Enhancing Quality of Life and Reducing Anxiety in Children with Leukemia Through Social Support: A Pilot Study

Enhancing Quality of Life and Reducing Anxiety in Children with Leukemia Through Social Support: A Pilot Study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 12 March 2025 V1 Latest version Share on Enhancing Quality of Life and Reducing Anxiety in Children with Leukemia Through Social Support: A Pilot Study Authors : Nesibe S. KUTAHYALIOGLU 0000-0001-8220-4290 [email protected] and Gamze DEMIRBAS Authors Info & Affiliations https://doi.org/10.22541/au.174176646.64271036/v1 300 views 176 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Leukemia is the most common pediatric cancer and remains a leading cause of mortality in children under 15, with an estimated global incidence of approximately 400,000 cases annually among children and adolescents. Despite advancements in treatment improving survival rates, the disease and its prolonged therapeutic process impose significant physical (e.g., pain, fatigue) and psychological (e.g., anxiety, hopelessness, depression) burdens. Additionally, children with leukemia often face social and academic challenges, including difficulties with social support, adaptation, self-esteem, and educational attainment. The existing literature highlights the need for targeted interventions to address these psychological difficulties and provide holistic support. This study aimed to enhance the emotional well-being and resilience of children with leukemia by fostering a sense of solidarity and self-efficacy through mentorship from leukemia survivors. Thirteen participants (8 girls, 5 boys; mean age = 10 years) from the eastern provinces of the country engaged in structured online sessions over three months with mentors who had successfully recovered from leukemia. These mentors provided both motivational and academic support. Findings revealed statistically significant improvements in participants’ trait anxiety levels (p = 0.029), overall quality of life (p = 0.007), and coping skills related to cancer (p = 0.005). These results suggest that structured mentorship programs can positively impact the psychological and social well-being of children with leukemia. By fostering social connectedness and alleviating motivational challenges, such initiatives may contribute to improved long-term psychological health, underscoring the potential of mentorship-based interventions as a valuable component of comprehensive care strategies. Enhancing Quality of Life and Reducing Anxiety in Children with Leukemia Through Social Support: A Pilot Study Authors: *Nesibe S. KUTAHYALIOGLU, PhD, RN (Assistant Professor), Karabük University, Faculty of Health Sciences, Pediatric Nursing Department, Karabük, Turkey. ORCID ID: https://orcid.org/0000-0001-8220-4290 Gamze DEMIRBAS, RN, Besni State Hospital, Adiyaman, Turkey ORCID ID: https://orcid.org/0009-0007-3718-1430 *Corresponding Author: Nesibe S. Kutahyalioglu, PhD, RN (Assistant Professor) Postal Address: Karabük Üniversitesi Sağlık Bilimleri Fakültesi Demir Çelik Kampüsü 78050 Karabük/Turkey Phone: +90 370 418 9396 E-mail: [email protected] Words Count Abstract: 250 words Main Text: 3930 words Number of Tables: 2 Running Title: Enhancing Quality of Life and Reducing Anxiety in Leukemia Keywords: Children, leukemia, mentorship, quality of life, anxiety, coping skills Abbreviation Key Table: WHO World Health Organization ALL Acute Lymphoblastic Leukaemia NGO Non-Governmental Organizations Enhancing Quality of Life and Reducing Anxiety in Children with Leukemia Through Social Support: A Pilot Study Leukemia is the most common pediatric cancer and remains a leading cause of mortality in children under 15, with an estimated global incidence of approximately 400,000 cases annually among children and adolescents. Despite advancements in treatment improving survival rates, the disease and its prolonged therapeutic process impose significant physical (e.g., pain, fatigue) and psychological (e.g., anxiety, hopelessness, depression) burdens. Additionally, children with leukemia often face social and academic challenges, including difficulties with social support, adaptation, self-esteem, and educational attainment. The existing literature highlights the need for targeted interventions to address these psychological difficulties and provide holistic support. This study aimed to enhance the emotional well-being and resilience of children with leukemia by fostering a sense of solidarity and self-efficacy through mentorship from leukemia survivors. Thirteen participants (8 girls, 5 boys; mean age = 10 years) from the eastern provinces of the country engaged in structured online sessions over three months with mentors who had successfully recovered from leukemia. These mentors provided both motivational and academic support. Findings revealed statistically significant improvements in participants’ trait anxiety levels (p = 0.029), overall quality of life (p = 0.007), and coping skills related to cancer (p = 0.005). These results suggest that structured mentorship programs can positively impact the psychological and social well-being of children with leukemia. By fostering social connectedness and alleviating motivational