QUESTION: Do Patients Die from the Cancer… or from the Treatment?
After spending 35 years in the world of occupational safety and health, where every workplace accidents and injury is recorded, logged, and investigated, I entered the world of oncology—as a patient. And what I found was staggering. In OSHA, prevention is everything. Accidents and Injuries are classified, tracked, and turned into actionable prevention. In cancer care, treatment comes first and harm, if it’s recorded at all, is often buried in trials, misattributed, or ignored altogether.
I speak from personal experience. I’m a two-time head and neck cancer survivor. I received cisplatin and radiation, and I live with a permantly damaged thryroid, long-term cognitive impairment that was minimized as “chemo fog.” Now, more than five years post-treatment, I learned—on my own—that I’m at heightened risk for stroke due to carotid artery narrowing from radiation. Throw in oral complications including cracked and fractured teeth, not once where these risk explained to me before treatment. This kind of omission is not rare—it's systemic.
So here’s the hard question: Do people die from the cancer… or from the treatment and its unspoken downstream harms? The honest answer is both—and the tragedy is, we don’t measure the difference well enough to inform patients properly.
What We Know (and What We Choose Not to Track)
During treatment, the risks are already sobering. In modern clinical trials, chemoradiation for head and neck cancers carries a 1–3% treatment-related death rate. In real-world practice—outside of trials, where patients are more medically complex—that number is often higher. These aren’t statistics you can dismiss when you're the one affected.
For those receiving palliative chemotherapy, early mortality within 30 days of treatment is closely monitored as a safety signal. That’s because in some cases, it’s not the cancer that kills quickly, it’s the treatment: infections, organ failure, or immune complications triggered by aggressive drugs.
But it's the years after treatment that tell the more silent story. Radiation to the neck, for instance, significantly raises the long-term risk of carotid artery stenosis and stroke. Several peer-reviewed studies recommend ultrasound surveillance beginning 2–5 years post-treatment and continuing regularly. Yet to this day my oncologist never mentions it. There’s no standard survivorship protocol, no routine screenings, and often no acknowledgement of this late but lethal risk.
Even in major clinical trials, cause of death is often misclassified. A death caused by treatment toxicity or delayed injury may still be recorded as a “cancer death.” This blurs the line of attribution, misleading both doctors and patients.
The Invisible Harm: Errors, Misdiagnosis, and Missing Data
Errors in diagnosis are another hidden danger. A 2024 study estimated nearly 800,000 Americans a year are seriously harmed or die from major diagnostic mistakes. These aren’t rare glitches; they’re systemic failures. And yet, these deaths rarely show up in national mortality data because our death certificates aren’t designed to capture “medical error” as a cause.
In 2016, a controversial but influential BMJ study argued that medical error would rank as the third leading cause of death in the United States if we counted it accurately. Even its critics agreed on the core point: our reporting system conceals more than it reveals.
What OSHA Would Do (But Oncology Doesn’t)
In occupational health and safety, an employer must log every injury, who it happened to, what caused it, how bad it was, and what was done. These logs feed national databases that power prevention strategies. Oncology, by contrast, has no such system.
There’s no national “harm log” that captures toxicities, complications, or long-term treatment effects outside of select clinical trials. The FDA’s adverse-event database is voluntary and underreported. Cancer registries like SEER are fantastic at tracking incidence and survival but are not designed to capture treatment harms in any standardized, useful way.
Even the structure of the death certificate ensures treatment-related deaths are hidden. There's simply no box for “this person died because the treatment caused fatal damage.” So we continue to undercount and undertreat the full scope of harm.
Case in Point: Head & Neck Radiation and Stroke Risk
As a survivor, I learned long after treatment that head and neck cancer patients who undergo radiation face a much higher risk of stroke due to carotid artery damage. This is not speculative, it’s documented across multiple studies and institutions.
Some expert protocols now recommend routine carotid artery screening, beginning just a few years of post-treatment. But the vast majority of survivorship care plans never mention it. That kind of silent omission would never be tolerated in the OSHA world. Yet in oncology, it’s just standard practice.
How We Can and Must—Do Better
The fix isn’t theoretical. We already have a working model in OSHA. Here’s what oncology could learn:
Create a national “Treatment Harm Log.” Every patient’s treatment should be tracked with standardized fields: drugs, doses, radiation sites, immediate toxicities, long-term outcomes. This isn’t just possible, it’s overdue.
Mandate a “Critical Risks Checklist.” Survivors deserve better than silence. Patients should receive a baseline and post-treatment risk disclosure: stroke risk after neck radiation, cardiotoxicity from certain chemo drugs, cognitive risks from neurotoxic agents. These should be revisited annually, especially at the 1- and 5-year marks.
Reform death reporting. Add a structured field to capture treatment-related or care-contributed deaths. This alone could reshape how we understand cancer outcomes.
Make adverse-event reporting mandatory. Serious toxicities need to be logged by law, with consequences for non-reporting—and made public, just like OSHA’s dashboards.
The Bottom Line
This isn’t about pointing fingers. It’s about acknowledging that treatment, while life-saving, can also cause serious, lasting harm and sometimes death. We can’t protect patients from every risk. But we can start by measuring them honestly and informing patients fully.
Cancer didn’t kill me. The treatment didn’t either. But parts of me were lost along the way, pieces that no one warned me I’d be risking. We owe future patients a better standard: one that tracks harm with the same precision we track hope.