Children With Cancer

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Extraordinary progress has been made in treating childhood leukemia and other pediatric cancers in recent years. Children with certain blood malignancies, for example, can now expect to survive at least five years after diagnosis—the curative benchmark. The future promises even better therapies, perhaps even conquering cancer once and for all.

But for now, as many educators in Canada are discovering, cancer and its treatments often take their toll on the youngest patients. Aside from physical disabilities, children may experience short-term classroom challenges and longer-term learning impairments. Helping these children readjust and flourish depends in large part on how well educators, parents and healthcare workers function as a team, using time-proven methods.

Most children with cancer who return to school do so within four to six months of their initial—and most intensive—period of treatment. While they may be in remission, the children are literally carrying the physical and emotional scars of their experience. They may have no hair, are easily fatigued, overweight or underweight depending on treatment, and have a central line catheter that limits their physical activity. In addition, they may suffer from vomiting, diarrhea, headache, mood swings and chemo-induced neuropathy in the hands and feet. Pain may range from low-grade to severe.

Cognitive Trouble

Over time, a significant percentage of pediatric cancer survivors will begin showing signs of cognitive impairment and learning disabilities. About 40% of all children with acute lymphocytic leukemia (ALL), the most common form of childhood cancer, treated with chemotherapy alone will develop serious learning disabilities within two to three years following treatment. For children who receive radiotherapy to the brain, with or without chemo, the percentage is 80 to 90%.

Common late cognitive effects include:

• A marked slowing in thinking (processing) speed;
• Attention problems, including daydreaming, “spacing out” and a tendency to distract easily;
• Difficulty planning and organizing tasks and materials;
• Poor handwriting, reading comprehension and math skills, particularly in calculations.

Teachers and parents soon realize that little things become a major chore for a child with cancer-related cognitive disabilities. Simple homework becomes a six-hour ordeal every night; reading is difficult because of the energy expended to decode the phonetics of a word, making comprehension an afterthought. Handwriting may be illegible.

Early Intervention and Education: Keys to Success

Experts recommend a series of strategies to help educators and parents ease kids back into an academic environment. For starters, teachers and parents should reach out to organizations like The Leukemia & Lymphoma Society of Canada. Based in Toronto, the Society operates three chapters and two branch offices nationally; plans are underway to open a new chapter in Montreal. They distribute free and informative materials and maintain an award-winning Web site (www.LLS.org/Canada) to help educate school staff, parents and students about cancer. Society experts are available Monday through Friday, 9 a.m. to 6 p.m. ET, to discuss any issue related to leukemia, lymphoma and myeloma.

For most children, the No. 1 educational therapy is school. School is the workplace, the learning place for all children. As soon as possible, parents should seek an Individual Education Plan (IEP) for their child, developed in collaboration with their local school board and their province’s Ministry of Education. The IEP outlines the accommodations that are needed for the child to be academically successful during and after intensive cancer treatment. They may include:

• Two sets of textbooks, one for home and one for school, so that students can study when absent from class, and so they do not have to carry the heavy backpacks back and forth when physical stamina is an issue;
• Exemption from all physical education activities requiring contact sports, strenuous exercises and long-distance running;
• Permission to wear a hat or scarf throughout the day;
• Moderate homework or make-up work, emphasizing quality over quantity;
• Assignment of a home instruction teacher to assist with assignments when absent from school.

Educators can help the returning student by offering a short classroom discussion on the basics of cancer, treatments and their side effects and suggestions for good personal hygiene habits around the patient. Since these are somewhat technical topics, a medical adviser or educational consultant can be brought in to lead the discussion.

Depending on the IEP, classroom strategies, ranging from the simple to the complex, may include:

• Putting the child near the front of the class;
• Assigning an educational assistant;
• Giving oral tests instead of written tests;
• Reducing homework load;
• Limiting handwriting requirements;
• Providing extra help with math, spelling, reading and organizational skills;
• Modifying test requirements, including minimizing or eliminating time limits and avoiding computerized answer sheets;
• Providing large-print and/or audio books;
• Allowing calculators in class and during tests;
• Recommending electronic organizers;
• Providing special computer software to facilitate learning, including voice-recognition programs that can scan printed material;
• Assigning a “peer buddy” to copy notes and assignments during periods of absence.

The future for these children is bright. Children recovering from leukemia, lymphoma and other cancers can indeed succeed in school, providing that everyone involved works as a partnership.

For more information, visit www.LLS.org/Canada or call the Society’s Information Resource Centre at (800) 955-4572.

Jill Pritchard, who has a background in both nursing and social work, is the Patient Services Manager for the Greater Toronto Area Chapter of The Leukemia & Lymphoma Society of Canada. Her role includes providing disease-specific information to young patients and their families, and encouragement and support as they face the many issues related to surviving a blood cancer diagnosis. Ms. Pritchard is also a “graduate” of the IPRC process, having supported her own special needs child throughout his school years, and has many years of advocacy experience.