Planning a return to school : steps to follow

1- Gather Information

A key step in planning for the student’s return is to gather information about his / her situation.
The child’s parents should have all the information you need regarding the specific type of cancer and how it is being treated. Further information can be obtained from the hospital treatment centre.

It will be helpful for you to know:

• How treatment is administered, what potential side effects there are and the likely impact on appearance and behaviour.
• An approximate schedule of upcoming treatment, procedures or tests which may result in the student’s absence from school.
• Limitations, if any, on the student’s activities.
• What the student knows about the illness (although current policy is to be honest with young people who have cancer, there are exceptions).
• For younger children, what the family would like classmates and school staff members to know.
• For teenagers, whether the student wishes to talk directly with teachers about any of the above points.

2- Proceed to planning

Once the information about the situation has been obtained, planning can proceed.

If the treatment centre is close, doctors, nurses, social workers or Child Cancer Family Support workers along with school personnel, and parents should meet.

It is important to understand the family’s right to confidentiality, so only enough information needs to be shared to allow the child to fit in to school.

Permission for any meetings must be sought from the family at the outset, in order to allow these partnerships to proceed and be maintained.

If including caregivers is not possible, a consistent approach should be developed by identifying one key person from your school to liaise with the family. The liaison person should have the time and be willing to assume responsibility for keeping all relevant teachers, including those of their brothers and sisters, informed.

This is especially important for intermediate and secondary school students who come in daily contact with several teachers, all of whom should have accurate information on the student’s condition.

Another means of ensuring good communication is to arrange a meeting at the beginning of each term between a member of the student’s medical team, school staff and the parents. The liaison person will need to ensure any special needs are provided; for example, transport or a place to rest, wearing of non-uniform clothing such as a hat or footwear, time out to eat a snack or just be alone by themselves for a while.

3- The classroom

Limit concessions to the necessary

Students with cancer should be accepted for who they are; children or young people with a life threatening disease who require periodic treatment.

If the cancer is ignored, a major part of that person’s life is overlooked.

On the other hand, if the cancer is made the overwhelming concern, the other important aspects of the child or young person’s life may be neglected.

Some concessions will be necessary, of course, but a balance must be struck between what students can reasonably do and what they must do for their own self image.

Like their peers, children with cancer need love, support, and understanding.

Keep reasonable limits and expectations

They should not be overprotected, rather apply the same limits on behaviour as their classmates.

Teachers should discipline, and hold reasonable academic expectations for the student with cancer. Doing less will rob them of their pride in learning and accomplishment and will prevent camaraderie with their peers.

Obvious special treatment will create resentment among classmates and can be devastating to the student with cancer. For example, assignment deadlines may need to be adjusted to accommodate a student’s treatment schedule.

However, the completed work should be evaluated by the same criteria used for the rest of the class.

Teachers who become aware of any new learning or behavioural problems (peer fighting, hostility, irritability) should draw this to the attention of the person acting as liaison between the school, family and treatment centre.

Cancer treatment, especially cranial irradiation, has, in some children, been associated with problems in attention and concentration, performance under pressure, visual and auditory memory, and mathematical skills. This coupled with disruptions in school attendance may impact on educational achievement, see article: Late Effects of Treatment.

It is also important for the student with cancer to feel a part of their class, even if absences for medical reasons preclude full-time attendance. It may be helpful to send assignments to them at home or to the hospital.

Other approaches, including attending school for part of the day or arranging for extra tuition, can be used, depending on the school situation.

Physical environment

Good hygiene will be needed such as hand washing and avoiding infectious diseases.

Some adaptations of the physical environment to allow full access to school facilities and activities might be required.

You might have to allow some modifications to uniform, the curriculum, work requirements, timetable or subject choices.

4- Classmates

Open discussion about childhood cancer, treatment, and side effects with classmates helps to foster understanding and acceptance of the student with cancer.

It may be useful to do this in the total context of health care and chronic illness and disabilities.

The first step is to consult with the parents, (depending on the child’s age) to ensure they are happy with the resources available, and your aims for the discussion. (Some children newly diagnosed with cancer may not want too much attention focused on the subject initially.)

A well planned discussion will be an excellent opportunity to reassure classmates that cancer is a serious but treatable disease, that it is not hopeless or too terrible to mention, and most importantly that it is not infectious.

Information should be geared to the students’ level of understanding and aimed at minimizing perceived “differentness” in the student with cancer.

It is important to be aware that each student will have his/her own individual issues and fantasies regarding cancer. To some it may be linked to an unpleasant memory about the death of a grandparent or some other significant person or even a pet.

Therefore, it is of the utmost importance that teachers encourage students to talk about their experiences with cancer and educators have found it useful to conduct such discussions in the classroom setting. Obviously, the discussions will vary according to the student’s developmental levels.

Suggested guidelines for discusion:

1. Begin by asking the class how they like to be treated when they are ill or how they feel when around someone who is sick. Use their answers as the basis for discussing how classmates might treat their school friend with cancer.

2. With the parent’s permission explain to the class the type of cancer their friend has, the kind of treatment he/she is having and the ways the treatment may affect his/her appearance and behaviour. This is particularly useful in dealing with embarrassing side effects such as temporary weight gain and hair loss. Classmates who know these changes come about because of life saving therapy are less likely to tease and may even defend their friend against ill-considered remarks of others. It is also important to reassure classmates that they cannot ‘catch’ cancer and emphasise that the cause of cancers in children and young people is unknown.

3. For older students a health or science project for the study of cancer will be useful. Assign groups to develop research reports on types of cancer, their treatment, and side effects, ensuring the source material is up to date. Reporting back to the class will increase their basic knowledge of cancer as well as their classmate’s disease.

4. Through the child’s parents - invite staff from the treatment centre or a support coordinator, to make a presentation to the class. This approach should be a supplement, rather than a substitute, for class discussion led by the teacher. In the case of prolonged absence from school, continued communication with the class will provide the student with cancer with an important link to his/her “regular” life.

Source: The Child Cancer Foundation New Zeland

La Fondation La Roche-Posay and CCI make every effort to ensure that information provided is accurate and up-to-date at time of printing. We do not accept responsibility for information provided by third parties, including those referred to or signposted to in this publication. Information in this publication should be used to supplement appropriate professional or other advice specific to your circumstances.