Effect of Perianal Disease on Quality of Life, Fecal Incontinence, and Sexual Function in Patients with Crohn's Disease.

Childhood cancer survival rates have improved over the past few decades, transforming what was once considered a terminal diagnosis into a survivable condition for many children. The relative 5-year survival rate for pediatric cancer patients in the USA surpasses 80%, and in Germany, the survival probability in the first fifteen years after diagnosis is more than 80%. Therefore, childhood cancer survivors’ (CCS) long-term mental health becomes an increasingly important focus in research and practice. In addition to dealing with the late effects of the disease, its treatment and developmental delays, CCS often face profound psychological and social challenges extending far into adulthood. The long periods of hospitalization, invasive medical procedures, and physical changes associated with cancer treatment can disrupt normal childhood development and social relationships, leading to delayed psychosexual development, lower rates of marriage or cohabitation, and non-independent living. Young adult CCS have an elevated risk of experiencing loneliness, proven to be a risk factor for anxiety and suicidal ideation. Pahl et al. advocate for screenings for social isolation in vulnerable subgroups of CCS due to the well-established links between social connectedness and psychological health. Decades after diagnosis and treatment, CCS have a higher risk for depression, anxiety and post-traumatic stress compared to their siblings and have more medical visits for mental health complaints than the general population. At the same time, there is a substantial heterogeneity in CCS’ psychosocial outcomes, and a better understanding of the factors shaping their diverging trajectories could inform supportive measures for both current pediatric cancer patients and (long-term) survivors. Indeed, the majority of CCS do suffer from clinically relevant levels of mental distress. In previous studies, CCS also reported having experienced posttraumatic growth (which was related to comparatively better mental health outcomes), especially regarding close relationships. Other positive valuations concerned CCS’ recalled parental rearing behavior, i.e., recollections of parents’ emotional support, warmth, and care throughout the disease and recovery process while growing up. These experiences were also associated with fewer depression and anxiety diagnoses. This finding is consistent with the wealth of evidence for the sustained relevance of supportive and sensitive early relationship experiences for mental health and well-being: Originating from the foundational work of Bowlby and expanded by Ainsworth, attachment theory has shown how individuals develop mental representations of attachment experiences, which shape their expectations, perceptions, and responses to behavior of others: For instance, whether others will be helpful and responsive or dismissive and rejecting if one needs to rely on them. Bowlby further proposed that the attachment system becomes especially active in times of high stress, reflecting an innate drive to seek security and support from attachment figures, which help mitigate emotional distress and foster resilience during challenging life events. Such experiences are, over time, internalized as a secure attachment style. Insecure attachment styles of anxious and avoidant attachment, according to Brennan et al., lead to difficulties in relying on and enjoying social relationships due to exaggerated worries or by becoming compulsively self-reliant, respectively. These orientations and their relevance for well-being also apply to cancer patients.