Psychosocial Risk in Young Survivors of Early Onset Pediatric Cancer: The Role of Physical and Neurocognitive Late Effects

尽管存活率增加，但超过三分之二的癌症儿童会出现晚期效应，如 继发性癌症、感觉运动缺陷和神经认知障碍。2，3心理社会晚期效应， 特别是社会孤立和受害，形成和维持友谊的困难，以及情感上的困难。 痛苦，常见于中枢神经系统（CNS）疾病的幸存者或接受CNS- 定向治疗（例如，颅放射、鞘内化疗）。4 -6不幸的是， 7，8那么，为什么儿童癌症幸存者没有朋友，感到快乐呢？ 我们的模型假定，社会认知的残余缺陷会导致消极的同伴互动， 然而，大多数工作都集中在脑损伤的成年幸存者身上。 儿科癌症，而不是在生命早期（学龄前）诊断的儿童。这些年轻的幸存者可能最多 困难的风险有几个原因。首先，最常见的儿科癌症的发病高峰出现在 6.1其次，他们的治疗对大脑发育有特别有害的影响， 2，3第三，儿童接受长达3年的治疗，并在社交活动的关键时刻被隔离。 发展第四，父母面临痛苦的风险，这可能会削弱他们缓冲负面影响的能力。 17，18因此，迫切需要对早期接受治疗的儿童的心理社会风险进行描述。 发病的癌症，并评估我们的模型的效用，以告知更有效的，有针对性的干预措施。我们长久以来- 长期目标是降低癌症儿童的发病率，改善他们的健康。的目的 一项对照的多地点研究旨在确定年轻癌症患者友谊和情绪困扰的预测因素 幸存者（即，诊断<6岁，停止治疗>1年）。使用严格的匹配控制设计，我们将 评估小学课堂中的同伴互动和友谊（即，3-5级）的200名幸存者。 将在对幸存者家属和200名儿童进行家访时评估个人和家庭的功能。 匹配的同学。我们将确定社会认知和同伴互动以及环境方面的缺陷。 资源（例如，父母教养，学校氛围），预测长期的心理社会调整（即，友谊， 危难）。其基本原理是，社会认知和同伴互动的缺陷会导致心理社会风险， 这可以通过学校和家庭环境中的资源来减轻。目标1。比较长期 年轻幸存者对匹配同龄人的心理社会适应，并确定社会认知的群体差异 和同伴间的互动可能预示着适应不良。目标二。确定特定的社会认知和同伴 解释年轻幸存者心理社会适应的相互作用因素。目标3。识别环境 保护年轻幸存者心理社会适应的资源。这项研究意义重大，因为它将 描述早期风险和保护因素，预测年轻幸存者的长期适应， 在制定干预措施以改善幸存者护理和预防长期发病方面处于首要地位。

Despite increased survival,1 over two-thirds of children with cancer experience late effects, such as secondary cancers, sensorimotor deficits, and neurocognitive impairment.2,3 Psychosocial late effects, particularly social isolation and victimization, difficulties forming and maintaining friendships, and emotional distress, are common for survivors of central nervous system (CNS) disease or those who receive CNS- directed therapy (e.g., cranial radiation, intrathecal chemotherapy).4-6 Unfortunately, interventions to improve outcomes have had limited success.7,8 So why don’t childhood cancer survivors have friends and feel happy? Our model posits that residual deficits in social cognition contribute to negative peer interactions and poor psychosocial outcomes in children with brain injury.10,11 However, most work has focused on adult survivors of pediatric cancer and not children diagnosed early in life (preschool). These young survivors may be at greatest risk for difficulties for several reasons. First, the peak onset of the most common pediatric cancers occurs before age 6.1 Second, their treatments have an especially harmful impact on brain development and a high rate of sensorimotor deficits.2,3 Third, children are treated up to 3 years and isolated at a critical time for social development. Fourth, parents are at risk for distress, which may impair their ability to buffer negative effects on their children.17,18 Thus, there is an urgent need to characterize psychosocial risk in children treated for early onset cancer and to evaluate the utility of our model to inform more effective, targeted interventions. Our long- term goal is to reduce morbidity and improve the well-being of children with cancer. The objective of this controlled, multi-site study is to identify predictors of friendships and emotional distress in young cancer survivors (i.e., diagnosed < age 6, >1 year off treatment). Using a rigorous matched control design, we will assess peer interactions and friendships in the elementary classrooms (i.e., grades 3-5) of 200 survivors. Individual and family functioning will be assessed during home visits with families of survivors and 200 matched classmates. We will identify deficits in social cognition and peer interactions, as well as environmental resources (e.g., parenting, school climate), that predict long-term psychosocial adjustment (i.e., friendships, distress). The rationale is that deficits in social cognition and peer interactions contribute to psychosocial risk, which could be mitigated by resources in the school and family environments. Aim 1. Compare the long-term psychosocial adjustment of young survivors to matched peers and identify group differences in social cognition and peer interactions that may predict poor adjustment. Aim 2. Identify specific social cognitive and peer interaction factors that account for psychosocial adjustment in young survivors. Aim 3. Identify environmental resources that protect psychosocial adjustment in young survivors. This research is significant as it will delineate early risk and protective factors that predict long-term adaptation for young survivors and leave us in a prime position to develop interventions that will improve survivorship care and prevent long-term morbidity.