challenges, such initiatives may contribute to improved long-term psychological health, underscoring the potential of mentorship-based interventions as a valuable component of comprehensive care strategies. Introduction Approximately 400,000 children and adolescents worldwide are diagnosed with new cancers each year (WHO, 2020). Besides, one in every 285 children is diagnosed with cancer before reaching the age of 20 (Ward et al., 2014). According to the 2020 data of the World Health Organization, approximately 2% of children diagnosed with cancer die (WHO, 2020). Leukemia is the most prevalent cancer among children, constituting approximately 25.4% of all pediatric cancer cases (Seer Cancer Statistics, 2022). In addition to being the most common childhood cancer, it is one of the leading causes of death in children under the age of 15 (Seer Cancer Statistics, 2022). When we look at the data from Turkey, approximately 1000 new children, both boys and girls, are diagnosed with leukemia every year (Turkey Cancer Statistics, 2017). Leukemia is characterized by a challenging, prolonged, and costly treatment process. While the etiology of childhood leukemia remains largely unknown, advancements in treatment have significantly improved survival rates. Treatment modalities such as chemotherapy, radiotherapy, and surgical interventions are administered at regular intervals (Özyurt, 2007). In recent years, Turkey has achieved cure rates comparable to those of developed countries. However, despite advancements in treatment, the disease remains challenging to treat, necessitating intensive and prolonged therapy. Cancer symptoms and therapy-related complications continue to adversely affect the quality of life, particularly in pediatric patients (Ernst et al., 2023; Saleh et al., 2023). The social and psychological challenges associated with chronic illnesses in children vary depending on factors such as the individual child, family dynamics, disease type, social environment, and the quality of medical care received. These factors can either facilitate or hinder a child’s adaptation to their illness (Engin et al., 2021). The diagnosis of a chronic disease presents a complex and demanding process, which can be even more challenging for children than for adults. During this time, children must not only manage the symptoms of their illness but also navigate intensified social, psychological, developmental, and environmental difficulties stemming from various contributing factors (Altundağ et al., 2016). Childhood cancers can be treated at a rate of 70-80% and survival rates have reached 85% in Turkey (Turkey Cancer Statistics, 2017). Bone marrow transplantation is required in cases where recovery cannot be achieved with chemotherapy, and both chemotherapy and bone marrow transplantation can be applied in accordance with European standards. Despite all these positive developments, cancer diagnosis is one of the most challenging experiences in human life and causes many physical (pain, nausea-vomiting, diarrhea, fatigue, etc.) and psychological (anxiety, fear, sadness, hopelessness, depression, trauma, etc.) negativities, especially in children (Saleh et al., 2023; Cieslak, 2013). In addition, the prolonged treatment process for pediatric cancer patients introduces numerous stressors that affect both children and their families. These challenges encompass difficulties in social support and adaptation, disruptions in family dynamics, economic hardships, self-confidence issues, and decreased academic performance (Bretones, 2022; Schoors et al., 2019; Andersen et al., 2017). Psychosocial support provided during this challenging process plays a critical role in mitigating the risk of psychological maladjustments or disorders that may arise under adverse life circumstances and in their aftermath. Such support has been shown to facilitate the restoration of familial and community relationships for affected individuals and enhance their ability to adapt to the transition back to “normal” life. These interventions not only address immediate emotional and social needs but also contribute to long-term resilience and psychological well-being (Kazak et al., 2021; Çoban & Olca, 2023). In addition to psychosocial support in the healthy management of this process, the positive effect of social support cannot be denied. Social support is conceptualized as the provision of material and/or emotional assistance by individuals within the social network of a person experiencing stress. This support serves as a critical resource, mitigating the adverse effects of stress and enhancing psychological well-being by fostering a sense of belonging and reducing perceived isolation (Thoids, 2011). Social support has a direct and significant impact on an individual’s physical and psychological health, facilitating coping mechanisms in the face of challenges while addressing fundamental social needs, such as love, self-esteem, and belonging. In the context of pediatric care, social support plays a critical role in preserving the child’s holistic health during periods of physical and psychological distress. It has been shown to expedite recovery, enhance adherence to medical treatments, improve quality of life, and contribute