- Return After a New Diagnosis and Extended Absence
- Typical Reactions of Classmates Upon Return to School
- Typical Reactions of Student with Cancer
- Availability of Cancer Re-entry Programs and Other Re-entry Support Material
- Ways to Ease the Return
Students initially diagnosed with cancer (including leukemia) often spend many days in the hospital for medical evaluation and treatment and, depending on the type of treatment, may experience extended school absences (see Missed Instruction section). Even after treatment, some students miss school days because of adverse reactions to treatment. Most experts suggest that students with cancer return to school as soon as possible in a process often referred to as school re-entry. Early school reintegration facilitates resumption of learning and is important for social adjustment and promoting a renewed sense of normalcy.
Many students have never known a classmate with cancer. For many, cancer knowledge is sparse; for some apprehension is high. There is a risk of negative reactions and a potential for bullying at the hands of classmates. On the eve of school return, teachers should prepare for how to deal with such reactions. Thus, teachers may wish to learn details about how to facilitate classmate support (see the Interpersonal and Emotional Problems section for details).
A prime concern of the returning student is classmate reaction. Physical changes (such as hair loss, amputation/prosthetic device use, weight loss or gain) raise the stakes regarding fear of teasing, rejection, and concern about isolation. In fact, studies find that students perceive children with a brain tumor to be significantly more socially isolated than healthy classmates. Likewise, 40% of children with cancer in another study recalled bad memories about their classmate’s attitude toward their illness. Preparation for re-entry, thus, makes sense (see Interpersonal and Emotional Problems section for possible reentry interventions).
Fortunately, programs exist to help school staff, teachers, parents, and students through the school re-entry process. Unfortunately, most of these programs exist only at large children’s hospitals or medical centers, and program comprehensiveness varies widely. An example of a successful comprehensive re-entry program is STAR School/Social Transition and Re-entry Services. STAR aims to facilitate peer communication during treatment and upon school reentry, provide classroom presentations and workshops, foster collaboration between school and medical personnel, afford patient and family counseling, and help secure needed special education services or program modifications (link to STAR School/Social Transition program).
Empirical support exists for programs like this. For example, a 2000 review of cancer re-entry programs determined that classmates gained cancer knowledge and enhanced interest for social interaction with the ill student via program participation. Likewise, school staff gained cancer knowledge as well as improved confidence for teaching the student with cancer. Moreover, comprehensive programs, which involved collaboration between the home, school, and hospital, resulted in reduced externalizing and internalizing behavior problems according to parents, higher social competency and self-esteem scores, and higher teacher ratings of child adjustment.
Sadly, some research finds that parents and educators are critical of current re-entry practices. They cite inconsistencies in support from school staff during re-entry, poor communication between health professionals and school personnel, and simply a lack of available school re-entry programs. If a formal re-entry program is available, EdMedKids suggests it be carefully considered. If no re-entry program exists, teachers can still take steps toward ensuring that a child with cancer successfully reintegrates to school (see Ways to Ease the Return below). Various forms for support have been developed for teachers educating children with chronic illnesses, including cancer. These include: (1) readings and manuals, (2) workshops, (3) web-based training, and (4) presentations to classmates. Also, some hospital-based reentry programs offer online resources for teachers to facilitate reentry (see Stony Brook Medical Center’s reentry tips for teachers).
Before the Student’s Return to School
Prior to the student’s return to school, it is recommended that the school team (i.e., teacher, principal, counselor, psychologist, parent, school nurse, medical professional, and other professionals as necessary) meet to determine a school re-entry plan. Access to a medical professional (in person, by conference call, or by Skype) is advised. In general, it is helpful for participants to share information regarding continued treatment and possible side effects, potential absences, a plan for schoolwork during absences, and details of any neuropsychological evaluations, including recommendations. A thorough review of the student’s current functioning and medical treatment often helps school staff identify what services and accommodations will be needed once the student returns to school and to determine a plan for educating teachers, school staff, and peers. The team should also identify a plan for information sharing between parents and school staff (e.g., daily logs, phone calls, progress reports, etc.). Of course, this meeting might also result in a 504 plan or an IEP according to the OHI category (see the Disability Rights section for more information on 504 plans, OHI, and IEPs).
Preparing Students with Cancer for Classmate Interaction
As the time for re-entry approaches, role-play activities with the ill child can prepare him/her for school. Example topics include: how to respond to schoolmates’ questions about cancer, changes in physical appearance, and reasons for recent school absenteeism. At other points in the re-entry process, teachers might enlist a school counselor, social worker, or school psychologist to assist in role-play. It is generally believed important that teachers remain involved in this process to help facilitate ongoing (post re-entry) classroom interactions.
To encourage peer interactions while the child is undergoing initial treatment, classmates can be encouraged to write cards and letters to the absent classmate, send audio or video recordings made by the class, or even take a hospital trip for face-to-face contact (see the Interpersonal and Emotional Problems section for more tips on facilitating interaction).