Anticipatory anxiety in children with cancer undergoing chemotherapy is one of the complex psychological experiences on the course of treatment of childhood malignant illnesses that is formed by waiting to face treatment situations, recalling previous unpleasant experiences, and anticipating pain, nausea, injections, hospitalization, or separation from family. This type of anxiety is not simply a reaction to an existing event, but an emotional response to an event that the child expects to happen in the near future and may begin even before entering the hospital, viewing medical equipment or hearing the name of chemotherapy. Understanding this phenomenon requires simultaneous attention to the child's cognitive, emotional, behavioral, physical, and social processes and examining the interaction between developmental characteristics, treatment history, quality of communication with treatment team members, and family support practices. Diagnosis of cancer in childhood changes the usual structure of life and exposes the child to experiences that may not be commensurate with his/her level of cognitive understanding and emotional ability. Chemotherapy also provides a basis for the formation of persistent anxiety and fear conditioning due to the frequency of sessions, the possibility of physical complications, limitation of daily activities, and exposure to unfamiliar environments. From a theoretical perspective, anticipatory anxiety can be explained using classical learning theory; according to this view, when a child experiences multiple times such as injection pain, nausea, or physical discomfort in the treatment setting, the symptoms associated with that situation, such as the smell of disinfectants, the sound of equipment, staff clothing, or the sight of a treatment bed, may become anxiety-inducing triggers. As a result, even before medical intervention begins, the child's body and mind exhibit a standby response that can be accompanied by increased heart rate, sweating, muscle tension, restlessness, crying, stomachache, or refusal to cooperate. This process suggests that a child's fear is not always proportional to the actual intensity of the stimulus present, but may be influenced by previous learning and the anticipation of unpleasant consequences. Along with classical conditioning, cognitive mechanisms also play an important role in the persistence of predictive anxiety, as the child makes predictions about what is going to happen based on limited information, imagination, personal perceptions, and previous experiences. If the child fails to understand the nature of the disease and the stages of treatment in accordance with his or her level of development, he may perceive necessary medical measures as a sign of imminent danger, or assume that each time he enters the hospital will necessarily be accompanied by severe pain. In young children, objective thinking, difficulty in understanding time, and limitations in expressing complex concepts can make waiting for treatment feel longer and more threatening. School-age children may have a lot of questions about the complications of chemotherapy, appearance changes, absenteeism, peer reactions, and the possibility of the disease returning, while adolescents may also suffer from loss of independence, disruption of social relationships, and changes in their body image, in addition to worrying about the consequences of treatment. Therefore, explaining predictive anxiety provides an incomplete picture of this experience, regardless of the child's stage of cognitive and emotional development. Cognitive Emotion Assessment Theory also emphasizes that the intensity of anxiety is not only dependent on the nature of the event, but also on the child's assessment of the extent of the threat and his or her ability to cope with it. When a child evaluates the therapeutic situation as unpredictable, out of control, and beyond his or her capacity to tolerate, the likelihood of anxiety reactions increases. In contrast, providing clear information, providing the opportunity to make choices in manageable things, teaching coping strategies, and the presence of a trusted caregiver can enhance the perception of control and a sense of security. From the perspective of attachment theory, the presence of parents and the quality of their emotional relationship with them are also important in regulating anxiety, as the child seeks the help of his primary caregiver in threatening situations to regain calm and interpret environmental cues. When parents are anxious, agitated, or unable to explain appropriately to the child's age, they may inadvertently reinforce the danger message; however, parental anxiety should not be considered as the sole cause of a child's emotional problems, as their worry is also often a natural reaction to difficult illness situations. Psychological support for parents, teaching calm response techniques, and coordination between the family and the treatment team are an essential part of a holistic approach to managing predictive anxiety. From a neuropsychological perspective, anticipation for a threatening event can activate risk-processing, attention, and emotion regulation systems and, if recurring, increase the child's sensitivity to treatment-related symptoms. Activation of the stress response may be associated with spontaneous body changes, increased physiological arousal, and difficulty in returning to a relaxed state. However, these reactions alone are not indicative of a psychiatric disorder and should be interpreted in the context of physical condition, treatment complications, age of the child, and clinical conditions. It is important to distinguish between anticipatory anxiety, actual pain, chemotherapy-induced nausea, and other physical complications, as these phenomena can exacerbate