9558 Background: Due to challenges in the delivery of pediatric oncology care in low-middle income countries (LMIC), diagnosis and treatment remains inadequate for the majority of patients. The University of Zambia School of Medicine/University Teaching Hospital (UTH) and Vanderbilt University School of Medicine/Vanderbilt Institute for Global Health established a partnership to investigate treatment outcomes at UTH, the only institution providing pediatric oncology care in Zambia, and assess risk factors associated with treatment abandonment. Methods: A retrospective study was conducted in a cohort of patients, presenting from July 2008 – June 2010, using an established database and medical record review. Results: Of the 230 children enrolled in the database, 162 met the inclusion criteria. The average age at diagnosis was 6.0 years; males comprised 55.6% of the cohort; 51.6% had a histopathological diagnosis and 10.5% of the cohort was HIV positive. The most common diagnoses were lymphoma (25.9%), Wilms tumor (22.8%), and retinoblastoma (17.9%). Leukemia and Kaposi sarcoma accounted for 7.4% each. Death (46.3%) and abandonment of treatment (45.7%) were the most common outcomes with only 8.0% having completed treatment or currently undergoing treatment, including palliative regimens, at the time of data acquisition. Residence in Lusaka or Central provinces, closest in proximity to UTH, was associated with a decreased risk for abandonment of treatment (Odds Ratio (OR) 0.41 (95% CI 0.21-0.81, p = 0.009) while maternal education less than secondary school (OR 2.73 95% CI 1.2-6.6, p = 0.03) was associated with an increased risk for abandonment of treatment. Conclusions: At the only pediatric cancer center in Zambia, treatment outcomes are dire with the majority of the cohort abandoning treatment or dying during therapy. Challenges include access to cancer chemotherapy, logistical facilitation, fiscal support of radiotherapy, and community engagement. Further investigation is required to inform effective intervention strategies to improve outcomes.