Childhood Cancer

Childhood Cancer

Returning to school

Parents may not even think about school when treatment first begins, but returning to school can help children regain a sense of normalcy and provide a lifeline of hope for the future.

Shoshana (16 years old) did incredibly well psychologically while being treated for osteosarcoma. She kept up with school (tutors at home and hospital for tenth and eleventh grade). She also took the SATs and went for a college interview (bald and on crutches). She wrote a research paper using a college library (she was the brains and I was her legs) that blew them over at the interview. She also helped to create a multimedia project for patient information at the hospital.

Shoshana was back in school for her senior year. It was a big adjustment socially. Some kids didn’t remember her; some thought she was a transfer student. She was still recovering from the side effects of chemo (lower counts, weight loss, low energy). Shosh was determined to put it all behind her and made college plans. She interned in a research lab and won an award from our community called Courage to Come Back. She won a full scholarship to our local university (Distinguished Honor Scholar).

Preparation is the key to a successful return to school. You and the hospital school liaison may want to prepare a package for the school staff that contains the following information:

•  A doctor’s statement that describes your child’s health status; ability to safely return to the school environment; physical restrictions, including any limits to physical education or recess; and probable attendance disruptions.

•  Whether your child will attend full or half days.

•  A description of any changes in physical appearance, such as weight loss or hair loss, and suggestions about how to help the other children handle them appropriately.

Adam was not comfortable going back to school (kindergarten) when his hair fell out. His blood counts were down most of the time and he caught every cold that came around. When people asked what happened to his hair, he would simply reply, “Cancer,” but he wouldn’t go into detail. After 5 years, he still doesn’t go into details. I think that he tries to put it behind him and go on with life. He’s done a very good job with that.

•  A request that your bald child be permitted to wear a wig, hat, or scarf to school.

•  An explanation of possible effects medications may have on academic performance and a list of medications or other health services that will need to be provided at school (see section later in this chapter called “Individual healthcare plan”).

•  A list of signs and symptoms requiring parent notification (e.g., fever, nausea, vomiting, pain, swelling, bruising, or nosebleeds) and notification procedures to be followed.

•  Concerns about exposure to communicable diseases, if necessary (e.g., if you live in an area with low immunization rates, you will need to know whenever students in the school have chicken pox, whooping cough, or measles).

•  Any accommodations, such as extra snacks, rest periods, extra time to get from class to class, use of the nearest restroom (even if it is the staff restroom), and the need for restroom breaks without permission. This list should also include any requests for academic accommodations such as extended time for tests, reduced workload, or access to online textbooks. (These services are discussed in greater detail later in this chapter.)

My 16-year-old son was allowed to leave each textbook in his various classrooms. This prevented him from having to carry a heavy backpack all day. They also let him out of class a few minutes early because he was slower moving from room to room.

School reentry plans require peer education and teacher education, but the guiding principle should be meeting the needs of the returning student. Therefore, frequent communication among school personnel, parents, the student, and the hospital liaison is paramount before, during, and after school reentry. The following are parent suggestions for preventing problems through preparation and communication:

•  Keep the school informed and involved from the beginning to foster a “we’re all in this together” spirit.

•  Bring a pediatric oncology nurse or school liaison into the classroom to talk about childhood cancer and answer questions. Make sure to ask whether your child wants to be part of the presentation. If treatment is lengthy, this should be done at the beginning of each school year to prepare new classmates. Because the sick child may be given accommodations that could cause other students to feel upset or jealous, the nurse or school liaison should explain that the student has some different rules because of the illness.

•  Explain what is happening to their classmate and reassure them that cancer is not contagious.

Elizabeth was in preschool at the time of her Wilms diagnosis. The manager did a wonderful job of integrating her back into the fold. All of the other children at the school were taught what was happening to Elizabeth and what would be happening (such as hair loss). They learned that they had to be gentle with her when playing. The manager was a former home health nurse, so I was very confident that she would be able to take care of my daughter in the event of an emergency. She was already familiar with central lines and side effects from chemotherapy. She was a gem!

•  Ask the school liaison or other hospital personnel to make a PowerPoint that contains pictures of places that the child usually visits and the people she interacts with. This will help tell the story of her hospital life.

•  Arrange places for your child to rest if she is too tired to participate in class.

Robby was diagnosed in January of his kindergarten year. He returned to kindergarten the same day he got out of the hospital. His teacher was wonderful. She moved the desks around in the classroom so that if Robby got tired, she would go get his cot and put it in the center of the classroom so he could lay down and still listen. If a child had a cold, she would move him/her to the other side of the classroom. The kids washed their hands at least four times a day. The teacher’s aide would sit in the rocking chair holding Robby if he was sad.

•  For elementary school children, enlist the aid of the school liaison or school counselor to help select the teacher for the upcoming year. You do not have a legal right to choose a particular teacher, but you can write a letter to the principal discussing your child’s particular needs and requesting that they be considered when making assignments for the upcoming year.

Because my son has had such a hard third-grade year, I have really researched the fourth-grade teachers. I sat in class and observed three teachers. I sent a letter to the principal, outlining the issues, and requested a specific teacher. The principal called me and said, “You can’t just request who you want. What would happen if all the parents did that? You’ll have to give me three choices just like everybody else.” I said, “My son has medical problems, behavior problems, and learning disabilities. Can you think of a child who has a greater need for special consideration?” My husband and I then requested a meeting with him, and at the meeting he finally agreed to honor our teacher request.

•  Prepare the teacher(s) and your child for the upcoming year.

I asked for a spring conference with the teacher selected for the next fall and explained what my child was going through, what his learning style was, and what type of classroom situation seemed to work best. Then, I brought my son in to meet the teacher several times, and let him explore the classroom where he would be the next year. This helped my son and the future teacher get to know to one another.

•  Have a mental health therapist talk with your child about his emotions and life both inside and outside of school.

My daughter went to a psychotherapist for the years of treatment. It provided a safe haven for frank discussions of what was happening, and also provided a place to practice social skills, which were a big problem for her at school.

•  Realize that teachers and other school staff can be frightened, overwhelmed, and discouraged by having a child with a life-threatening illness in their classroom. Accurate information and words of appreciation can provide much-needed support.

It can be so helpful for the school staff to have periodic meetings to address concerns, fears, progress, or to learn about upcoming procedures. I don’t think enough parents know they can request meetings (for an Individualized Education Program [IEP] or otherwise) as they feel the need, and so can school staff. When Matt started school (elementary), I requested monthly inclusion meetings for the first semester and then every other month during the second semester with his IEP team. We wrote this in his IEP so it actually happened. I learned to do this from a parent much wiser than me!