title: [Survivors of pediatric cancer. Developmental paths and outcomes between trauma and resilience].
abstract: In Europe and North America, about 80% of all patients with cancer in childhood and adolescence survive their leukemia, lymphomas or tumors. Therefore, neuropsychological impairments, psychopathological comorbidity and health-related quality of life become relevant parameters for treatment evaluation and conceptualization of future therapy protocols. During the last decade, a number of patient registries, multicenter studies and meta-analyses have analyzed the interaction of disease- and treatment-associated risk factors with pre-existing socio-demographic and psychosocial vulnerability factors. Brain tumors and treatment strategies including CNS surgery, cranial radiotherapy and intrathecal chemotherapy carry an increased risk for neurological and neuropsychological long-term outcomes, which in turn also threatens the patients' psychosocial and vocational participation. In the area of psychosocial adaptation, a wide range of developmental paths results, ranging from increased psychological comorbidity, to subclinical impairments in quality of life, to normal courses to resilient outcomes, even with a developmental benefit. A hypothetical model is presented to explain this enormous variance in outcomes. Protective cognitive-emotional schemata already established at the premorbid stage predispose patients to be able to cope successfully with cancer-related challenges and thus further enhance the patients' future adaptability. In contrast, dysfunctional schemata at the premorbid level increase risks of coping failure and thus intensify the long-term risk for psychopathological comorbidity in terms of post-traumatic stress disorder, anxiety disorder or depression.
authors.affiliation: Psychologischer Psychotherapeut für Kinder, Jugendliche und Erwachsene, Zentrum für Kinderheilkunde der Universität Bonn, Adenauerallee 119, 53113, Bonn, Deutschland. m.noeker@uni-bonn.de
authors.forename: M
authors.initials: M
authors.lastname: Noeker
mesh_terms: D015984:Causality; D002648:Child; D002908:Chronic Disease / Q000401:mortality* / Q000523:psychology; D015897:Comorbidity; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D009026:Mortality / Q000639:trends*; D009369:Neoplasms / Q000401:mortality* / Q000523:psychology; D017741:Survivors / Q000706:statistics & numerical data*