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

早发儿科癌症年轻幸存者的心理社会风险：身体和神经认知迟发效应的作用

• 批准号: 10737753
• 负责人: CYNTHIA A GERHARDT
• 金额: $ 2.9万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-09 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10737753
• 关键词: Acute Lymphocytic Leukemia; Adult; Affect; Affective; Age; Behavior; Behavioral; Brain; Brain Injuries; Brain Neoplasms; Buffers; Caring; Central Nervous System; Central Nervous System Diseases; Child; Child Rearing; Child Welfare; Childhood Cancer Treatment; Cognitive; Cranial Irradiation; Data; Development; Diagnosis; Distress; Early Diagnosis; Emotional; Employment; Ensure; Environment; Failure; Family; Female; Friends; Friendships; Goals; Happiness; Healthcare Systems; Hearing; Home visitation; Hospitalization; Human; Impairment; Individual; Intervention; Intrathecal Chemotherapy; Knowledge; Late Effects; Life; Link; Malignant Childhood Neoplasm; Malignant Neoplasms; Marriage; Mediating; Medical; Mission; Modeling; Morbidity - disease rate; Nature; Neuroblastoma; Neurocognitive; Neurocognitive Deficit; Nursery Schools; Organ; Outcome; Parents; Pediatric Oncology; Population; Positioning Attribute; Predictive Factor; Problem Solving; Public Health; Quality of life; Race; Research; Residual state; Resources; Retinoblastoma; Risk; Risk Factors; Role; School-Age Population; Schools; Second Primary Cancers; Site; Social Development; Social Values; Social isolation; Subgroup; Survivors; Time; Toxic effect; United States National Institutes of Health; Victimization; Vision; Vulnerable Populations; Work; burden of illness; childhood cancer survivor; cost; design; developmental psychology; disability; early onset; educational atmosphere; effective intervention; emotional distress; experience; heuristics; high risk; improved; improved outcome; informant; neurotoxic; peer; prevent; primary outcome; protective factors; psychosocial; psychosocial adjustment; resilience; sex; skills; social; social cognition; social neuroscience; success; survivorship; teacher; young cancer survivor

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.

尽管生存增加了，但三分之二多的患有癌症的儿童经历了晚期影响，例如 次要癌症，感觉运动缺陷和神经认知障碍。2,3社会心理后期影响， 特别是社会隔离和胜利，很难形成和维护朋友以及情感 困扰，对于中枢神经系统（CNS）疾病或接受CNS-的患者的生存很常见 定向疗法（例如颅辐射，鞘内化疗）。4-6不幸的是，干预措施以改善 成果的成功有限。7,8那么，为什么儿童癌症的幸存者不再有朋友并感到高兴呢？ 我们的模型认为，社会认知中的残留缺陷导致负面的同伴相互作用和差 10，11然而，大多数工作都集中于成人生存 小儿癌，而不是儿童在生命早期被诊断出（学前班）。这些年轻的冲浪者可能是最大的 出于多种原因而出现困难的风险。首先，发生最常见的小儿癌的峰值发作 在6.1秒之前，他们的治疗对大脑发育产生特别有害的影响，并且很高 感觉运动缺陷的速度。2,3第三，儿童最多3年，并在社会的关键时期隔离 发展。第四，父母有遇到困扰的风险，这可能会损害他们缓冲对负面影响的能力 他们的孩子。17,18，迫切需要表征早期治疗的儿童的社会心理风险 发作癌症并评估我们模型的实用性，以告知更有效，有针对性的干预措施。我们的长期 术语目标是降低发病率并改善癌症儿童的福祉。这个目的 受控的多站点研究是为了确定朋友的预测因素和年轻癌症的情绪困扰 幸存者（即诊断<6岁，> 1年休假）。使用严格的匹配控制设计，我们将 评估200个表面的小学教室（即3-5年级）中的同伴互动和朋友。 在与表面家庭的家庭访问期间，将评估个人和家庭功能 匹配的同学。我们将确定社会认知和同伴互动中的定义以及环境 资源（例如，育儿，学校攀岩），可以预测长期的社会心理调整（即朋友， 遇险）。理由是在社会认知和同伴互动中定义有助于心理社会风险， 在学校和家庭环境中的资源可以减轻这种情况。目标1。比较长期 对年轻生存的社会心理调整以匹配同龄人并确定社会认知的群体差异 以及可能预测调整不佳的同伴相互作用。目标2。确定特定的社会认知和同伴 解释年轻生存的社会心理调整的相互作用因素。目标3。确定环境 保护年轻生存的社会心理调整的资源。这项研究很重要，因为 描述早期风险和受保护因素，这些因素预测了年轻生存的长期适应，并使我们留在 开发干预措施的主要立场，可以改善生存护理并防止长期发病率。