Introduction Lung cancer screening is a tool available for patients with a significant smoking history. During the COVID-19 pandemic patient care was affected. Access to non-urgent follow up visits, screening and diagnostic procedures was limited, and in some cases, delays in care resulted in adverse outcomes. Case descriptionA 68-year-old man with 33-pack-year smoking history presented to the hospital for evaluation after a mechanical fall. He reported progressive left-sided neck pain and weakness of the left upper extremity for 6 months, and during an initial visit with PCP, he was diagnosed with arthritis. A follow-up visit was rescheduled due to rise of COVID 19 cases and decrease of non-urgent in-person office visits. Of note, the patient had undergone lung cancer screening with low dose chest CT 2 years prior without significant findings.At the time of his visit to the hospital, his physical exam was notable for a thin, cachectic, frail male with left-sided neck contracture and 3/5 left upper extremity strength. Blood work was unremarkable except for normocytic, normochromic anemia of 13 gr/L. CT of the neck showed a soft tissue mass eroding the left C6 to T1 vertebral bodies without fracture (Image 1A). A subsequent CT chest with contrast revealed a heterogeneous centrally necrotic mass at the left lung apex encasing and narrowing the lumen of the left subclavian artery (Image 1B). Multiple poorly differentiated lesions were also seen on the liver. Biopsy of the lung mass was consistent with poorly differentiated squamous cell carcinoma. Palliative radiation and comfort care were started, and ultimately patient expired. DiscussionLung cancer is the second most common cause of malignancy in the United States. Pancoast tumors account for up to 5% of all lung cancers. Data published for 2020 suggest a decrease in more than 50% of cancer screening visits, translating in the delay of care and ultimately treatment. Our patient is one of the many examples of how the COVID-19 pandemic affected patient care. Decreased access for non-urgent medical issues negatively impacted the clinical course of our patient. Although changes that allowed for the expansion of telehealth services were significant, we should continue developing evidence-based approaches to deliver care during medical emergencies. Increasing access for vulnerable populations by broadening telehealth programs or deploying physicians along with resources could significantly impact early diagnosis and provide relief to a system that may be underprepared for another pandemic.