to increased longevity in patients. The provision of robust social support systems is therefore essential in optimizing health outcomes and fostering resilience (Uchino et al., 2012; Engin et al., 2021). The literature identifies several factors contributing to the psychological impact on children facing chronic illness. These include concerns about the future, heightened anxiety levels, symptoms of depression, fear of not achieving recovery, and a sense of being different from their peers. These factors collectively influence the emotional well-being of children, underscoring the importance of addressing psychological needs alongside medical care (Compas et al., 2012; Gündüz et al., 2016; Phipps et al., 2014). Poirier et al. (2019) recommended that recommendations should be developed to cope with the psychological difficulties experienced by pediatric oncology patients and that these patients should be supported. Sarman (2021) highlighted that support programs designed for pediatric oncology patients yield significant physical and psychological benefits, underscoring their critical importance for the well-being of thousands of children and their families affected by cancer. Similarly, Huang and colleagues (2014) conducted a study involving 38 pediatric cancer patients, in which weekly materials containing recommendations were delivered via an internet-based program over a four-month period. The findings demonstrated a statistically significant reduction in anxiety, mood disorders, and depressive symptoms among participants in the intervention group compared to the control group, emphasizing the effectiveness of such programs in addressing psychological challenges in pediatric oncology. Moreover, Coughtrey and colleagues (2018), in their systematic review examining the impact of psychosocial education and support programs on pediatric oncology patients, reported a reduction in anxiety and depressive symptoms and an improvement in quality of life following the implementation of psychosocial support interventions across nine studies. Furthermore, six studies within the review highlighted the positive effects of invasive interventions, including significant reductions in pain and physiological symptoms such as nausea during the treatment process, thereby enhancing the overall well-being of pediatric patients. However, the duration and type of interventions vary, and there are notable limitations in their implementation. Specifically, uncertainties remain regarding which interventions are most effective for particular individuals and the optimal timing for initiating these support programs. The primary objective of this cross-sectional study was to support the adaptation of children with leukemia to the emotional and psychological challenges encountered during their treatment. The study aimed to enhance their quality of life, improve their coping mechanisms in managing cancer, and alleviate anxiety. Additionally, the study sought to connect participating children diagnosed with leukemia to young individuals and volunteer survivors who had successfully completed leukemia treatment and achieved full recovery. Through this mentoring support, the study intended to ease the children’s adjustment to the emotional and psychological changes experienced during treatment and to foster a sense of solidarity, ensuring they did not feel isolated during this demanding and exhausting process. Methods Research Design This cross-sectional study utilized a single-group pretest-posttest design to evaluate the impact of a support program for children with leukemia. Initially, a pretest was administered to assess baseline levels prior to the implementation of the support program. The online program was then conducted over a three-month period, after which the dependent variables were reassessed. Study Population and Sample Selection The study population consisted of children aged 7–17 years who were diagnosed with leukemia. Based on statistical calculations (α = 5%, confidence level = 80%, expected effect size = 0.8, standard deviation = 1), a minimum sample size of 13 participants was required (Chow, Shao, & Wang, 2008). Additionally, approximately 10 leukemia survivors, whose treatment had been completed and who had achieved full recovery, were included as volunteer mentors to facilitate the support programs. A convenience sampling method was employed for participant recruitment. This non-probability sampling approach involves selecting participants who are readily accessible and meet eligibility criteria. It is widely used due to its efficiency, reduced time requirements, and lower costs (Bornstein et al., 2013). In this study, one of the researcher, herself a leukemia survivor under follow-up at Gaziantep Oncology Hospital, advertised the study within the clinic to recruit a sufficient sample. Measurements Data collection was conducted via an online program and included demographic questionnaire, the General Child Quality of Life Scale (KINDL) , the State-Trait Anxiety Inventory for Children , and the Pediatric Cancer Coping Scale . General Child Quality of Life Scale (KINDL): Developed by Ravens-Sieberer and Bullinger (1998) and adapted into Turkish by Eser and colleagues (2008), the KINDL scale