A Prospective Study of Social Competence in Pediatric Brain Tumor Survivors

描述(由申请人提供)：儿童脑瘤幸存者经历了严重的神经认知和社会缺陷，继发于他们的疾病和相关的医疗治疗，这导致他们在儿童癌症幸存者中与健康相关的生活质量最差。尽管幸存下来的脑瘤儿童有很大的社会适应困难(例如，朋友更少，被同龄人接受的程度更低)，但很少有研究考察他们随着时间的推移的社会能力，或者确定他们社会适应的预测因素。来自其他儿童脑损伤人群(例如创伤性脑损伤)的研究结果表明，社会信息处理存在缺陷，并说明了家庭功能对社会结果的影响，但这些联系尚未在儿童脑瘤幸存者中进行探索。这项提议将是已知的对幸存者社会能力的第一次前瞻性调查，也是少数几项考察社会信息处理、家庭功能和社会适应各组成部分之间相互关系的研究之一。本申请的具体目的是1)定性描述照顾者对影响治疗后幸存者社会适应的因素的看法；2)比较儿童脑瘤和实体肿瘤幸存者的社会信息处理成分(社会问题解决、社会情感功能、神经认知功能)，并考察社会信息处理成分与社会适应随时间的关系；以及3)考察风险和弹性因素(治疗强度、家庭功能、亲子关系质量)对幸存者社会信息处理和社会适应的影响。方法：参与者将从费城儿童医院的癌症中心招募。项目开始时的定性阶段将通过探索影响幸存者社会适应结果的因素的视角，对长期儿童BT幸存者的照顾者进行单独抽样，从而为前瞻性设计提供信息。在纵向阶段，参与者将包括7-14岁的儿童脑肿瘤幸存者和儿童孤立性肿瘤幸存者，以及父母或照顾者。数据收集将在肿瘤导向治疗结束后大约一个月进行，并在一年和两年后再次进行。每个时间点的评估将包括对幸存者的社会信息处理、神经认知功能、社交技能和社会适应以及家庭功能和父母-幸存者关系的衡量。 质量。假设(1)儿童脑肿瘤幸存者的社会信息处理能力比实体肿瘤幸存者差，(2)随着时间的推移，较差的社会情感功能和社会问题解决能力将与较差的幸存者社会适应能力相关，(3)神经认知功能将与较差的社会情感功能、社会问题解决能力和社会适应能力相关，(4)在基线水平上较好的家庭功能将与较小的社会信息处理和社会适应领域的随时间推移的下降相关。职业目标：这一K07奖项将为马修·霍金博士提供必要的培训和指导，使其成为儿科心理肿瘤学和儿科神经肿瘤学生存领域的独立临床研究员和领导者。通过这一奖项，霍金博士将1)获得与了解生物、心理和社会背景因素之间的相互作用对幸存者心理社会结果的影响相关的特定内容领域的专业知识；2)获得方法学(如医疗保健经济学、认知神经科学)和统计学方法的专业知识，以检查儿童脑瘤幸存者的神经发育迟发性影响；3)提高旨在改善儿科癌症幸存者的社会功能的心理社会干预措施的开发和测试方面的技能；以及4)在拨款申请和同行评议的研究出版物方面提高科学技能。为了推进这些培训目标，霍金博士组建了一支经验丰富的导师团队，由Lamia Barakat博士和Anne Kazak博士领导，并精心制定了培训计划，其中包括课程作业、研讨会、期刊俱乐部、全国性研究会议、写作小组和不同的研究实验室经验。有了与该奖项相关的培训和支持，霍金博士将准备好开始一项独立的研究生涯，致力于改善儿童脑瘤幸存者的社会功能和生活质量：这项研究的结果可以为儿童脑瘤患者的临床护理和更广泛的受中枢神经系统疾病影响的幸存者群体的后续研究提供参考。这项研究可能确定减轻癌症治疗对幸存者社会功能的影响并提高幸存者及其家人的生活质量的潜在机制。建议的K07奖项将使霍金博士准备申请R01级别的资金来推进这项研究，并申请R21级别的资金来试点旨在改善儿童脑瘤幸存者的社会适应结果的基于家庭的干预措施。

DESCRIPTION (provided by applicant): Childhood brain tumor survivors experience significant neurocognitive and social deficits secondary to their disease and related medical treatments that contribute to them having the poorest health- related quality of life among childhood cancer survivors. Although children surviving brain tumors have significant social adjustment difficulties (e.g., fewer friendships, less accepted by peers), little research has examined their social competence over time or identified predictors of their social adjustment. Findings from other pediatric brain injury populations (e.g., traumatic brain injury) suggests deficits in social information processing and illustrates the influence of family functioning on social outcomes yet these associations have not been explored in pediatric brain tumor survivors. This proposal would be the first known prospective investigation of survivor social competence and one of the few studies to examine the interrelations between components of social information processing, family functioning and social adjustment. The specific aims of this application are to 1) qualitatively describe caregivers' perspectives on the factors contributing t survivor social adjustment after treatment; 2) compare components of social information processing (social problem- solving, social affective functions, neurocognitive functioning) between pediatric brain tumor and solid tumor survivors and examine associations between components of social information processing and social adjustment over time; and 3) examine the influence of risk and resilience factors (treatment intensity, family functioning, parent-survivor relationship quality) on survivor social information processing and social adjustment. Methods: Participants will be recruited from The Cancer Center at The Children's Hospital of Philadelphia. A qualitative phase at the