Educational issues in childhood cancer.

Abstract

Described school issues for children with cancer. The relationship between school performance and both acute and long-term consequences of the type of cancer, radiation therapy, and chemotherapy is presented. Results of studies of the cognitive and academic effects of cranial radiation and chemotherapy are reviewed, and a developmental model for understanding the emergence of deficits over time is described. Important considerations regarding assessment, classification, and individualized educational intervention are addressed, including specific suggestions of strategies that may aid in helping the child with cancer in the school setting.Each year in the United States, approximately 6500 children under 15 years of age are diagnosed with some form of cancer (Fernbach & Vietti, 1991). While there are many different types of cancer in children, the two most common are leukemias and brain tumors, which combine to account for approximately 50% of all cases (Robison, Mertens, & Neglia, 1991). For all children with cancer, there are multiple obstacles to normal school attendance and academic performance, including frequent school absenteeism, acute effects of the malignancy, acute effects of chemotherapy (medications), and infections (Chesler & Barbarin, 1986). For children with leukemias or brain tumors, school problems may additionally be related to changes across time in the structure and/or function of the brain following treatment with chemotherapy administered into the cerebrospinal fluid (intrathecal chemotherapy) and/or radiation therapy to the brain Mulhem, 1994). Although a number of design and methodologic difficulties with the research in this area have been described (Brown & Madan-Swain, 1993;Butler & Copeland, 1993;Mulhern, 1994), empirical and clinical findings suggest that children treated with cranial radiation or cranial radiation combined with intrathecal chemotherapy have significant risk for persistent learning problems long after treatment has terminated (Mulhern, 1994;Mulhern, Crisco, & Kun, 1983), with a somewhat lower risk associated with intrathecal chemotherapy alone (Brown & Madan-Swain, 1993;

Hospital‐to‐school transition for children with chronic illness: Meeting the new challenges of an evolving health care system

“…Children with cancer, HIV/AIDS, cystic fibrosis, and other severe chronic illnesses are living longer and have more functional skills due to advances in medical treatment (Weller, Minkwovitz, & Anderson, 2003). Despite the impressive advances in medical care, children with chronic illness are at increased risk for academic and psychosocial difficulties (Armstrong, Blumberg, & Toledano, 1999). With more children with chronic illness surviving, there is an increased burden on schools to support effective transition and provide educational and psychosocial programs (Shapiro & Manz, 2004).…”

Educational outcomes among survivors of childhood cancer in British Columbia, Canada

“…19 Sharing of risk information between clinicians, parents, and school personnel is fundamental 59 in addressing the transition to school. Early identification of problems 16,50 and regular monitoring of progress over time 36 in the school system are essential to provide appropriate special education services or approaches to learning. The relation between special education programs and achievement among survivors (other than survivors of CNS tumors or leukemia) needs to be explored further to address the question of the contribution of special education to achievement in this group.…”

“…Previous studies have not always assessed the potential confounding effects of missed school, 34 SES, 35 and physical health or physical impairments. 36 Some studies have included inappropriate comparison groups, or no comparison group, 23,37 or small sample sizes. 38 Studies of educational effects commonly have used self-reported or proxy-reported data, 13,30 which are subject to reporting bias.…”

Comparative assessment of neuro-cognitive impairments among patients with brain tumor and healthy adults

“…In this regard, neurosurgeons, neurologists, psychiatrists and neuroscientists have tried to improve the patient's condition. Currently, researchers are of the view that the recognition and rehabilitation of cognitive impairments may possibly help to increase life expectancy and improve the lifestyle and quality of life of brain cancer patients (4,19,30,60). The most prevalent cognitive impairments amongst brain tumor patients include disorders in attention, executive functions, visuo-spatial and constructional skills, sensory perceptual functions, language, memory and intellectual functions (35).…”