Çocukluk Çağı Kanserlerinde Radyoterapinin Psikiyatrik Etkileri
Özet
Sağ kalım oranlarının artmasıyla kronik bir hal alan çocukluk çağı kanserlerinde, çoklu tedavi yöntemlerinden biri olan radyoterapinin (RT) akut ve uzun dönemli psikiyatrik etkileri pediatrik onkolojinin temel odak noktalarından biridir. Akut dönemde, aileden ayrılma zorunluluğu ve tedavi ortamının getirdiği unsurlar çocuklarda yüksek düzeyde stres ve kaygı yaratarak anestezi ihtiyacını artırmaktadır; bu süreçte psikoeğitim ve gevşeme egzersizleri gibi ilaç dışı psikiyatrik müdahaleler uyumu kolaylaştırmaktadır. Uzun vadede ise kranial RT, özellikle gelişmekte olan beyin dokusunu etkileyerek zeka puanlarında düşüşe, dikkat, bellek ve işlemleme hızı gibi spesifik nörobilişsel işlevlerde bozulmalara yol açmaktadır. Bu nörobilişsel kayıpların yönetiminde bireysel eğitim destekleri ve metilfenidat gibi uyarıcı ilaç tedavileri ön plana çıkmaktadır. Ayrıca, okul devamsızlıkları ve fiziksel görünüm değişiklikleri çocukların akran ilişkilerini zedeleyerek izolasyon, anestezi sonrası anksiyete ve depresyon riskini tetiklemektedir. Sosyal ve duygusal uyum sorunlarının en aza indirilmesi amacıyla çocukların en kısa sürede, planlı bir ekip çalışmasıyla okula dönüşlerinin sağlanması, bilişsel davranışçı terapiler ve sosyal beceri eğitimleriyle desteklenmesi hayati önem taşımaktadır.
With the increasing survival rates turning childhood cancer into a chronic condition, the acute and long-term psychiatric effects of radiotherapy (RT), a crucial component of multimodal treatment, have become a major focus of pediatric oncology. In the acute phase, factors such as mandatory separation from parents and the daunting treatment environment induce significant stress and anxiety in children, increasing the need for anesthesia; non-pharmacological interventions like psychoeducation and relaxation exercises facilitate compliance during this period. In the long term, cranial RT particularly affects the developing brain structures, leading to a decline in intelligence scores and impairments in specific neurocognitive functions such as attention, memory, and processing speed. Individual educational support and stimulant medications like methylphenidate are prominent in managing these neurocognitive deficits. Furthermore, school absenteeism and changes in physical appearance impair peer relationships, triggering risks of isolation, post-treatment anxiety, and depression. To minimize social and emotional maladjustment, ensuring children's return to school as early as appropriate through structured teamwork, and supporting them with cognitive behavioral therapies and social skills training is of vital importance.
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