ABSTRACT
Noncompliance with therapy is a big obstacle to successful therapy.
We aimed to evaluate the prevalence and risk factors affecting the
compliance of pediatric cancer patients with therapy in a tertiary care
center far away from the capital in a lower-middle income country
(LMIC). A retrospective cohort study of reports of all pediatric cancer
patients who were diagnosed and started treatment between 2006
and 2010 at South Egypt Cancer Institute (SECI) was done. The following
data were collected: Age, sex, diagnosis, compliance with therapy,
and data on potential risk factors that might affect compliance,
including time duration of travel from the patient’s home to SECI,
time lag between the first symptom until the first visit to SECI and
until the start of treatment, results of reevaluation after the initial
course of therapy, and therapy-related severe adverse events.
Noncompliance with therapy was defined as when patients missed
their determined therapy appointment for one week or more or
abandoned therapy. This study included 510 patients. Eighty-three
(16.3%) were non-compliant, as forty patients missed their therapy
appointment (7.8%), and 43 abandoned further therapy (8.4%).
Noncompliance was found to be more prevalent among patients with
solid tumors. Non-compliant patients suffered a significantly higher
relapse rate (47.7% vs. 11.2% in compliant patients, p < .001).
Unfortunately, 75% of the abandoned patients who returned for further
therapy suffered a relapse. Noncompliance with treatment is still
a big problem facing cancer management in LMICs.

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.

Abstract
Background and purpose: The use of traditional and complementary medicine (T&CM)
is common in children with cancer globally.We aimed to assess the prevalence, types,
reasons, perceived effectiveness, and disclosure rate of T&CMuse among children with
cancer in Southern Egypt. We also investigated whether T&CM use contributed to
delays in initial presentation and treatment.
Materials and methods: A cross-sectional design was utilized. Data were collected via
an interviewer-administered questionnaire. Eligible children and their caregivers at
the South Egypt Cancer Institute were invited to participate.
Results: Eighty-six children completed the study (response rate = 86%). T&CM use
was reported by 52 (60.5%) patients, with six (11.5%) experienced delayed presentation.
The reasons for T&CM use were complementary for 37 (71%) and alternative for
15 (29%) of the participants. The types of T&CM used included herbal (63%), nutritional
(33%), witchcraft (29%), and religious (19%) therapies. Approximately 48% of
users employed multiple T&CM types. Family members recommended T&CM for 60%
of the users.Most patients (65%) perceived T&CM as effective, with 71% initiating its
use during the early phases of treatment. Almost all participants (98%) reported that
healthcare providers did not inquire about T&CM use. T&CM usage was more prevalent
among wealthier families (p=.023). There was no significant relationship between
T&CM use and patient gender, diagnosis, residence, or paternal educational level.
Conclusions: The significant utilization of T&CMamong childrenwith cancer highlights
the need for healthcare providers to engage in open and early discussions with families
regarding T&CM use.

Abstract
Objective: A childhood cancer diagnosis is a traumatic experience for patients and
their families. However, little is known about the effect on grandparents. We aimed
to investigate the negative psychosocial impact, coping strategies, and positive
outcomes of grandparents of childhood cancer patients in Switzerland.
Methods: We collected data using a semi‐structured interview guide and applied
qualitative content analysis.
Results: We conducted 20 interviews with 23 grandparents (57% female; mean
age = 66.9 years; SD = 6.4; range = 57.0–82.4) of 13 affected children (69% female;
mean age = 7.5 years; SD = 6.1; range = 1.0–18.9) between January 2022 and April
2023. The mean time since diagnosis was 1.0 years (SD = 0.5; range = 0.4–1.9).
Grandparents were in shock and experienced strong feelings of fear and helplessness.
They were particularly afraid of a relapse or late effects. The worst part for
most was seeing their grandchild suffer. Many stated that their fear was always
present which could lead to tension and sleep problems. To cope with these negative
experiences, the grandparents used internal and external strategies, such as
accepting the illness or talking to their spouse and friends. Some grandparents also reported positive outcomes, such as getting emotionally closer to family members
and appreciating things that had previously been taken for granted.
Conclusions: Grandparents suffer greatly when their grandchild is diagnosed with
cancer. Encouragingly, most grandparents also reported coping strategies and
positive outcomes despite the challenges. Promoting coping strategies and providing
appropriate resources could reduce the psychological burden of grandparents and
strengthen the whole family system.

Since the first transplant in 1957 and hematopoietic stem cell transplantation (HSCT) is the curative modality for numerous hematological disorders. Nevertheless, it is not available for all patients. Besides unavailability of matched donors a lot of factors could hinder HSCT in a resource limited setting, as financial and administrative factors. In our daily practice we noticed other factors that hinder HSCT in our center, the common myths and misconceptions about HSCT and donation. This quasi-experimental study assessed, for the first time, common myths and misconceptions about HSCT among 218 medical and nursing students before and after an interventional educational program. The study tool was an investigators' developed self-administered questionnaire. Participants' male to female ratio was 1:2.5, and FAS was middle in 52.7%. Pretest high myths scores were reported in 53.4% and 90% of medical and nursing students that was reduced to 0% and 4% post-test, respectively. Pretest, 26.3% and 7% of medical and nursing students welling to donate HSC, that increased to 66% and 39% post-test, respectively. Rural residency, low and middle FAS associated with higher myths scores. Myths score is an independent effector of willingness to donate HSC among participants. In conclusion medical/nursing students had significant myths and misconceptions about HSCT that was corrected with the educational program. Thus, wide based educational programs about HSCT are mandatory to correct myths and augment HSC donation.

www.clinicaltrrial.gov: clinical trial ID NCT05151406.