reserving: A Climate-Informed Approach

arXiv:2606.11463v1 Announce Type: cross Abstract: Accurate loss reserving is foundational to insurer solvency, yet accelerating climate driven catastrophes systematically violate the stability assumptions on which traditional actuarial methods depend. This white paper presents a research program testing whether Long Short Term Memory (LSTM) neural networks can detect and adapt to these structural breaks faster and more accurately than Chain Ladder, Bornhuetter Ferguson, and Cape Cod methods. Using 15 plus years of regulatory development triangle data from Florida and Louisiana, enriched with NOAA hurricane intensity indices and sea surface temperatures, we hypothesize a targeted improvement of 15, 20% in reserve accuracy for catastrophe exposed years, a threshold grounded both in the prior neural network reserving literature and in the formal convergence results developed here. Beyond empirical validation, we develop a theoretical framework grounding LSTM structural break detection in probabilistic terms, providing formal performance guarantees that compensate for the limited number of catastrophe events in the test period. We document the research design, methodology, expected contributions, and a candid assessment of limitations.

25.
medRxiv (Medicine) 2026-06-12

Cancer care disruption during the COVID-19 pandemic in Ontario, Canada: A sequential mixed-methods study

Introduction The COVID-19 pandemic profoundly disrupted healthcare delivery worldwide, with cancer care among the most affected services. Prior studies documented delays in referrals, reduced specialist access, and increased provider burden. However, the extent to which these experiences were reflected at the system level remains unclear. Objective To document cancer care experiences and examine whether these experiences were reflected in population-level health system indicators across Ontario, Canada. Methods We used an exploratory sequential mixed-methods design. Qualitative data were collected through focus groups and semi-structured interviews with 32 participants, including patients with cancer (n=8), caregivers (n=5), healthcare providers (n=14), and decision-makers (n=5) across two hospital settings in Ontario, Canada. Emergent themes informed the development of quantitative indicators. We then conducted a retrospective population-based analysis of linked administrative health databases for cancer patients in Ontario (n=87,786) to assess the prevalence of identified themes. Results Four themes emerged: (I) delays in diagnosis and screening; (II) disrupted access to primary care; (III) barriers to specialist and mental health services; and (IV) fragmented care for patients with multimorbidity. Quantitative findings corroborated major themes. Screening rates declined for cervical (64.8% to 57.5%) and breast cancer (64.5% to 57.2%). While in-person primary care shifted almost entirely to virtual modalities (8.5% to 95.4%), overall visit volumes remained stable. Specialist care showed uneven patterns, with increased oncology visits but declines in cardiology and mental health services. Patients with multiple comorbidities experienced the largest reductions in non-oncology specialist care. Conclusion The pandemic disrupted key components of cancer care, particularly screening, access to certain specialist services, and care for patients with complex needs. Integrating qualitative and quantitative evidence highlights areas of system vulnerability and underscores the need for coordinated, resilient cancer care capable of maintaining essential services during future crises.