Early deaths in childhood cancer

Background. Deaths prior to or shortly after the diagnosis of childhood can cer may reflect inadequacies in detection and appropriate referral for care . This study was performed to determine the extent of and factors associate d with early death in childhood cancer. Procedure. Patients with of primary cancer, aged <20 years at diagnosis, were identified from the SEER data in = 23,470) from 1973 to 1995. Early deaths were defined as cases identified by 1) death certificate, 2) autopsy report, or 3) death within 1 month of initial diagnoses in = 481). Cause of death was determined by ICD-8 and -9 codes. Age at diagnosis, year of diagnosis, morphology, site of disease, ra ce, and gender were evaluated for association with early death. Results. Ag e <1 year at diagnosis (6.2% early deaths), being diagnosed earlier in the observation period, and a diagnosis of a brain tumor, neuroblastoma, leukem ia, or liver tumor were associated with increased early death. Gender and r ace were not associated with early death. Among the cases for whom the mali gnant diagnosis was made at the time of death in = 119), the cause of death was nonmalignant for 36. For 22 of these cases the malignancy was an incid ental finding and appeared not to contribute directly to the cause of death . Among these patients, 11 had neuroblastoma, 9 being <1 year of age. Concl usions. A decrease in the proportion of early deaths associated with childh ood cancer has occurred during the past 2 decades. This decrease may reflec t earlier diagnosis or improved imaging capabilities, surgical techniques, medical therapy, and supportive care. Awareness among pediatricians, genera l practitioners, and emergency physicians is warranted, with a focus on hig h-risk groups for early detection among childhood cancer patients. (C) 2000 Wiley-Liss, Inc.