includes Kid-KINDL (ages 8–12) and Kiddo-KINDL (ages 13–16). This 24-item, 5-point Likert scale assesses six dimensions: physical well-being, emotional well-being, self-esteem, family, friends, and school. Higher scores indicate better quality of life. The scale demonstrated strong reliability (Cronbach’s alpha = 0.78). State-Trait Anxiety Inventory for Children: Developed by Spielberger (1973) and adapted into Turkish by Özusta (1995), this tool comprises two 4-point Likert-type scales measuring state anxiety (current feelings) and trait anxiety (general feelings). The scale showed high reliability (Cronbach’s alpha = 0.65; Serin & Öztürk, 2007). Pediatric Cancer Coping Scale: Created by Wu et al. (2011) and adapted into Turkish by Şengül et al. (2022), this 33-item scale assesses cognitive coping, problem-focused coping, and defensive coping. Items are rated on a 4-point Likert scale, with higher scores reflecting more frequent use of coping strategies. The scale demonstrated excellent reliability (Cronbach’s alpha = 0.91). Preparation of the Support Program Volunteer survivors who had successfully recovered from leukemia and expressed a desire to provide support were recruited through a dedicated website developed by one of the researchers, herself a leukemia survivor. On this platform, survivor volunteers specified the type of support they were willing to offer, while children currently undergoing treatment created accounts and indicated the type of support they sought. The support program comprised two categories: academic support (e.g., Turkish, English, Mathematics, Science) and counseling support (e.g., mentoring based on survivors’ experiences, art, music, storytelling, and arts and crafts activities). Survivor volunteers participating in the program underwent preliminary interviews conducted by the first author. Additionally, a pediatric nurse and psychologist provided online training sessions to address the volunteers’ questions and prepare them for their roles. The second author coordinated the scheduling of sessions based on the children’s preferences, ensuring that interactions occurred via the Zoom platform. Sessions were conducted twice a week for one hour over three months. The online format minimized infection risks for children with compromised immune systems and facilitated communication across different cities. This approach aimed to offer motivation and mentoring support tailored to the children’s preferences and needs, ensuring they felt supported during their treatment. Pre-tests were administered online before the program began, and post-tests were conducted after three months to evaluate the intervention’s effectiveness. Ethical Considerations Ethical approval was obtained from the Clinical Research Ethics Committee of the University (Approval Number: 2022-KAEK-141). Since participants were under 18 years old, informed consent was obtained from their parents, with written consent collected online and verbal assent from the children. Data collection occurred through an online survey program, which required approximately 20 minutes to complete and was restricted to one submission per IP address. Participation was voluntary, and all personal information remained confidential. Upon program completion, survivor volunteers received thank-you cards, while children were gifted personalized pillows as tokens of appreciation. Data Analysis Data were analyzed using the Statistical Package for the Social Sciences (SPSS, Version 25). Following data cleaning, missing values and outliers were addressed. Descriptive statistics (e.g., frequency, percentage distributions, medians) were used to describe the sample. Non-parametric tests, including Chi-Square, Kruskal-Wallis, and Mann-Whitney U tests, were employed to assess relationships between independent variables and outcomes such as quality of life, coping with cancer, and anxiety levels. Additionally, pre-test and post-test comparisons were conducted to evaluate changes resulting from the program. Results The socio-demographic characteristics of the 13 children diagnosed with cancer (8 girls and 5 boys) and their families are detailed in Table 1. The children had a mean age of 10 years, with the youngest being 7 years old and the oldest 13 years old. Among the participants, an overwhelming majority (92%) were diagnosed with Acute Lymphoblastic Leukemia (ALL), the most common type of childhood cancer. The diagnosis significantly impacted their education, with more than half of the children (54%) unable to continue attending school after their diagnosis, resulting in an interruption to their education. In terms of parental education levels, notable disparities were observed. Seventeen percent of mothers were illiterate, while only 8% had attained a university-level education or higher. The remaining mothers had completed some level of primary or secondary education. Fathers demonstrated higher levels of educational attainment, with 58% being high school graduates. Despite this, economic challenges were evident, as 31% of fathers were unemployed, and the vast majority of mothers (92%) were housewives, likely contributing to financial strain within these families. These socio-economic factors highlight the additional burdens