Factors associated with executive function in children with lymphoma undergoing chemotherapy: A cross-sectional study based on the theory of unpleasant symptoms

Abstract

Objective This study aims to explore the factors influencing executive function of pediatric lymphoma patients based on the theory of unpleasant symptoms, across three dimensions: physiological, psychological, and situational. Methods A cross-sectional study was conducted involving 215 pairs of pediatric lymphoma patients and caregivers between October 2024 and October 2025. Patients completed the Depression-Anxiety-Stress Scales-21, while caregivers provided demographic information and completed the Simplified Coping Style Questionnaire, the Feetham Family Functioning Survey and the Behavior Rating Inventory of Executive Function. Descriptive statistics, univariate analysis, Pearson correlation analysis, and hierarchical multiple regression were used for statistical analyses. Results The Global Executive Composite score was 106.78 ± 21.61. Higher levels of patients' anxiety ( β = 0.249, P = 0.015) and stress ( β = 0.245, P = 0.014) were significantly associated with greater executive function impairment. Situational factors, including having fathers as primary caregivers ( β = 0.121, P = 0.038), non-only child status ( β = 0.129, P = 0.027), lower family income ( β = -0.140, P = 0.047), passive caregiver coping style ( β = 0.147, P = 0.020) and poorer family functioning ( β = 0.185, P = 0.002) were also significant independent predictors. The final model explained 45.2% of the variance in executive function. Conclusions Executive function impairment of pediatric lymphoma patients was influenced by the interaction of physiological, psychological, and situational factors. These findings underscored the necessity for comprehensive interventions that not only treat the disease but also address psychological stress and provide guidance for families, to preserve children's cognitive function.