Nutritional Needs and Treatment Adherence Among Children with Cancer ReceivingChemotherapy in the Middle Euphrates Region

Objective: To assess nutritional needs and chemotherapy adherence among children with cancer receiving chemotherapy in the Middle Euphrates region and to identify factors associated with nutritional status and treatment adherence. Study Design: A cross-sectional quantitative studyPlace and Duration of Study: This study was conducted in three Oncology Hospitals in AL-Najaf AL-Ashraf, Holly Karbala, and Babylon, Iraq between December 2025 and April 2026. Methods: A purposive sample of 170 children with cancer aged below 18 years and their parents participated in the study. Results: The majority of children were male (71.2%), early childhood ages (41.8%), and had been diagnosed with ALL (75.9%). The body mass index was found to be in the normal range in 41.2% of them, but 37.6% of them were underweight. Both parents and children had high nutritional knowledge (73.5%) and only 37.1% of children had high nutritional status. Regarding chemotherapy adherence, the majority of the participants demonstrated high adherence (65.9%), while 31.8% were moderately adherent, and only 2.3% showed low adherence. There were significant correlations between parent knowledge and education for father (p = 0.022) and mother (p = 0.002). The adherence-related psychological and sensory factors were significantly correlated with child age (p = 0.001) andmother's educational level (p = 0.014). Conclusions: The nutritional challenges faced by children are moderate and the knowledge of parents and their adherence to treatment is generally good in the Middle Euphrates region. Educational strategies for mothers are important, not only for nutritional awareness, but also to remove psychological barriers for adherence to chemotherapy. Enhancing nutritional counselling and psychosocial support services can help to enhance the treatment in children with cancer.