Psychobiological stress vulnerability, executive control, and emotion regulation in children and adolescents with cancer

项目摘要/摘要 儿童癌症的诊断对儿童和青少年来说是独一无二的令人不安的，从长远来看， 管理复杂的治疗方案、反复住院和不可预测的并发症 会产生持续的压力，通常持续很多年。有压力的早期生活经历有持久的 对长期的身心健康造成影响，并可能损害情绪处理。多么年轻 对压力的反应与调节情绪和培养韧性的能力有意义地联系在一起，这有 对长期发展的重要影响，包括制定一系列内部化和 精神病理学的外化症状，尽管韧性是强有力的保护因素。单程 大脑通过皮质醇来控制免疫系统，皮质醇是一种糖皮质激素，在压力和睡眠中释放 部分负责上调和下调促炎细胞因子的活性。执行控制也是 通常在压力反应过程中会被破坏。科斯格罗夫博士研究计划的长期目标是研究 患有癌症的青年及其家人如何应对压力以识别 那些心理社会和神经认知结果较差的风险较高的人，反过来会通知分配 儿科肿瘤学中的心理健康服务。NCI K08奖重新提交的具体目标 应用于确定最近诊断出的年轻人对应激诱导的免疫反应 血液、脑或其他中枢神经系统癌症预示情绪调节功能受损， 随访时的生活和神经认知(执行控制)结果。我们将近距离招募70名青年 (2-10个月)诊断和研究基线心理生物应激之间的纵向关系 6个月和12个月随访时的脆弱性和心理社会/神经认知结果。这个K08奖将 为科斯格罗夫医生提供必要的培训和指导：(1)发展儿科精神病方面的专业知识 肿瘤学，侧重于多方向的应激-免疫-情绪调节关系；(2) 了解在儿科医疗中增加情绪调节和提高生活质量的方法 (3)发展情感科学方面的专门知识，应用于儿科肿瘤学，包括 用神经认知评估测量执行控制；(4)研究涉及的伦理考虑 通过开展儿科肿瘤学研究，形成独特的弱势群体；(5)提高科学技能 写作，包括联邦/基金会/校内赠款和同行评审的科学手稿。要完成 为了实现这些培训目标，她组织了一支强大的导师团队(Kory Hood，博士；Matthew Hocking， 博士；David Spiegel，M.D.，Laura Roberts，M.D.，M.S.)和咨询委员会(雪莉·斯平特，医学博士，辛西娅 Gerhardt博士、Holden Maecker博士和Christine Blasey博士)，具有儿科和成人方面的专业知识 心理肿瘤学、儿科心理学和肿瘤学、神经认知评估、生物统计学和临床 对弱势群体进行研究。

Project Summary/Abstract A diagnosis of pediatric cancer is uniquely disquieting for children and adolescents, and the long-term management of complex treatment protocols, repeated hospitalizations, and unpredictable complications generates persistent stress, often spanning many years. Stressful early life experiences have enduring consequences on long-term physical and mental health and may impair emotional processing. How youth respond to stress is meaningfully linked to ability to regulate emotions and cultivate resilience, which have important implications for long-range development, including development of a range of internalizing and externalizing symptoms of psychopathology although resilience emerges as robust protective factor. One way the brain governs the immune system is via cortisol, a glucocorticoid hormone released during stress and in part responsible for the up- and down-regulation of pro-inflammatory cytokine activity. Executive control is also often undermined during a stress response. The long-term goal of Dr. Cosgrove's research program is to study the psychology and biology of how youth with cancer and their families respond to stress in order to identify those at elevated risk for poor psychosocial and neurocognitive outcomes, in turn informing allocation of mental health services in pediatric oncology. The specific objective of this NCI K08 Award resubmission application is to determine whether immune responses to stress induction in youth recently diagnosed with blood, brain, or other central nervous system cancers predict impairment in emotion regulation, low quality of life, and neurocognitive (executive control) outcomes at follow-up. We will recruit 70 youth in close proximity (2-10 months) to diagnosis and study longitudinal relationships between baseline psychobiological stress vulnerability and psychosocial/neurocognitive outcomes at 6- and 12-month follow-ups. This K08 Award will provide Dr. Cosgrove with the necessary training and mentorship to: (1) develop expertise in pediatric psycho- oncology, with a subspecialty emphasis on multidirectional stress-immune-emotion regulation relationships; (2) understand ways to increase emotion regulation and promote quality of life outcomes in pediatric medical illnesses; (3) develop expertise in affective science as applied within pediatric oncology, including measurement of executive control with neurocognitive assessments; (4) study ethical considerations involved with conducting research in pediatric oncology, a uniquely vulnerable population; (5) advance skills in scientific writing, including federal/foundation/intramural grants and peer-reviewed scientific manuscripts. To accomplish these training goals, she has organized a strong mentorship team (Korey Hood, Ph.D.; Matthew Hocking, Ph.D.; David Spiegel, M.D., Laura Roberts, M.D., M.S.) and advisory committee (Sheri Spunt, M.D., Cynthia Gerhardt, Ph.D., Holden Maecker, Ph.D., and Christine Blasey, Ph.D.), with expertise in pediatric and adult psycho-oncology, pediatric psychology and oncology, neurocognitive assessment, biostatistics, and clinical research with vulnerable populations.