Disclosures: Zaorsky reports no relevant financial disclosures.
June 10, 2020
3 min read

Pediatric cancer survivors at risk for competing causes of death

Disclosures: Zaorsky reports no relevant financial disclosures.
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For children with cancer, the short-term imperative is to effectively treat the primary disease and prevent mortality and possible recurrence.

However, in the years following successful treatment, survivors of certain types of pediatric cancers become more likely to die of causes other than the primary malignancy, with risk for death due to those other factors — such as heart disease, suicide and sepsis — rising throughout their lives, according to study results published in Cancer.

When managing these patients, clinicians should consider the various long-term risks for competing causes of death, according to Nicholas G. Zaorsky, MD, assistant professor in the department of radiation oncology at Penn State Cancer Institute.

Nicholas G. Zaorsky, MD,
Nicholas G. Zaorsky

“My research group focuses on identifying competing causes of death among cancer survivors,” Zaorsky said in an interview with Healio. “We’re trying to figure out which patients are at risk to die of which cause, and then we are trying to implement strategies that will target that specific cause.”

Zaorsky spoke with Healio about the results of the study and how clinicians can help mitigate these long-term risks.

Question: What prompted you to study the long-term causes of death among pediatric cancer survivors?

Answer: I am very interested in how we can decrease the risk for death due to cancer and other causes. We’re trying to figure out how to increase survival of the primary cancer ; in the current work, we focused on young patients. Additionally, because survivors of pediatric cancer may survive for many, many years after treatment, we wanted to determine their risk for death due to other conditions.

Q: How was the study conducted and what did you find?

A: We used the SEER database to evaluate patients aged younger than 20 years who were diagnosed with cancer between 1980 and 2015. We wanted to look at patients who were children in the 1980s and are now adults.

We found a few things. First, we saw that certain patients are very much at risk for dying of their primary cancer. Usually, these are patients with malignancies such as pediatric brain tumors. In contrast, patients with leukemia and lymphomas had a much higher risk for dying of something else, such as heart disease, infection or other competing causes. It depends on the cancer and the time since diagnosis and treatment.


Q: Did you observe changes over time in the causes of death due to the development of less invasive, more targeted treatments?

A: We started out looking at the numbers that way, but we ultimately decided not to take that approach. One of the reasons we chose this time frame was that we felt it went back far enough that there were advances in treatments over that time. Also, it wasn’t so far back that we didn’t have treatments — where patients with lymphomas and testicular cancer died of their cancers. So, we chose something in the middle, like a “Goldilocks” time window, that would account for a variety of factors.

Q: Why did the risk for suicide appear high among most patients?

A: My research group conducted another study, published in Nature Communications, titled “Suicide Among Cancer Patients.” We’ve seen this risk among patients who had testicular cancer and some types of leukemia and lymphoma as children. In terms of why they may be at risk, one factor may be that often, the chemotherapy they receive may make them infertile. The treatments also cause other effects that may decrease patients’ quality of life. A combination of these factors probably leads to increased risk for suicide.

Q: What other insights did the study yield?

A: Many of the pediatric cancers we see today are treatable, and the children who live to be adults live for a very long time. So, it’s very important not only to prevent the risk for death due to cancer, but also due to these competing causes. We’re trying to identify care that will decrease their risk for death due to these causes. I think exercise can certainly help, and our grant and clinical trial focuses on this intervention.

Another important finding is that, unfortunately, we still don’t have great control over some of these pediatric cancers. Children still die of these cancers in these modern times.


Zaorsky NG, et al. Nat Commun. 2019;doi:10.1038/s41467-018-08170-1.

For more information:

Nicholas G. Zaorsky, MD, can be reached at 500 University Drive, Hershey, PA 17033; email: nzaorsky@pennstatehealth.psu.edu.