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

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.