Association of coping pathways with anxiety symptoms in children with hematological cancers: a cross-sectional study using regression and fuzzy-set qualitative comparative analysis

Abstract Background Children with hematological cancers are vulnerable to anxiety symptoms during chemotherapy. Coping is a modifiable psychosocial factor that can be assessed and supported in pediatric oncology nursing practice. However, previous studies have mainly examined coping strategies separately, providing limited insight into how different coping characteristics may co-occur among children with varying levels of anxiety symptoms. This study aimed to examine coping-related factors associated with anxiety symptoms and to identify coping configurations associated with high and low anxiety symptoms. Methods A cross-sectional study was conducted among 390 children aged 7–14 years with hematological cancers from four hospitals in China. Data on anxiety symptoms, coping strategies, and demographic and clinical characteristics were collected using structured questionnaires. Multiple linear regression was used to identify coping-related factors independently associated with anxiety symptoms. Fuzzy-set qualitative comparative analysis (fsQCA) was then applied to explore combinations of coping-related conditions associated with high and low anxiety symptoms. Results Emotional reaction coping and self-comfort coping were positively associated with anxiety symptoms, whereas global coping self-assessment was negatively associated with anxiety symptoms. Male sex was associated with lower anxiety symptoms compared with female sex. The regression model explained 47.1% of the variance in anxiety symptoms. identified multiple configurations associated with high and low anxiety symptoms, suggesting that different anxiety symptom levels may be related to different combinations of coping characteristics. High anxiety symptoms were commonly characterized by maladaptive coping, limited adaptive coping resources, and reduced emotional expression. In contrast, low anxiety symptoms were associated with stronger global coping self-assessment, lower emotional reactivity, and lower avoidance. Conclusions Anxiety symptoms among children with hematological cancers were associated with both individual coping characteristics and broader coping configurations. By integrating regression analysis with fsQCA, this study provides complementary evidence on variable-level associations and configurational patterns. The findings support routine coping assessment and profile-informed psychosocial care to help identify children with higher anxiety symptoms and guide targeted supportive interventions during chemotherapy.