outset of the project with a separate sample of caregivers of long-term pediatric BT survivors will inform the prospective design by exploring perspectives on the factors that shape survivor social adjustment outcomes. In the longitudinal phase, participants will include survivors of pediatric brain tumor and survivors of pediatric soli tumor, ages 7-14, and a parent or caregiver. Data collection will occur about one month after the end of tumor-directed treatment and again one and two years later. Assessments at each time point will include measures of survivor social information processing, neurocognitive functioning, social skills and social adjustment, as well as family functioning and parent-survivor relationship quality. It is hypothesized that(1) pediatric brain tumor survivors will have worse social information processing than solid tumor survivors, (2) poorer social-affective function and social problem-solving will be associated with worse survivor social adjustment over time, (3) neurocognitive functioning will be associated with poorer social-affective functioning, social problem-solving and social adjustment, and (4) better family functioning at baseline will be associated with smaller declines across domains of social information processing and social adjustment over time. Career Goals: This K07 award will provide the necessary training and mentorship for Matthew Hocking, Ph.D. to become an independent clinical researcher and leader in the field of pediatric psycho-oncology and pediatric neuro-oncology survivorship. Through this award, Dr. Hocking will 1) gain expertise in specific content areas relevant to understanding the interplay between biological, psychological and social context factors in contributing to survivor psychosocial outcomes; 2) acquire expertise in methodological (e.g., healthcare economics, cognitive neuroscience) and statistical approaches to examining the neurodevelopmental late effects of pediatric brain tumor survivors; 3) enhance skills related to the development and testing of psychosocial interventions directed at improving the social functioning of pediatric cancer survivors; and 4) advance scientific skills in grant writing and peer-reviewed research publication. To advance these training goals, Dr. Hocking has assembled a highly experienced mentorship team, led by Drs. Lamia Barakat and Anne Kazak, and a carefully constructed training plan that includes coursework, seminars, journal clubs, national research conferences, writing groups, and different research lab experiences. With the outlined training and support associated with this award, Dr. Hocking will be well poised to initiate an independent research career dedicated to improving the social functioning and quality of life of pediatric brain tumor survivors Importance: Findings from this study could inform clinical care with childhood brain tumor patients and subsequent research among a broader group of survivors affected by central nervous system disease. This study might identify potential mechanisms that mitigate the effects of cancer treatment on survivor social functioning and improve quality of life for survivors and their families. The proposed K07 award will prepare Dr. Hocking to apply for R01-level funding to advance this research and for R21-level funding to pilot a family- based intervention directed at improving social adjustment outcomes in pediatric brain tumor survivors.