Abstract
BACKGROUND: Invasive procedures such as bone marrow aspiration (BMA) and lumbar puncture (LP) are essential in the management of pediatric leukemia but often induce significant state anxiety. This cross-sectional study aimed to evaluate procedural state anxiety using the Chinese Version of the State Anxiety Scale for Children (CSAS-C) and identify associated socio-demographic and clinical factors in Chinese pediatric leukemia patients. METHODS: A convenience sample of 119 patients aged 8-18 years with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) undergoing BMA or LP was recruited from a tertiary pediatric oncology center in China. State anxiety was assessed via the CSAS-C (score range: 20-60, higher scores indicating greater anxiety). Socio-demographic (gender, age, education) and clinical data (diagnosis, treatment history, procedural type, site, history) were collected. Data were analyzed using R software (version 4.4.3). Non-normally distributed variables were presented as median (P25, P75). Group comparisons employed the Mann-Whitney U test for two groups and the Kruskal-Wallis test with Dunn's post-hoc for multiple groups, with P < 0.05 considered significant. RESULTS: The overall median CSAS-C score was 27.0 (21.0, 32.0), indicating mild to moderate anxiety. Significantly higher anxiety was associated with younger age (8-12 years; P < 0.001), primary school education (P < 0.001), AML diagnosis (P = 0.004), hospitalization setting (P < 0.001), and first-time procedures (P < 0.001). No significant differences were observed by gender (P = 0.439), treatment history (P = 0.066), or procedural type (P = 0.238). Multivariable linear regression confirmed that first-time procedures were an independent predictor of higher anxiety (β = 11.82, p = 0.001), with a marginal effect for lumbar puncture (β = 7.16, p = 0.056). CONCLUSION: Procedural state anxiety is prevalent among pediatric leukemia patients undergoing BMA or LP, particularly in younger, less educated, AML, inpatient, and novice patients. These findings underscore the need for tailored anxiety-reduction interventions in pediatric oncology to improve patient experience and compliance.