placed on families dealing with pediatric cancer. Psychological support within the family was notably limited, with only 15% of participants reporting receiving such support. This finding is concerning, given the known psychological and emotional challenges associated with cancer diagnoses and treatment, particularly in children. Access to psychological resources may play a crucial role in mitigating the stress and anxiety experienced by both the children and their families during this difficult time. There was considerable variation in the timeline from diagnosis to treatment initiation. Approximately 31% of children began treatment within the first month of their diagnosis, reflecting timely medical intervention. However, 7.5% of participants started treatment within 3-6 months, another 7.5% within 6-12 months, and a significant proportion (54%) initiated therapy over a year after their diagnosis. These delays could have been influenced by various factors, including access to healthcare, socio-economic barriers, or delayed recognition of symptoms. Treatment modalities varied among the participants. All children received chemotherapy, which remains a cornerstone of pediatric cancer treatment. Additionally, 17% underwent radiotherapy, and 25% required surgical interventions as part of their treatment plans. The duration of treatment was extensive for most participants, with 76% undergoing treatment for over 12 months. This prolonged treatment period underscores the enduring physical, emotional, and social challenges faced by these children and their families. TABLE 1 Distribution of Socio-Demographic Characteristics of Children (n=13) and Their Parents Variables Median (Min-Max) Age 10 (7-13) n % Diagnosis Acute Lymphoblastic Leukemia 12 92 Brain Tumor 1 8 Current school attendance Yes 7 54 No 6 46 Gender Girl 8 62 Boy 5 38 Mother’s education No literacy 2 17 Primary school 8 58 High school 2 17 University and above 1 8 Father’s education Primary school 4 34 High school 8 58 University and above 1 8 Mother’s working status Housewife 12 92 Unemployed 1 8 Father’s working status Unemployed 4 31 Employed 9 69 Psychological support received in the family Yes 2 15 No 11 85 Time between diagnosis and start of treatment 0-1 month 4 31 3-6 months 1 7.5 6-12 month 1 7.5 More than 12 months 7 54 Treatment methods received Chemotherapy 13 100 Radiotherapy 2 17 Surgery 3 25 Duration of treatment (months) 0-3 months 1 8 6-9 months 1 8 9-12 months 1 8 More than 12 months 10 76 Four key variables—state anxiety, trait anxiety, quality of life, and coping with cancer—were measured both before and after the three-month support program to assess its impact on children diagnosed with leukemia. Table 2 provides a detailed comparison of these variables’ pre-test and post-test results. One participant was excluded from the data analysis due to their passing before completing the three-month support program. The State Anxiety Inventory, designed to evaluate anxiety levels at a specific moment, showed a slight reduction in median scores following the program (Median pre-test = 36, Median post-test = 35.5). However, this change was not statistically significant (p = 0.157), suggesting that while the intervention may have affected immediate anxiety, the reduction was insufficient to reach statistical significance. In contrast, the Trait Anxiety Inventory, which assesses more persistent, general anxiety levels, revealed a notable decrease in median scores (Median pre-test = 44.5, Median post-test = 42.5). This reduction was statistically significant (p = 0.029), indicating that the support program effectively alleviated long-term anxiety in the participants. The General Child Quality of Life Scale measured various dimensions of the children’s well-being, including health, emotional state, relationships, and school-related activities. The comparison of pre-test and post-test results revealed a significant improvement in the quality of life scores (Median pre-test = 63.6, Median post-test = 75.5, p = 0.007). This finding highlights the positive impact of the support program on enhancing the children’s overall well-being and their ability to engage in daily life activities. Finally, the Pediatric Coping with Cancer Scale was employed to assess the children’s coping mechanisms during their cancer treatment. The results showed a marked increase in coping levels following the intervention (Median pre-test = 62, Median post-test = 81.5). This improvement was statistically significant (p = 0.005), suggesting that the support program played a critical role in equipping the children with practical strategies to manage the emotional and psychological challenges associated with their illness. In summary, the support program demonstrated a significant positive impact on trait anxiety, quality of life, and coping with cancer among the participating children, with moderate improvements in state anxiety. These findings underscore the value of structured psychosocial interventions in enhancing the psychological and emotional resilience of children undergoing cancer treatment. TABLE 2 Comparison of children’s pre-test and post-test levels State Anxiety Inventory for Children Pre-test 12 36 28-52 21.000 0.157 Post-test 35.5 