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

项目概要/摘要 儿科癌症的诊断对儿童和青少年来说是唯一令人不安的，长期而言， 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，通常会持续多年。早期的压力经历 对长期的身心健康造成影响，并可能损害情绪处理。青年如何 对压力的反应与调节情绪和培养韧性的能力有着有意义的联系， 对长期发展的重要影响，包括发展一系列 尽管复原力作为强有力的保护因素出现，但它仍然是精神病理学的外在症状。一种方式 大脑通过皮质醇来控制免疫系统，皮质醇是一种在压力和应激期间释放的糖皮质激素。 部分负责促炎细胞因子活性的上调和下调。执行控制也是 往往在应激反应中被破坏。科斯格罗夫博士研究项目的长期目标是研究 癌症青年及其家人如何应对压力的心理学和生物学， 那些心理社会和神经认知结果不佳的风险较高的人，反过来又为分配 儿科肿瘤学的心理健康服务。本次NCI K 08奖重新提交的具体目标 应用是为了确定最近被诊断患有糖尿病的年轻人是否对应激诱导产生免疫反应。 血液、脑或其他中枢神经系统癌症预示着情绪调节受损， 随访时的生活和神经认知（执行控制）结果。我们将招募70名年轻人 (2-10月）诊断和研究基线心理生物学压力之间的纵向关系 6个月和12个月随访时的脆弱性和心理社会/神经认知结局。本次K 08奖将 为Cosgrove博士提供必要的培训和指导，以：（1）发展儿科心理学方面的专业知识， 肿瘤学，亚专业强调多方向的压力-免疫-情绪调节关系;（2） 了解如何增加情绪调节和提高生活质量的结果，在儿科医疗 （3）发展儿科肿瘤学中应用的情感科学专业知识，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 在儿科肿瘤学，一个独特的弱势群体进行研究;（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。完成 为了实现这些培训目标，她组织了一个强大的导师团队（Korey Hood博士;马修·霍金 博士学位;大卫斯皮格尔，医学博士，劳拉·罗伯茨医学博士（硕士）和咨询委员会（Sheri Spunt，医学博士，辛西娅 格哈特博士，霍尔顿梅克尔博士，和克莉丝汀布莱西博士），在儿科和成人 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 研究弱势群体。

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.