Pre-chemotherapy anxiety is one of the common psychological experiences in children with cancer, which can be influenced by fear of pain, hospital environment, injections, complications of treatment, separation from parents, and unpleasant memories of previous sessions. From a psycho-oncology perspective, pre-treatment anxiety is not just a simple emotional reaction, but is the result of the interaction between cognitive, emotional, physical, familial, and environmental factors and can affect the child's cooperation with the treatment team, his perception of pain, avoidance behaviors, and the overall treatment experience. In this framework, art-based interventions can be used as a complementary approach to reduce distress and prepare the child psychologically before chemotherapy. The theoretical basis of these interventions is based on the capacity of art to facilitate non-verbal expression of emotions, increase feelings of control, reduce focus on anxiety-inducing stimuli, and create a predictable and participatory experience. The child may not be able to explain his or her fear of chemotherapy directly, but he or she can express his or her concerns and communicate them with the psycho-oncologist through drawing, coloring, collage, character building, art play, or visual storytelling. In the pre-chemotherapy phase, the psycho-oncologist first examines the severity of anxiety, developmental status, previous treatment experiences, physical conditions, and family factors affecting the child's distress, and then chooses artistic activity appropriate to the child's age and capacity. The goal of the intervention is not to eliminate anxiety completely, but rather to reduce the intensity of distress and help the child experience a greater sense of security, predictability, and control. Artistic activity can allow the child to represent the therapeutic environment in a different way, for example, the child can show their hospital, chemotherapy room, medical equipment, or even their emotions in the form of a picture and then talk to the therapist about what they have created. This process can help identify anxious thoughts and correct unrealistic perceptions, and provide the basis for the use of adaptive coping strategies. The use of colors, lines, soothing images, and simple creative activities can shift the child's attention from anxious expectation to a purposeful activity before entering the therapy process. In some situations, artistic activities combined with slow breathing, soft music, mental imagery, or coping skills training can be performed as a combination intervention. The psycho-oncologist can also use art to teach the steps of chemotherapy in child's language to make the treatment process more understandable and predictable for the child. Visualizing the treatment process, making up a story about a hospital visit, or painting sources of support can help reduce ambiguity and increase child involvement. Parental involvement in this process is also important, as parental anxiety can affect a child's emotional experience, and calm and supportive parental interaction can foster a child's sense of security. In terms of clinical application, art-based interventions can be implemented in the waiting room, pediatric oncology ward, before medication injections, or between the initial assessment and the start of chemotherapy. The duration and intensity of the activity should be consistent with the child's physical condition, fatigue level, and attention capacity, and should not become a factor for further stress or fatigue. The psycho-oncologist should pay attention to the individual differences of children, as one artistic activity may be soothing to one child and unattractive to another. Choosing an activity based on a child's preference can increase their sense of authority and participation. Despite these capacities, art therapy should not replace medical treatments or evidence-based psychological interventions in children with severe anxiety, but should be used as part of comprehensive, multidisciplinary care. Important challenges in this area include differences in the way interventions are implemented, the variety of art tools, differences in children's age and developmental stage, and the difficulty of accurately measuring anxiety changes. Also, the severity of the disease, type of treatment, the child's previous experience, family support, and the conditions of the hospital environment can affect the response rate to the intervention. Another limitation is the heterogeneity of the existing research and differences in the tools to measure anxiety and psychological outcomes, which make it difficult to compare the results. Therefore, it is suggested that future research use more standardized protocols, larger samples, and validated tools to measure anxiety and investigate the effect of art-based interventions in different periods of treatment and in long-term follow-up. Also, investigating the role of age, type of cancer, previous experience of chemotherapy, and parental involvement can help to personalize interventions. The psycho-oncologist can target pre-chemotherapy anxiety by providing a creative, safe, and participatory environment and help the child express their fears and concerns, feel more in control, and enter the treatment process with a more appropriate psychological readiness. In this approach, art is not a substitute for medical treatment, but rather a complementary tool for creating communication, regulating emotion, strengthening coping strategies, and humanizing the child's chemotherapy experience.