Risk and Protective Factors for Immune Health in Pediatric Cancer

小儿癌症免疫健康的风险和保护因素

• 批准号: 8224892
• 负责人: Marcia A Winter
• 金额: $ 11.7万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8224892
• 关键词: Activities of Daily Living; Address; Age; Animal Experimentation; Attention; Behavioral Mechanisms; Biological; Biological Factors; Blood Cell Count; Cancer Patient; Child; Child Mental Health; Child health care; Childhood; Chronic stress; Data; Data Analyses; Development; Diagnosis; Disease; Disease Progression; Event; Family; Family Caregiver; Family Process; Fostering; Foundations; Funding; Health; Health behavior; Hospitals; Immune; Immunocompromised Host; Immunologic Factors; Individual; Infant; Intervention; Knowledge; Life; Life Stress; Link; Longitudinal Studies; Malignant Childhood Neoplasm; Malignant Neoplasms; Mediating; Medicine; Mental Health; Methodology; Methods; Modality; Modeling; Onset of illness; Outcome; Patients; Pattern; Pediatrics; Population; Process; Proteins; Psyche structure; Public Health; Quality of life; Recovery; Research; Risk; Secure; Sleep; Staging; Stress; Survival Rate; Survivors; Symptoms; System; Testing; Training; Translating; Vulnerable Populations; Work; acute stress; biobehavior; biopsychosocial; caregiving; coping; cytokine; design; diet and exercise; immune function; mature animal; novel; psychologic; psychosocial; skills; theories; tumor

DESCRIPTION (provided by applicant): Advances in medicine have dramatically increased pediatric cancer survival rates; 80% of children diagnosed with cancer will survive beyond five years. This victory carries with it new agendas for research, as attention shifts to the mechanisms underlying the quality of life of survivors. Quality of life includes div aspects of functioning including functional ability, psychological functioning, and disease- and treatment-related symptoms. Understanding these processes demands integrative, biobehavioral models of functioning in the cancer context. Unfortunately, development and testing of competing models in pediatrics has lagged behind research focusing on adults and animals. The proposed research is designed to be a first step in identifying biological and behavioral mechanisms by which risk and protective factors influence children's health. Evidence from both adult and animal studies indicates a relationship between stress and immune function, with much of the current focus on cytokines, the key proteins in the immune cascade. Broad sociodemographic and life stress (e.g., SES, life events), biological factors (e.g., age at disease onset), health behaviors (e.g., sleep, diet, exercise), and psychosocial processes (e.g., coping, meaning making) interact to influence mental health and immunologic factors in turn influences disease processes (e.g., progression, recovery, quality of life). For example, adult and animal research demonstrates that chronic and acute stress can compromise immune function, which in turn fosters poorer cancer outcomes. Yet, this research has not been translated to children with cancer, despite evidenced links between stress and biological, psychological, and relationship system functioning in other contexts. The two proposed studies are each short-term longitudinal studies of the mediating and moderating relationships among sociodemographic stress and family protective processes as they influence child health outcomes. In the first study, the association of infants' immune function with stressful family life events and maternal sensitive care giving is examined. In the second study, the association of pediatric cancer patients' immune and mental health function with sociodemographic stress and (1) child secure appraisals and health behaviors, and (2) caregiver and family protective processes. The public health significance of this work lies in its potential to highlight multiple, individual- and famil-level points of intervention within populations of vulnerable, immunocompromised children. PUBLIC HEALTH RELEVANCE: This research advances a novel, integrative biopsychosocial model of pediatric mental and immune function in the context of sociodemographic and family risk and protective factors. Existing research implicating cytokines as mechanisms by which stress influences cancer outcomes is translated to children. The public health significance of this work lies in its potential to highlight multiple, individual- and family-level points of in within populations of vulnerable, immunocompromised children.

描述（由申请人提供）：医学进步显著提高了儿童癌症存活率；80%被诊断患有癌症的儿童能存活5年以上。随着人们的注意力转向幸存者生活质量背后的机制，这一胜利也带来了新的研究议程。生活质量包括功能的各个方面，包括功能能力、心理功能、疾病和治疗相关症状。了解这些过程需要在癌症背景下的综合生物行为模型。不幸的是，儿科中竞争性模型的开发和测试落后于针对成人和动物的研究。拟议的研究旨在成为确定风险和保护因素影响儿童健康的生物学和行为机制的第一步。来自成人和动物研究的证据表明，压力和免疫功能之间存在关系，目前主要关注免疫级联中的关键蛋白质细胞因子。广泛的社会人口和生活压力（如社会地位、生活事件）、生物因素（如发病年龄）、健康行为（如睡眠、饮食、运动）和心理社会过程（如应对、意义创造）相互作用影响心理健康，而免疫因素反过来影响疾病过程（如进展、康复、生活质量）。例如，成人和动物研究表明，慢性和急性压力会损害免疫功能，从而导致较差的癌症预后。然而，尽管在其他情况下，压力与生物、心理和关系系统功能之间存在联系，但这项研究尚未转化为患有癌症的儿童。这两项拟议的研究都是对社会人口压力和家庭保护过程之间的中介和调节关系的短期纵向研究，因为它们影响儿童健康结果。在第一项研究中，研究了婴儿免疫功能与家庭生活压力事件和母亲敏感护理的关系。在第二项研究中，儿童癌症患者的免疫和心理健康功能与社会人口压力、(1)儿童安全评价和健康行为、(2)照顾者和家庭保护过程的关系。这项工作的公共卫生意义在于，它有可能在免疫功能低下的弱势儿童群体中突出多重、个人和家庭层面的干预点。