each other, but they are not the same in nature and management method. For example, anticipatory nausea may occur before chemotherapy medications are started and in some children it may be associated with unpleasant experiences from previous periods; however, not every type of pretreatment nausea can be considered purely psychological without a medical evaluation. A review of research evidence in the field of pediatric oncology shows that anxiety associated with therapeutic measures, procedural pain, and predictive nausea are known issues of psychological care and support, and that the child's previous experiences can affect his reactions in subsequent sessions. Research on psychological interventions in children with cancer supports the capacity of methods such as coping training, age-appropriate preparation, tranquility, guided mental imagery, distractions, play therapy, and cognitive-behavioural interventions to reduce some symptoms of anxiety and distress; however, the effectiveness of these methods depends on the type of intervention, treatment setting, characteristics of the child, quality of programme implementation and the indicator measured. Therefore, it cannot be concluded that a single approach is equally effective for all children or at all stages of chemotherapy. One of the basic principles of clinical intervention is regular assessment of anxiety before the start of therapy sessions and during the care process. In addition to the severity of anxiety, this assessment should include the time of its onset, the main triggers, physical reactions, avoidance behaviors, previous therapeutic experiences, and the extent of daily dysfunction. Age-appropriate dialogue, observing the child's behavior, receiving information from parents, and using valid tools to measure children's distress can help identify psychological needs. In choosing the assessment tool, its validity for the child's age group, language, clinical conditions, and communication ability should be considered, and no score alone should replace clinical judgment. The evaluation should be repeated periodically, as anxiety may increase at the beginning of treatment, after experiencing an unpleasant complication, or in the face of an aggressive action, and decrease in other situations. Based on the cognitive-behavioral approach, one of the important goals of therapy is to identify and correct catastrophic predictions and strengthen the child's coping skills. The therapist can help the child express his or her thoughts about therapy with simple, non-threatening questions, distinguish between reality and imagination, and learn strategies that can be used to manage the situation. For example, a child who thinks that every time he enters the treatment room is necessarily accompanied by severe pain, he or she can make a more realistic prediction of a therapeutic action by receiving a detailed and honest explanation, practicing relaxation skills, and experiencing a supported therapeutic action. This process should not lead to pain denial or unrealistic reassurance; saying things like "he won't feel any pain" may diminish the child's confidence if there is a possibility of discomfort. The appropriate approach is to provide honest, concise, and commensurate information with the level of understanding, while at the same time emphasizing helpful tools and the presence of supportive people. Teaching slow breathing, relaxing muscles, relaxing imagery, and focusing on pleasant stimuli can help reduce arousal, provided that the skills are practiced before a stressful situation and are tailored to the child's preference. The use of play therapy and play medicine also provides a good opportunity to represent therapeutic experiences and increase the child's familiarity with the equipment. In this method, the child can reveal their questions and concerns through dolls, safe tools, and role-playing, and feel that they are participating in the learning and preparation process. Play should not be designed to force the child to face fear unintentionally or forcedly, but rather should be done at a tolerable pace, child choice, and expert supervision. Art therapy can also be used as a complementary method to facilitate the expression of emotion, identify threatening perceptions, and foster a sense of agency. Drawing, storytelling, creating imaginary characters, and using colors may help the child represent an experience that is difficult to express verbally in a more understandable way. However, the interpretation of the painting should not be based on invalid symbolic perceptions or definitive conclusions about the child's mental state; the clinical value of these activities lies mostly in the process of communication, direct observation, the meaning that the child himself gives to the work, and the opportunity for supportive dialogue. Digital tools, interactive games, and virtual reality can also be used for distraction, education, and the practice of coping skills in some situations, but accessibility, sensory tolerance, the possibility of fatigue, developmental needs, and safety considerations should be taken into account in their selection. These tools are not a substitute for human communication, pain management, or specialized care, and their use should be coordinated with the child's medical condition. In the treatment setting, pre-chemotherapy preparation can include a step-by-step explanation of the process, introducing those present, specifying the approximate waiting time, providing an opportunity for questioning, and determining a personalized coping strategy. Predictive schedules and staff coordination in how to communicate reduce the likelihood of confusion and allow for more active participation. A child's involvement in small choices, such as choosing music, toys, posturing