A Prospective Study of Social Competence in Pediatric Brain Tumor Survivors

描述（由申请人提供）：儿童脑肿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学治疗，导致他们在儿童癌症幸存者中拥有最差的健康相关生活质量。虽然脑瘤存活的儿童有明显的社会适应困难（例如，较少的友谊，较少被同龄人接受），但很少有研究长期检查他们的社会能力或确定他们社会适应的预测因素。来自其他儿童脑损伤人群（如创伤性脑损伤）的研究结果表明，社会信息处理存在缺陷，并说明家庭功能对社会结果的影响，但这些关联尚未在儿童脑肿瘤幸存者中得到探讨。这项建议将是已知的第一个对幸存者社会能力的前瞻性调查，也是为数不多的研究社会信息处理、家庭功能和社会适应组成部分之间相互关系的研究之一。本应用程序的具体目的是：1)定性地描述护理人员对治疗后促进幸存者社会适应的因素的观点；2)比较儿童脑肿瘤和实体瘤幸存者的社会信息加工成分（社会问题解决、社会情感功能、神经认知功能），并研究社会信息加工成分与社会适应之间的关系；3)研究风险和恢复力因素（治疗强度、家庭功能、亲子关系质量）对幸存者社会信息加工和社会适应的影响。方法：参与者将从费城儿童医院的癌症中心招募。在项目开始的定性阶段，长期儿童BT幸存者的护理人员的单独样本将通过探索塑造幸存者社会适应结果的因素的观点来告知前瞻性设计。在纵向阶段，参与者将包括儿童脑肿瘤幸存者和儿童soli肿瘤幸存者，年龄7-14岁，父母或照顾者。数据收集将在肿瘤定向治疗结束后约一个月进行，并在1年和2年后再次进行。每个时间点的评估将包括幸存者社会信息处理、神经认知功能、社会技能和社会适应，以及家庭功能和父母-幸存者关系的测量

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.