24-45 Trait Anxiety Inventory for Children Pre-test 12 44.5 41-55 8.500 0.029** Post-test 42.5 37-52 General Child Quality of Life Scale Pre-test 12 63.6 48.9-88 54.00 0.007** Post-test 75.5 63-100 Pediatric Cancer Coping Scale Pre-test 12 62 23-83 75.000 0.005** Post-test 81.5 57-95 * one sample was not able to complete study; **p <0.05 Discussions This study aimed to enhance anxiety management, overall quality of life, and coping mechanisms in children diagnosed with leukemia by providing social support and mentorship. To achieve this, a structured mentorship program was implemented, involving 13 children aged 7 to 13 who participated in biweekly online mentoring sessions over a period of three months. The effectiveness of the intervention was assessed using a pre-test/post-test design, revealing significant improvements in the targeted outcomes. An analysis of the socio-demographic characteristics of the participants and their families highlighted three key findings. First, a substantial proportion of parents (33%) were unemployed, indicating a potential need for financial support. This economic vulnerability may have contributed to delays in initiating treatment or the lack of psychological support during the treatment process, as only 17% of the children received professional psychological assistance. Second, parental education levels were notably low. This factor appears to be linked to the delay in treatment initiation, as more than half of the families postponed treatment for over 12 months following the initial diagnosis. These findings underscore the importance of addressing financial and educational disparities among caregivers to facilitate timely access to medical and psychological support for children with leukemia. Finally, approximately half of the children were unable to attend school during their treatment period. The high demand for academic support among the requested services highlights the significant need for educational assistance within this population. The decision to keep children out of school during treatment may be linked to the lower educational levels of parents, which could influence their awareness of alternative educational opportunities. Conversely, this decision may also reflect a deliberate protective parenting strategy aimed at minimizing the risk of infection during a period of heightened vulnerability. Among the dependent variables, only a slight reduction was observed in the State Anxiety Inventory for children, which was not statistically significant. This minimal change may be attributed to the influence of external factors, such as the immediate environment or situational conditions, on the children’s temporary emotional state. In contrast, a statistically significant decrease was found in the Trait Anxiety Inventory, indicating a more substantial and lasting reduction in general anxiety levels. This finding aligns with previous research in the literature (Çavuşoğlu & Sağlam, 2015; Altundağ et al., 2016; Coughtrey et al., 2018). While the present study demonstrated a decrease in trait anxiety within a relatively short intervention period of three months, Altundağ and colleagues (2016) reported that the positive effects of similar support interventions persisted for up to 24 months. A statistically significant increase was observed in the pre-test and post-test scores of the General Child Quality of Life Scale, suggesting that the weekly activities and sessions contributed to the child’s ability to more effectively manage challenges related to health, daily activities, emotional well-being, peer relationships, and academic life. This finding is consistent with existing literature, which highlights the positive impact of psychosocial interventions on improving children’s quality of life (Saleh et al., 2023; Hegazy et al., 2019; Duran et al., 2020). Furthermore, a statistically significant increase was observed in the pre-test and post-test scores of the Pediatric Coping with Cancer Scale, indicating an improvement in children’s ability to cope with their illness following the intervention. Although the duration of support programs varies across studies, findings similar to those of the present study have been reported in the literature, demonstrating the effectiveness of such interventions in enhancing coping mechanisms among pediatric cancer patients (Cheung et al., 2019; Çoban & Olca, 2022). One of the primary challenges encountered during the project was the difficulty in recruiting a sufficient number of participants. In Turkey, two major non-governmental organizations (LÖSEV and KAÇUV) were contacted for potential collaboration. However, these organizations indicated that children receiving leukemia treatment in their respective regions, primarily in major cities, already had access to extensive support services and therefore did not require the resources provided by our project. They highlighted their well-established initiatives, including access to various technological tools, academic support through study centers, transportation services for social and educational activities, and financial assistance. However, their support was largely concentrated in the western regions of the country. In contrast, all participants in our study