when possible, or arranging for non-essential activities, can foster a sense of control; however, necessary medical decisions should be made in accordance with the principles of safety and professional responsibility. In cases where severe anxiety causes refusal of treatment, panic attacks, significant sleep disturbances, or an inability to tolerate medical procedures, a professional evaluation by a child psychologist or psychiatrist is necessary, and more intensive intervention and close coordination with the oncology team may be required. Proper management of pain, nausea, and other physical symptoms should also be considered at the same time, as psychological intervention can be ineffective or even discrediting to the child without adequately addressing physical discomfort. One of the clinical challenges is the significant differences in children's mood, history of anxiety, medical experiences, level of development, family status, and type of treatment, so implementing a completely identical protocol for all patients may overlook their individual needs. Another limitation relates to the difficulty of separating predictive anxiety from generalized anxiety, pain response, medication complications, and distress caused by diagnosis. In addition, some children are unable to report their anxiety clearly due to their young age, communication problems, fatigue, or concern about the consequences of expressing emotions, and a purely self-reported assessment may not show the true severity of distress. In research in this area, heterogeneity of samples, differences in measurement tools, limited size of some studies, lack of long-term follow-up, and differences in chemotherapy protocols can make it difficult to compare results and generalize findings. Therefore, in interpreting the evidence, a distinction should be made between the findings of controlled studies, preliminary reports, and clinical experiences, and the generalization of the results of a limited intervention to all children with cancer should be avoided. Also, time pressure in health wards, limited specialized manpower, unequal access to psychological services, and difficulty in continuing interventions in families facing economic or geographical problems are important barriers to the implementation of support programs. Attention to family culture, communication language, illness-related beliefs, and parenting practices is also essential, as a program that is not aligned with the values and needs of the child and family may generate limited participation. It is suggested that pediatric oncology centers integrate treatment-related anxiety screening into their routine care plan and use information from previous sessions, the intensity of emotional reactions, pain experience, and avoidance to identify children at risk early. The design of intervention programs should be based on individual assessment, clear goals, and measurement of measurable outcomes, and include indicators such as anxiety intensity, child cooperation, pain experience, predictive nausea rate, quality of life, and family satisfaction. Educating health care workers about empathetic communication, age-appropriate information, avoiding unnecessary threats and coercion, and identifying symptoms of anxiety can help create a safer environment. It is also necessary for parents to be educated about the role of anxiety, the importance of validating children's feelings, how to answer questions, and the need to avoid unrealistic promises. Developing hybrid protocols including psychological preparation, cognitive-behavioral skills, play, art therapy, distractions, and appropriate control of physical symptoms can allow for a flexible response to the different needs of children, provided that the choice of methods is based on evidence, the child's preference, and the opinion of the treatment team. Future research should investigate the pathway of predictive anxiety change at different stages of chemotherapy with longitudinal designs and various samples and determine which characteristics of the child, family, and treatment environment are associated with the persistence or reduction of this anxiety. Comparing different interventions, evaluating the sustainability of the effects, examining the cost of effectiveness, and studying the feasibility of implementing methods in treatment centers with different facilities can also help to develop more accurate clinical guidelines. The participation of children and families themselves in the design of research programs is of particular importance, because their lived experience can reveal hidden dimensions of fear, the need for control, worry about pain, and effective relaxation practices. Overall, anticipatory anxiety in children with cancer undergoing chemotherapy is a multifactorial phenomenon that is influenced by the interaction of prior learning, cognitive threat assessment, emotional development, physiological responses, experience of physical symptoms, and supportive relationships. Effective management requires moving beyond a purely behavioral view of a child's fear and paying attention to the meaning they receive from the disease, treatment, and the future. Providing understandable information, creating a sense of security, fostering child participation, addressing pain and nausea at the same time, supporting the family, and providing psychological interventions tailored to individual needs can help reduce distress and improve the treatment experience. The ultimate goal is not for the child to never experience fear or worry, but to provide the conditions to be able to express their feelings, learn more effective coping strategies, and go through the chemotherapy process with greater psychological security and active participation with the support of the family and the treatment team.