Psychological Adaptation to cancer in adolescents and young adults (AYA): an investigation into the mechanisms of psychopathology and resilience

癌症的诊断和治疗往往会干扰患者的正常生活，并导致压力水平的增加，这可能会对年轻患者的心理健康产生负面影响。尽管大多数年轻的癌症幸存者过着充实的生活，但这些弱势群体中有近30%的人出现了临床水平的焦虑和抑郁。识别那些在达到缓解后发展为精神病理的高风险人群对于预防以后情绪障碍的发作至关重要。儿童肿瘤患者较差的社会心理结果的一些已知危险因素是：在青春期被诊断出来，家庭功能不佳，以及先前存在的精神病理。另一方面，在青春期之前被诊断出来并拥有强大的支持系统被证明是有保护作用的。目前还没有研究直接测量年轻癌症幸存者的皮质醇水平及其与压力相关精神疾病的关系。通过分析雅芳父母与儿童纵向研究（ALSPAC）的数据，该研究旨在确定样本中年轻癌症幸存者抑郁和焦虑的患病率，评估异常皮质醇水平与精神病理学之间的关系，并根据所提出的研究结果提出改进当前精神病理学筛查工具的方法。与健康对照组相比，患过儿童癌症的人的情绪障碍水平预计要高得多，并且表现出明显的皮质醇异常。这些结果将扩展现有的关于年轻癌症患者和幸存者情绪障碍风险因素的文献，并为精神病理学筛查方法的进步提供一个平台。虽然未来的研究应该旨在确定这一人群中焦虑和抑郁的更多生物标志物，但与此同时，定期关注受癌症折磨的儿童和青少年的心理健康应该成为一种常态。随着现代医学的进步，肿瘤学的筛查和药物干预变得越来越好，儿童癌症的存活率大大提高。在某些诊断中，如急性淋巴细胞白血病，超过90%的患者达到缓解[10,22]。尽管有如此高的缓解率，癌症仍然被认为是一种慢性疾病，它对儿童癌症幸存者心理健康的影响不应轻易忽视。尽管研究人员总是注意到并考虑到癌症后的痛苦和抑郁，但儿科心理肿瘤学领域的早期流行病学研究呈现出不同的结果。一些作者认为抑郁症是癌症患者最常见的精神诊断，并将其描述为“与治疗相关的正常丧失”的病理反应[7,26]。其他研究发现，儿童癌症幸存者和健康对照组的抑郁水平没有显著差异，认为“儿童没有达到足够的认知水平，使他们能够完全了解自己的疾病。”在Dejong & Fombonne（2006）最近的一篇综述中，作者评估了自1980年以来所有关于儿童癌症中抑郁症结果的研究，发现只有适度的患病率。作者指出，由于不确定的结果可能是由于方法薄弱、样本小、缺乏足够的对照组以及依赖于自我报告的测量方法，因此需要进行进一步的研究。与抑郁症一样，焦虑、创伤后应激障碍或创伤后应激症状（PTSD或PTSS）等障碍和适应障碍也在儿科心理肿瘤学中受到一些关注。

Cancer diagnosis and treatment often interfere with patient's normal routine, and cause increased levels of stress, which can negatively impact the psychological wellbeing of the young patient. Even though the majority of young cancer survivors lead fulfilling lives, almost 30% of this vulnerable population develops clinical levels of anxiety and depression. Identifying those at higher risk for developing psychopathology upon reaching remission is crucial to prevent the onset of mood disorders later on. Some of the known risk factors for poorer psychosocial outcomes in paediatric oncology are: being diagnosed in adolescence, poor family functioning, and pre-existing psychopathology. On the other hand, being diagnosed before adolescence and having a strong support system proved to be protective. No studies have yet directly measured cortisol levels and its association to stress-relatedmental illness in young cancer survivors.By analyzing data from Avon Longitudinal Study of Parents and Children (ALSPAC), a community-representative prospective study of women, and their children, this study aims to establish the prevalence of depression and anxiety in young cancer survivors in the sample, assess the relationship between abnormal cortisol levels and psychopathology, and propose ways in which current screening tools for psychopathology could be improved in light of presented findings. Compared to healthy controls, levels of mood disorders are expected to be significantly higher in those who had experienced childhood cancer, and have presented with significant cortisol abnormalities.These results will expand on the existing literature on risk factors for mood disorders in young cancer patients and survivors, and provide a platform upon which advances in screening approaches for psychopathology could be made. While future studies should aim to identify more biomarkers for anxiety and depression in this population, in the meantime, regular attendance to psychological wellbeing of children and adolescents afflicted by cancer should become a norm.With advances in modern medicine that allow for ever better screening and pharmacological interventions in oncology, the survival rates for paediatric cancer immensely improved. In some diagnoses such as acute lymphoblastic leukemia well over 90% of patients reach remission [10, 22]. Despite such high remission rates, cancer is still considered a chronic illness, and its effects on the psychological wellbeing of childhood cancer survivors should not be dismissed lightly.Though researchers always noted and considered distress and depression in the aftermath of cancer, early epidemiological studies in the field of paediatric psycho-oncology present mixed findings. Some authors regarded depression as the most common psychiatric diagnosis in cancer patients and described it as a pathological response to the "loss of normalcy associated with treatment"[7, 26].Other studies found no significant difference in depression levels among childhood cancer survivors and healthy controls [18], arguing that "children do not reach a sufficient cognitive level that enables them to understand their illness completely." In a more recent review by Dejong & Fombonne (2006), authors evaluated all the studies since 1980 that looked at depression outcomes in paediatric cancer and found only modest prevalence rates. The authors point at the need for future studies as the inconclusive findings may be attributable to weak methodology, small samples, lack of sufficient control groups, and reliance on self-report measures [13].Along with depression, disorders such as anxiety, posttraumatic stress disorder or posttraumatic stress symptoms (PTSD or PTSS), and adjustment disorders also received some attention in paediatric psycho-oncology.