Social Connectedness in Pediatric Brain Cancer Survivors

项目摘要/摘要 儿童脑肿瘤的幸存者在治疗期间经常遇到严重的社会联系问题 对成年有持久影响的年轻人(例如，结婚率降低)。然而，导致这些问题的因素 这些困难尚不清楚，关于社会联系领域如何影响健康也知之甚少。 儿童脑癌存活者随时间推移的相关生活质量和心理幸福感。 此外，由于缺乏对潜在问题的研究，解决这些问题的干预努力一直受到限制 社会联系的风险和机制因素。应聘者的风险和机械因素包括年龄 跨许多领域的诊断、治疗和与治疗相关的发病率(例如，认知、神经学、 内分泌、代谢)。此外，脑癌治疗会扰乱神经发育过程 对社交行为至关重要，如大脑连接、面部处理和社交注意。建立 社会连通性对整体健康的重要性以及促进社会健康的机制过程 儿童脑癌幸存者的连接性损害是重要的，以便发展适当的 干预措施。这项提议的广泛目标是比较以下几个领域的社会联系 恶性脑瘤幸存者对非恶性脑瘤幸存者的社会影响评价 幸存者的HQRL与心理幸福感的关联性，并评估风险和机制 影响社会联系发展轨迹的因素。我们建议对接受治疗的青年进行一项创新的研究 髓母细胞瘤(MB)、小脑毛细胞性星形细胞瘤(PA)或颅咽管瘤(CP)(N=180；年龄8-16岁) 采用两年加速纵向设计，每年访问一次，队列按诊断后的时间分层。 不同组之间的临床差异(例如，恶性/非恶性，使用颅脑脊髓照射)允许 测试其对社会联系的独特影响，并确定潜在的干预目标。 参与者将从费城儿童医院招募。在每次考察访问中，参与者将 对社会联系、HRQL和心理健康的完整测量，以及对 身体成分、神经内分泌功能、听力、大脑连通性(例如核磁共振)、社交信息 处理(SIP)和社交行为。感兴趣的神经成像标记物包括结构连接性、休息 状态功能连接，以及社交处理任务期间社交大脑中的功能连接。我们 假设社会联系，从而HRQL和心理幸福感，在 MB幸存者，以及风险(如CSI)和机械性因素(如听力、社会行为)影响社会 随时间推移的连通性。我们预计，在社交联系方面的缺陷将在 髓母细胞瘤幸存者对HRQL和幸福感的显著影响并确定其机制 社会联系。通过确定社会联系的潜在机制，我们可以开发 针对关键机械因素的干预措施，改善社会连通性、健康和福祉。

PROJECT SUMMARY/ABSTRACT Survivors of pediatric brain tumors often experience significant problems with social connectedness during youth that have lasting effects as adults (e.g., reduced rates of marriage). However, the factors contributing to these difficulties are unclear and little is known about how domains of social connectedness influence health- related quality of life (HRQL) and psychological well-being over time in survivors of pediatric brain cancer. Further, intervention efforts to address these issues have been limited by a lack of research on the underlying risk and mechanistic factors of social connectedness. Candidate risk and mechanistic factors include age at diagnosis, treatment, and treatment-related morbidities across many domains (e.g., cognitive, neurologic, endocrine, metabolic). Additionally, brain cancer treatments disrupt neurodevelopmental processes that are essential to social behavior, such as brain connectivity, face processing, and social attention. Establishing the importance of social connectedness to overall health and the mechanistic processes contributing to social connectedness impairments in pediatric brain cancer survivors is important in order to develop appropriate interventions. The broad objectives of this proposal are to compare domains of social connectedness among survivors of malignant brain tumors to survivors of non-malignant brain tumors, evaluate the influence of social connectedness on HQRL and psychological well-being among survivors, and to evaluate risk and mechanistic factors for the trajectory of social connectedness. We propose an innovative study of youth treated for medulloblastoma (MB), cerebellar pilocytic astrocytoma (PA) or craniopharyngioma (CP) (N = 180; ages 8-16) using a 2-year accelerated longitudinal design with annual visits with cohorts stratified by time since diagnosis. Clinical differences between groups (e.g., malignant/non-malignant, use of craniospinal irradiation) allow for tests of their unique impacts on social connectedness and for identification of potential intervention targets. Participants will be recruited from the Children's Hospital of Philadelphia. At each study visit, participants will complete measures of social connectedness, HRQL, and psychological well-being, as well as assessments of body composition, neuroendocrine function, hearing, brain connectivity (e.g., MRI), social information processing (SIP) and social behavior. Neuroimaging markers of interest include structural connectivity, resting state functional connectivity, and functional connectivity in the social brain during social processing tasks. We hypothesize that social connectedness, and thus HRQL and psychological well-being, are uniquely impacted in MB survivors, and that risk (e.g., CSI) and mechanistic factors (e.g., hearing, social behavior) affect social connectedness over time. We expect to establish deficits in social connectedness as a notable late effect in survivors of medulloblastoma with significant impact on HRQL and well-being and to identify mechanisms of social connectedness. By identifying the mechanisms underlying social connectedness, we can then develop interventions that target key mechanistic factors and improve social connectedness, health, and well-being.