Thank you to Schell and colleagues for your interest in our manuscript. We agree that there is a need for further research into the mechanisms of co-existence of cancer and comorbid diseases and the need for development and application of comorbidity assessment and management tools that are validated in the younger cohort. We wish to stress however that our study did not include patients younger than 50 years and thus we are not able to comment on the relationship of cancer and comorbid diseases in individuals younger than 50. Other large cohort studies have demonstrated higher prevalence of comorbidities of survivors of childhood cancer emphasizing the importance of this issue in all cancer survivors and underscoring the importance of research in this area [1]. It is unclear if the etiology and mechanisms for cancer and chronic disease development in paediatric/adolescent individuals with cancer is similar or different to those in middle age and older adults. Future research including preclinical and animal model research may shed a light into this intriguing area.