Abstract
Introduction
Children with suspected cancer may succumb to their bad condition shortly after admission,
even before a definitive diagnosis can be reached. We aimed to address the issue of
delayed presentation and early deaths among children suspected of having cancer. We
analyzed also the types and causes of mortalities across different tumor types.
Materials and methods
A retrospective review of reports from newly admitted patients between 2006 and 2010 at
the pediatric oncology department of the South Egypt Cancer Institute (SECI) was done.
Parameters included age, gender, diagnosis, symptoms, the interval between initial symptoms
and the first visit to SECI, the duration from admission to death, and the cause of
death.
Results
Among the 502 patients with confirmed malignancies, 238 (47.4%) succumbed. Causes of
death were predominantly treatment-related mortalities (TRM) (66%). Mortalities within
hematological malignancies were mainly TRM (81%), whereas solid tumors were primarily
disease-related (70%), p <0.0001. The leading causes of TRM was infection (60%).
About 5% of patients experienced early death within 48 hours after presenting to SECI.
The mean duration from initial symptoms to the first SECI visit was 67 days, and the period
from admission to death averaged 27 hours. Common initial symptoms included abdominal
swelling (29.6%), or fever (26%). The leading causes of death were respiratory failure
(29.6%), tumor lysis syndrome (22%), or septicemia (22%).

Conclusions
Delayed presentation leading to early deaths poses a significant obstacle to the successful
treatment of childhood cancers. Early diagnosis and improved supportive care are essential
to enhancing the overall survival, particularly in patients with hematologigical malignancies.