Survival rates for childhood cancer now exceed 80% at five years post-diagnosis, yet up to one quarter of children experience clinically significant anxiety, depression, or post-traumatic stress surrounding diagnosis, with psychosocial morbidity persisting across all phases of care. Existing reviews predominantly examine experiences within isolated care phases, limiting understanding of how needs change across the continuum. This review aimed to synthesise qualitative evidence on the psychosocial needs and experiences of children and adolescents (0-19 years) with cancer across diagnosis, treatment, and survivorship, and to examine how these needs evolve over time.
A meta-ethnographic synthesis was conducted following Noblit and Hare's seven-phase approach, reported in accordance with eMERGe guidance, and informed by Bronfenbrenner's ecological systems theory, Erikson's psychosocial development framework, and Piaget's theory of cognitive development. Six databases were searched, identifying 31 qualitative studies published between 2009 and 2025. Constructs were extracted, coded by developmental age band and care phase using a hybrid deductive-inductive approach, and integrated into a line-of-argument synthesis. Sample size was determined by theoretical saturation consistent with meta-ethnographic methodology.
Six psychosocial domains shaped children's experiences: family, relationships, psychosocial care, emotions, control, and information needs. Although structurally consistent, their expression shifted in developmentally patterned ways. At diagnosis, needs centred on protection through parental containment and clinician-mediated buffering. During treatment, children actively sought participation through micro-autonomies to reassert agency. In survivorship, needs reflected ownership through identity reconstruction and future-oriented information, yet were met with fragmented services and a cliff edge at treatment completion. The synthesis generated a line-of-argument model - Protection, Participation, Ownership - explaining this developmental progression.
Children's psychosocial needs are phase-specific, developmentally embedded, and ecologically shaped. These findings identify the prehabilitation window at diagnosis as a critical yet underutilised opportunity for early intervention, and provide a theoretically grounded framework for developmentally responsive psychosocial care across the cancer continuum.