The purpose of this work was to identify demographic, medical, and psychosocial variables that predict radiation therapy-related distress among pediatric patients with cancer.

Seventy-nine children between the ages of 2 and 7 years were consecutively enrolled in the study. Radiation therapy-related distress was measured by rates of anesthesia, observed behavioral distress, and heart rate.

Younger age and higher observed behavioral distress predicted the use of anesthesia, higher baseline heart rate predicted lower initial observed behavioral distress, and prone treatment position was associated with increases in both observed behavioral distress and heart rate relative to baseline.

Modifiable treatment and psychological variables directly relate to pediatric radiation therapy-related distress. Implementation of developmentally appropriate and cost-effective interventions to reduce procedural radiation therapy distress is warranted.