title: Evaluation of treatment-related mortality among paediatric cancer deaths: a population based analysis.
abstract: BACKGROUND
  Objectives were to describe the proportion of deaths due to treatment-related mortality (TRM) and to identify risk factors and probable causes of TRM among paediatric cancer deaths in a population-based cohort.
  
  
  METHODS
  We included children with cancer ⩽18 years diagnosed and treated in Ontario who died between January 2003 and December 2012. Deaths were identified using a provincial registry, the Pediatric Oncology Group of Ontario Networked Information System. Probable causes of TRM were described.
  
  
  RESULTS
  Among the 964 deaths identified, 821 were included. The median age at diagnosis was 6.6 years (range 0-18.8) and 51.8% had at least one relapse. Of the deaths examined, TRM occurred in 217/821 (26.4%) while 604/821 (73.6%) were due to progressive cancer. Deaths from TRM did not change over time. Using multiple regression, younger age, leukaemia diagnosis and absence of relapse were independently positively associated with TRM. The most common probable causes of TRM were respiratory, infection and haemorrhage.
  
  
  CONCLUSIONS
  TRM was responsible for 26.4% of deaths in paediatric cancer. Underlying diagnosis, younger age and absence of relapse were associated with TRM and causes of TRM differed by diagnosis group. Future work should evaluate TRM rate and risk factors among newly diagnosed cancer patients.
authors.affiliation: Pediatric Oncology Group of Ontario, 480 University Ave., Toronto, Ontario, M5G 1V2, Canada.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Pole
authors.affiliation: Division of Haematology/Oncology, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd. E., London, Ontario, N6A 5W9, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Gibson
authors.affiliation: Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada.
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Ethier
authors.affiliation: Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada.
authors.forename: Tanya
authors.initials: T
authors.lastname: Lazor
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Johnston
authors.affiliation: Department of Pediatrics, McMaster Children's Hospital, 1280 Main St West, Hamilton, Ontario, L8N 3Z5, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Portwine
authors.affiliation: Department of Pediatrics, Kingston General Hospital, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada.
authors.forename: Mariana
authors.initials: M
authors.lastname: Silva
authors.affiliation: Department of Pediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Alexander
authors.affiliation: Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada.|Department of Pediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada.
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000401:mortality; D009864:Ontario / Q000453:epidemiology; D012042:Registries