Neurodevelopmental consequences of pediatric cancer and its treatment: applying an early adversity framework to understanding cognitive, behavioral, and emotional outcomes.
Neurodevelopmental consequences of pediatric cancer and its treatment: applying an early adversity framework to understanding cognitive, behavioral, and emotional outcomes.
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DOI：
10.1007/s11065-017-9365-1
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发表时间：
2018-06
影响因子：
5.8
通讯作者：
Rabinak CA
中科院分区：
文献类型：
--
作者：
Marusak HA;Iadipaolo AS;Harper FW;Elrahal F;Taub JW;Goldberg E;Rabinak CA
今天，儿童在儿科癌症中以前所未有的速度存活下来，使其成为现代医学真正的成功故事之一。然而，我们越来越意识到癌症的几种有害影响以及随后的“治愈”，这些影响超出了身体后遗症。事实上，儿童癌症幸存者通常报告认知，情感和心理困难，包括注意力困难，焦虑和创伤后应激症状（PTSS）。认知的晚期和长期效应主要归因于癌症治疗的神经毒性效应（例如，化疗、颅照射、手术）对大脑发育的影响。儿童期逆境在儿科癌症中的作用-即存在危及生命的疾病和侵入性医疗程序的耐受性-在现有的神经科学文献中基本上被忽视，尽管我们小组和其他人的令人信服的研究表明，暴露于更常见的不良童年经历（即，家庭和社区暴力，身体，性和情感虐待）强烈地影响神经发育。虽然这些不良的童年经历在许多方面与儿童癌症的经历不同（例如，背景、性质、来源），但它们确实有一个共同的面临威胁的因素（即，对生命或身体完整性的威胁）。因此，我们认为，早期威胁和癌症治疗的双重打击可能会改变神经发育，并最终改变认知，行为和情感结果。在本文中，我们（1）回顾了现有的儿童，青少年和成人癌症幸存者的神经影像学研究，（2）总结了我们目前的理解差距，（3）提出了一个新的神经生物学框架，将儿童癌症描述为一种儿童逆境，特别是一种早期威胁，重点是海马体和显着性和情绪网络（SEN）的发展，（4）提出未来的研究方向。
Today, children are surviving pediatric cancer at unprecedented rates, making it one of modern medicine’s true success stories. However, we are increasingly becoming aware of several deleterious effects of cancer and the subsequent “cure” that extend beyond physical sequelae. Indeed, survivors of childhood cancer commonly report cognitive, emotional, and psychological difficulties, including attentional difficulties, anxiety, and posttraumatic stress symptoms (PTSS). Cognitive late- and long-term effects have been largely attributed to neurotoxic effects of cancer treatments (e.g., chemotherapy, cranial irradiation, surgery) on brain development. The role of childhood adversity in pediatric cancer – namely, the presence of a life-threatening disease and endurance of invasive medical procedures – has been largely ignored in the existing neuroscientific literature, despite compelling research by our group and others showing that exposure to more commonly studied adverse childhood experiences (i.e., domestic and community violence, physical, sexual, and emotional abuse) strongly imprints on neural development. While these adverse childhood experiences are different in many ways from the experience of childhood cancer (e.g., context, nature, source), they do share a common element of exposure to threat (i.e., threat to life or physical integrity). Therefore, we argue that the double hit of early threat and cancer treatments likely alters neural development, and ultimately, cognitive, behavioral, and emotional outcomes. In this paper, we (1) review the existing neuroimaging research on child, adolescent, and adult survivors of childhood cancer, (2) summarize gaps in our current understanding, (3) propose a novel neurobiological framework that characterizes childhood cancer as a type of childhood adversity, particularly a form of early threat, focusing on development of the hippocampus and the salience and emotion network (SEN), and (4) outline future directions for research.
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