Abstract
<title>Abstract</title> <p>Purpose This study aims to examine pattern-based discrepancies in emotional mediation and quantify differential mediating effects of distinct emotional distress patterns in the sleep–fatigue association among early-treatment Chinese childhood cancer survivors (CCS). Methods We analyzed baseline data from 336 CCS (aged 7–18 years; ≤6 months of diagnosis; active treatment) enrolled in the Chinese Childhood Cancer Survivorship Wellbeing Cohort. Sleep was assessed with an adapted BEARS index, and emotional distress and fatigue were assessed using C-Ped-PROMIS. Structural equation models were used to compare indirect effects across distinct distress patterns. Results Participants (N = 336) had a median age of 11 years, and 70.8% were diagnosed with hematological tumors. Although tumor history status was association with fatigue (Z = −2.241, P < 0.05), its independent effect was negligible (β = 0.04) in multivariate regression. Among sleep problems, bedtime difficulties were most prevalent (46.7%). A greater number of sleep problems were positively associated with higher fatigue (β = 0.351, P < 0.001). The depression–anxiety–anger triad had the largest indirect effect (20.765, 95% CI 12.736–33.275), followed by two-emotion combinations, and single-state effects were the smallest. Conclusions Emotional distress patterns differed in mediating the sleep–fatigue association. Mediating effects strengthened as co-occurring emotions increased. Integrated sleep–emotion interventions targeting multi-emotion patterns may reduce fatigue in early-treatment CCS. Implications for Cancer Survivors Targeting clustered multi-emotional distress offers a key chance to boost early-treatment outcomes in CCS. Incorporating multi-emotion pattern screening and tailored integrated interventions into early care pathways can advance their physical and psychological wellbeing.</p>