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

青少年和年轻人对癌症的心理适应（AYA）：对精神病理学和复原力机制的调查

• 批准号: 1925463
• 金额: --
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-1925463
• 关键词: Psychological; Adaptation; cancer; adolescents; young

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.

癌症的诊断和治疗往往会干扰患者的正常生活，并导致压力水平增加，从而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，但近30%的弱势群体发展出临床水平的焦虑和抑郁。确定那些在达到缓解后发展为精神病理学的高风险是至关重要的，以防止发病的情绪障碍later on.Some的不良心理社会后果在儿科肿瘤学已知的风险因素是：被诊断为青春期，家庭功能差，和预先存在的精神病理学。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保护性的。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。通过分析雅芳父母和子女纵向研究（ALSPAC）的数据，该研究是一项针对女性及其子女的社区代表性前瞻性研究，本研究旨在确定样本中年轻癌症幸存者的抑郁和焦虑患病率，评估异常皮质醇水平和精神病理学之间的关系，并根据现有的研究结果提出改进目前精神病理学筛查工具的方法。与健康对照组相比，情绪障碍的水平预计将显着更高的那些经历过儿童癌症，并提出了显着的皮质醇abnormality.These结果将扩大现有的文献中的风险因素情绪障碍的年轻癌症患者和幸存者，并提供了一个平台，在精神病理学的筛查方法的进步。虽然未来的研究应该致力于在这一人群中确定更多的焦虑和抑郁的生物标志物，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，允许更好的筛查和肿瘤学药物干预，儿科癌症的生存率大大提高。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]。尽管癌症的缓解率如此之高，但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被轻视。尽管研究人员一直注意并考虑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提出了不同的结果。一些作者认为抑郁症是癌症患者最常见的精神病诊断，并将其描述为对“与治疗相关的正常状态丧失”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者的抑郁水平没有显着差异[18]。认为“儿童没有达到足够的认知水平，使他们能够完全理解自己的疾病。在Dejong & Fombonne（2006）最近的一篇综述中，作者评估了自1980年以来所有研究儿童癌症抑郁结局的研究，发现患病率很低。作者指出，需要进一步研究，因为不确定的结果可能归因于薄弱的方法，小样本，缺乏足够的对照组，以及依赖自我报告措施[13]。沿着抑郁症，焦虑，创伤后应激障碍或创伤后应激症状（PTSD或PTSS）等疾病，以及适应障碍也在儿科心理肿瘤学中受到一定的关注。