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This study investigates the prevalence of vitamin and iron deficiencies at cancer diagnosis. Newly diagnosed children between October 2018 and December 2020 at two South African pediatric oncology units (POUs) were assessed for nutritional and micronutrient status (Vit A, Vit B12, Vit D, folate, and iron). A structured interview with caregivers provided information regarding hunger and poverty risks. There were 261 patients enrolled with a median age of 5.5 years and a male-to-female ratio of 1:0.8. Nearly half had iron deficiency (47.6%), while a third had either Vit A (30.6%), Vit D (32.6%), or folate (29.7%) deficiencies. Significant associations existed between moderate acute malnutrition (MAM) and low levels of Vit A (48.4%; p =.005), Vit B12 (29.6%; p <.001), and folate (47.3%; p =.003), while Vit D deficiency was associated with wasting (63.6%) (p <.001). Males had significantly lower Vit D levels (respectively, 40.9%; p =.004). Folate deficiency was significantly associated with patients born at full term (33.5%; p =.017), age older than five years (39.8%; p =.002), residing in provinces Mpumalanga (40.9%) and Gauteng (31.5%) (P =.032); as well as having food insecurity (46.3%; p <.001), or hematological malignancies (41.3%; p =.004). This study documents the high prevalence of Vit A, Vit D, Vit B12, folate, and iron deficiency in South African pediatric cancer patients, demonstrating the need to include micronutrient assessment at diagnosis to ensure optimal nutritional support for macro-and micronutrients. [ABSTRACT FROM AUTHOR]