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.
