Relationships among demographic characteristics, clinical characteristics, and psychological symptoms among Indonesian children with cancer: A cross-sectional study.

AIM: Despite growing recognition of psychological distress in pediatric cancer patients globally, a comprehensive understanding of the relationships between depression, anxiety, and stress symptoms among Indonesian children with cancer remains limited. This study aimed to examine the relationships among demographic characteristics, clinical characteristics, depression, anxiety, and stress symptoms among Indonesian children with cancer.

METHODS

A cross-sectional, correlational study was conducted from February to September 2024 in the pediatric oncology and chemotherapy units of Dr. Kariadi Semarang Central General Hospital, a national referral hospital in Semarang City, Indonesia. A total of 96 children aged 6 to 19 years (mean age = 9.70 years, standard deviation = 3.63) with a confirmed cancer diagnosis were recruited using convenience sampling based on predetermined inclusion criteria. Psychological symptoms, including depression, anxiety, and stress, were measured using the culturally validated Indonesian version of the Depression Anxiety Stress Scales (DASS-21). Statistical analyses included descriptive statistics, Spearman's rank correlations, Mann-Whitney U tests, and Kruskal-Wallis tests.

RESULTS

The sample was predominantly male (58.3 %), with acute lymphoblastic leukemia being most common (55.2 %). Moderate to severe levels of psychological symptoms were frequently observed: moderate depression (37.5 %), moderate anxiety (43.8 %), and moderate stress (33.3 %). Age significantly influenced depression (p < 0.01), while gender affected both depression (p = 0.04) and anxiety (p = 0.03). Cancer diagnosis type influenced anxiety (p = 0.04) and stress symptoms (p = 0.01). Strong correlations emerged between depression-anxiety (r = 0.63, p < 0.01), anxiety and stress symptoms (r = 0.62, p < 0.01), and depression and stress symptoms (r = 0.58, p < 0.01).

CONCLUSION

Based on these study findings, we suggest nurse-led symptom screening during chemotherapy visits could provide a practical strategy for early recognition and timely support, with particular attention to age-appropriate and diagnosis-specific approaches in mental health support. Given the shortage of psychological care, integrating psychosocial services into pediatric cancer protocols is essential. Future longitudinal studies are needed to explore symptom trajectories and inform culturally responsive care in this population.

IMPLICATIONS TO PRACTICE: Routine nurse-led screening for depression, anxiety, and stress is essential during chemotherapy visits, especially for adolescents, female patients, and children with specific cancer types. Culturally adapted tools can support early identification of symptom clusters and guide timely psychosocial support. Integrating culturally sensitive mental health care into pediatric oncology services may enhance treatment cooperation in resource-limited settings.