Psychosocial Risk in Young Survivors of Early Onset Pediatric Cancer: The Role of Physical and Neurocognitive Late Effects

尽管存活率提高了，1超过三分之二的癌症儿童经历了晚期效应，例如 继发性癌症、感觉运动缺陷和神经认知障碍。2、3心理社会后遗症， 尤其是社会孤立和受害，难以建立和维持友谊，以及情绪 中枢神经系统(CNS)疾病的幸存者或接受CNS治疗的人常见的窘迫- 定向治疗(例如，头颅放疗、鞘内化疗)。4-6不幸的是，干预措施改善了 结果只取得了有限的成功。7、8那么为什么儿童癌症幸存者没有朋友并感到快乐呢？ 我们的模型假设，社会认知的残余缺陷会导致消极的同伴互动和不良 脑损伤儿童的心理社会后果。10，11然而，大多数工作都集中在成年脑损伤幸存者身上。 儿童癌症，而不是早期确诊的儿童(学龄前儿童)。这些年轻的幸存者可能是最好的 出于几个原因，有困难的风险。首先，最常见的儿科癌症的发病高峰发生在 在6.1岁之前，他们的治疗对大脑发育有特别有害的影响，而且 感觉运动缺陷率。2，3第三，儿童接受长达3年的治疗，并在社会危急时刻被隔离 发展。第四，父母面临痛苦的风险，这可能会削弱他们缓冲负面影响的能力 17、18因此，迫切需要确定接受早期治疗的儿童的心理社会风险。 评估我们的模型的实用性，以便提供更有效的、有针对性的干预措施。我们的长- 长期目标是减少癌症儿童的发病率，改善他们的福祉。这样做的目的是 多点对照研究旨在确定青年癌症患者友谊和情绪困扰的预测因素 幸存者(即确诊的6岁，停止治疗1年)。使用严格的匹配控制设计，我们将 评估200名幸存者在小学教室(即3-5年级)中的同伴互动和友谊。 将在对幸存者和200名幸存者的家人进行家访期间评估个人和家庭的功能 匹配的同学。我们将找出社会认知和同伴互动以及环境方面的缺陷 预测长期心理社会适应的资源(例如，父母教养、学校氛围)(例如，友谊， 遇险)。其理论基础是，社会认知和同伴互动的缺陷会导致心理社会风险， 这可以通过学校和家庭环境中的资源来缓解。目标1.比较长期 年轻幸存者对匹配同伴的心理社会适应和识别社会认知的群体差异 以及可能预示着不良适应的同龄人互动。目标2.确定特定的社会认知和同伴 解释年轻幸存者心理社会适应的交互因素。目标3.确定环境问题 保护年轻幸存者心理社会适应的资源。这项研究具有重要意义，它将 描述早期风险和保护性因素，预测年轻幸存者的长期适应，并让我们 这是制定干预措施的最佳位置，将改善生存护理和预防长期发病率。

Despite increased survival,1 over two-thirds of children with cancer experience late effects, such as secondary cancers, sensorimotor deficits, and neurocognitive impairment.2,3 Psychosocial late effects, particularly social isolation and victimization, difficulties forming and maintaining friendships, and emotional distress, are common for survivors of central nervous system (CNS) disease or those who receive CNS- directed therapy (e.g., cranial radiation, intrathecal chemotherapy).4-6 Unfortunately, interventions to improve outcomes have had limited success.7,8 So why don’t childhood cancer survivors have friends and feel happy? Our model posits that residual deficits in social cognition contribute to negative peer interactions and poor psychosocial outcomes in children with brain injury.10,11 However, most work has focused on adult survivors of pediatric cancer and not children diagnosed early in life (preschool). These young survivors may be at greatest risk for difficulties for several reasons. First, the peak onset of the most common pediatric cancers occurs before age 6.1 Second, their treatments have an especially harmful impact on brain development and a high rate of sensorimotor deficits.2,3 Third, children are treated up to 3 years and isolated at a critical time for social development. Fourth, parents are at risk for distress, which may impair their ability to buffer negative effects on their children.17,18 Thus, there is an urgent need to characterize psychosocial risk in children treated for early onset cancer and to evaluate the utility of our model to inform more effective, targeted interventions. Our long- term goal is to reduce morbidity and improve the well-being of children with cancer. The objective of this controlled, multi-site study is to identify predictors of friendships and emotional distress in young cancer survivors (i.e., diagnosed < age 6, >1 year off treatment). Using a rigorous matched control design, we will assess peer interactions and friendships in the elementary classrooms (i.e., grades 3-5) of 200 survivors. Individual and family functioning will be assessed during home visits with families of survivors and 200 matched classmates. We will identify deficits in social cognition and peer interactions, as well as environmental resources (e.g., parenting, school climate), that predict long-term psychosocial adjustment (i.e., friendships, distress). The rationale is that deficits in social cognition and peer interactions contribute to psychosocial risk, which could be mitigated by resources in the school and family environments. Aim 1. Compare the long-term psychosocial adjustment of young survivors to matched peers and identify group differences in social cognition and peer interactions that may predict poor adjustment. Aim 2. Identify specific social cognitive and peer interaction factors that account for psychosocial adjustment in young survivors. Aim 3. Identify environmental resources that protect psychosocial adjustment in young survivors. This research is significant as it will delineate early risk and protective factors that predict long-term adaptation for young survivors and leave us in a prime position to develop interventions that will improve survivorship care and prevent long-term morbidity.