Understanding the impact of the COVID19 pandemic on systemic anti-cancer therapy delivery (SACT) is crucial for a full appreciation of the short and long-term consequences for cancer patients and for planning future cancer care. In this article we report real-time national SACT delivery data from NHS Scotland. We demonstrate an initial rapid reduction in patient attendance for SACT of 28.7% with a subsequent rapid and full recovery following service re-design. Regional variation in the magnitude of impact on SACT delivery was observed, but nadirs occurred at the same time and the rate of recovery was similar across all regions. This recovery reflected a co-ordinated national approach and associated patient and clinician support structures which facilitated the creation of COVID-19 protected areas for SACT delivery in Scottish cancer centres and enabled rapid sharing of successful and innovative strategies. The data shows that these actions have limited the disadvantage to cancer patients.