Cultural influences on coping among Chinese children aged 7–14 undergoing chemotherapy: implications for pediatric oncology service delivery

BACKGROUND: Children undergoing chemotherapy experience significant psychosocial stress; however, limited research has examined how cultural and relational contexts shape stress appraisal and coping within pediatric oncology services in China. Understanding these mechanisms is essential for developing culturally responsive psychosocial care models. METHODS: A qualitative descriptive study was conducted using individual semi-structured interviews with 22 children aged 7-14 years undergoing chemotherapy for haematological cancers in a tertiary children's hospital in China. Data were analysed using thematic analysis following Braun and Clarke's framework. Reporting adhered to the Standards for Reporting Qualitative Research (SRQR). RESULTS: Children's stress during chemotherapy was shaped not only by physical discomfort and emotional distress, but also by concerns about family burden, disrupted schooling, and loss of normality in everyday life. Children coped mainly through emotion-focused strategies, including holding emotions in, engaging in creative activities, and reframing illness in more manageable terms. These coping practices were influenced by developmental stage as well as cultural and relational contexts, particularly expectations around endurance, emotional restraint, and maintaining stability in family relationships. Coping was also supported through interactions with family members, peers, and healthcare professionals, who provided emotional reassurance, connection, and a sense of safety throughout treatment. CONCLUSIONS: Coping among Chinese children undergoing chemotherapy was shaped by cultural and relational contexts, with important implications for pediatric oncology service delivery. Psychosocial care should move beyond symptom management to include culturally sensitive assessment of family- and school-related stress, support for emotional expression, guidance for caregivers, and opportunities for creative, non-verbal coping within routine care. Strengthening culturally responsive, family-centred services may help support children's emotional well-being during chemotherapy.