An 8 year audit of hospital deaths in children with cancer from a tertiary care cancer institute in India

Background: The outcome in pediatric cancers have significantly increased in the last few decades. Early diagnosis and risk directed therapy have been the cornerstone for success. However high treatment related mortality and deaths due to progressive disease in low middle income countries still prevail affecting the overall survival. We have analysed the hospital deaths in our pediatric oncology department for the years 2010-2017 to assess the treatment related mortality, factors affecting the same and have devised strategies to address these issues. Methods: All 4051 children registered between the years 2010-2017 were included. Data regarding their diagnosis and metastatic status was collected. About 375 deaths were documented in the hospital during these 8 years. Retrospective data was collected from the medical records department from the death files. Data about age, gender, primary diagnosis, phase of therapy, response to treatment, disease status and cause of death were analysed. Results: About 375 deaths were documented in hospital. There was a male predominance noted. Leukemia contributed to 64.8% of deaths. Treatment related mortality was significantly higher in the leukemia group contributing 32.1% compared to 13.6% in Solid tumor group. Advanced/progressive disease was the most common cause of death in solid tumor group, 71.9%. About 35.4% of children had presented at advanced disease state and 18.9% were metastatic at presentation. Metastatic disease at presentation was a significant risk factor for mortality (p=0.00001), while age (p=0.11) or gender (p=0.58) were not statistically significant. Conclusion: Analysis of mortality statistics is essential for growth of every pediatric oncology department. It provides information regarding status of supportive care and also the optimization of therapy intensification strategies to strike balance between treatment related toxicity and adequate treatment dosage. strengthening of peripheral health support and blood bank facilities in combination with antibiotic policies shall help in minimizing early deaths in children diagnosed with cancer.