Background and aims <p>Cancer-Related cognitive impairment is a prevalent complication in cancer children. Nonetheless, little is known about the risk factors for cognitive impairment in this group. The aim of this study was to analyze and evaluate the risk factors for cognitive impairment in children and adolescent cancer patients in western China.</p> Methods <p>A cross-sectional study was conducted in a tertiary hospital in western China. A total of 105 cancer children and adolescents were enrolled in the study. Cognitive function was assessed using the Six-subtest short-form of Wechsler Intelligence Scale for Children-four Edition. Demographic and clinical data were collected using a questionnaire. Binary logistic regression analysis was used to identify the risk factors for cancer-related cognitive impairment.</p> Results <p>The mean age of the patients was 10.04 years, and 60% were male. The incidence rate of Cancer-Related cognitive impairment was 39%. Binary logistic regression analysis showed that gender (OR = 0.11, 95% CI: 0.02–0.48), disposition (OR = 3.15, 95% CI: 0.88–11.37), course of disease (OR = 3.01, 95% CI: 1.56–5.83), sleep duration (OR = 0.48, 95% CI: 0.31–0.76), chemotherapy (OR = 19.46, 95% CI: 1.20-315.24), and father’s education level (OR = 0.04, 95% CI: 0.01–0.18), were independent risk factors for Cancer-Related cognitive impairment.</p> Conclusions <p>High prevalence of cognitive impairment among pediatric cancer patients. Key influencing factors included clinical factors, demographic characteristics, and sleep duration. These findings underscore the critical need to integrate routine cognitive and sleep assessments into standard clinical care. Early intervention targeting these modifiable factors, particularly sleep quality, is essential for mitigating cognitive decline in this vulnerable population.</p>