were from Eastern and Southeastern Anatolia, where they reported receiving no support from any institution or NGO. Despite a clear need for assistance and a willingness to participate, many children were ultimately unable to engage in the project. The most significant barrier was the lack of access to essential digital devices such as the internet, tablets, computers, and smartphones. This disparity underscores the stark contrast in available resources between different regions of the country, highlighting the need for more equitable distribution of support services for children undergoing leukemia treatment. To expand the participant pool, outreach was conducted to Gaziantep Oncology Hospital based on a reference; however, it was discovered that the oncology unit had been closed, and patients had been transferred to other medical facilities following the earthquake on February 6, 2023. Consequently, the number of eligible participants was significantly limited, reducing the opportunity to reach a larger population. Another major challenge impacting both the project and the volunteer team providing support was the instability in the lives of the participating children. Several unforeseen and distressing events disrupted participation and affected the emotional well-being of both the children and the research team. For instance, one child passed away just one month after enrolling in the study, while another was forced to withdraw after learning of his father’s cancer diagnosis, which was followed by his father’s passing. Additionally, the divorce of another participant’s parents during the program caused emotional distress, diminishing the child’s motivation and engagement. Furthermore, the low socioeconomic status of the participant families posed significant barriers to the continuity of the online support program. A prevalent issue among the children was limited access to communication tools; in most cases, the only available device was a parent’s mobile phone, with no access to tablets or computers at home. Even for those with mobile phones, internet connectivity was often restricted, further hindering sustained participation in the program. These challenges underscore the structural and economic disparities affecting access to psychosocial support for children with leukemia in disadvantaged regions. The experiences gained throughout this project, along with its findings, underscore the critical need to expand support programs, particularly in East region of country. There is a pressing necessity for long-term interventions (minimum 12 months) that provide comprehensive support not only for children diagnosed with leukemia but also for their families. Structured programs should include educational components aimed at increasing parental awareness regarding child development, the treatment process, and essential caregiving practices. Given the significance of early diagnosis in leukemia, timely initiation of treatment is paramount. Therefore, targeted efforts should be made to educate parents on recognizing symptoms and seeking prompt medical intervention. Additionally, children in this region require adequate access to technological resources to facilitate both academic and psychosocial support post-diagnosis. The low educational attainment of many families in this region may contribute to communication barriers, limiting their ability to effectively support their children through the leukemia treatment process. To address this gap, regular psychological support should be integrated into care plans for both children and their families. Furthermore, establishing structured systems to identify newly diagnosed children and their families—through non-governmental organizations (NGOs) or social responsibility initiatives—could facilitate the provision of economic, social, and psychological support tailored to their specific needs. Strengthening collaborations between healthcare institutions, governmental bodies, and NGOs will be essential in ensuring sustainable and equitable access to the necessary support services for children with leukemia and their families in underserved regions. Acknowledgements We sincerely thank TÜBİTAK for their financial support, which made this study possible. We also extend our heartfelt gratitude to the volunteer survivors for their mentorship and children who participated in this research. 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Supplementary Material File (tables.docx) Download 21.05 KB Information & Authors Information Version history V1 Version 1 12 March 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords leukemia psychosocial quality of life Authors Affiliations Nesibe S. KUTAHYALIOGLU 0000-0001-8220-4290 [email protected] Western University Faculty of Health Sciences View all articles by this author Gamze DEMIRBAS TC Saglik Bakanligi Besni Devlet Hastanesi View all articles by this author Metrics & Citations Metrics Article Usage 300 views 176 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Nesibe S. KUTAHYALIOGLU, Gamze DEMIRBAS. Enhancing Quality of Life and Reducing Anxiety in Children with Leukemia Through Social Support: A Pilot Study. Authorea . 12 March 2025. 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