Überlebende von Krebserkrankungen des Kindes- und Jugendalters

Entwicklungsverläufe zwischen Traumatisierung und Resilienz
Leitthema

Zusammenfassung

Etwa 80% aller Kinder- und Jugendlichen mit Leukämien, Lymphomen oder malignen Tumoren überleben in Europa und Nordamerika die Erkrankung langfristig. Damit einhergehend werden neuropsychologische Funktionsbeeinträchtigungen, die psychopathologische Komorbidität und gesundheitsbezogene Lebensqualität zu relevanten Parametern der Therapieevaluation und Konzeption zukünftiger Therapieprotokolle. Im letzten Jahrzehnt haben Multicenterstudien und Metaanalysen die Interaktion zwischen erkrankungs- und behandlungsassoziierten Risikofaktoren mit vorbestehenden soziodemografischen und psychosozialen Vulnerabilitätsfaktoren analysiert. Demnach bergen Hirntumoren sowie zerebral wirksame Therapiestrategien der ZNS-Chirurgie, der kranialen Radiotherapie und intrathekalen Chemotherapie besonders erhöhte Risiken für das neurologische, neuropsychologische und darüber vermittelt auch psychosoziale und beruflich-rehabilitative Langzeitoutcome. Im Bereich der psychosozialen Adaptation ergibt sich ein breites Spektrum von Entwicklungspfaden, die von erhöhter psychischer Komorbidität über subklinische Beeinträchtigungen der Lebensqualität zu unauffälligen Verläufen bis hin zu resilienten Verläufen mit einem Entwicklungsgewinn reichen. Im vorliegenden Beitrag wird ein hypothetisches Bedingungsmodell für diese extreme Varianz im Outcome vorgestellt. Demnach disponieren schon prämorbide herausgebildete, protektiv wirksame kognitiv-emotionale Schemata zu einer erfolgreichen Bewältigung auch der erkrankungs- und behandlungsbedingten Herausforderungen und damit zu einem die langfristige Adaptivität weiter stimulierenden Entwicklungsgewinn. Demgegenüber erhöhen im prämorbiden Stadium bereits manifeste, dysfunktionale Schemata das Risiko für erneute maladaptive Bewältigung und intensivieren so einen beeinträchtigten Langzeitverlauf bis hin zur Entwicklung klinisch manifester PTBS, Depression oder Angststörung.

Schlüsselwörter

Krebs bei Kindern und Jugendlichen Überlebende Komorbidität Posttraumatische Belastungsstörung Resilienz 

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.

Keywords

Cancer in children and adolescents Survivors Comorbidity Post-traumatic stress disorder Resilience 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2012

Authors and Affiliations

  1. 1.Psychologischer Psychotherapeut für Kinder, Jugendliche und ErwachseneZentrum für Kinderheilkunde der Universität BonnBonnDeutschland

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