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Educational Challenges

After finishing cancer treatment, some children and teens may face extra challenges in school that are related to their diagnosis and/or treatment.

Some problems may not surface until months or years later. These are known as late effects of cancer treatment.

Because childhood cancer is so rare, teachers and professors may work their entire careers without having a cancer survivor in one their classes. That is why it is so important for parents to be knowledgeable about their child’s cancer, treatment, and the potential effect on school progress.

Parents can then provide information to teachers and school administrators. Hospital school program teachers, school liaisons, social workers, psychologists, and nursing care managers often help with this process. Everyone can then work as a team to create the best learning environment for the student.

Risk factors for educational problems

Factors that may put students at increased risk for difficulties in school include:

  • Diagnosis of cancer at a very young age
  • Numerous or prolonged school absences
  • A history of learning problems before cancer diagnosis
  • Cancer treatment that results in reduced energy levels
  • Cancer treatment that affects hearing or vision
  • Cancer treatment that results in physical disabilities
  • Cancer therapy that includes treatment to the central nervous system
After finishing cancer treatment, some children and teens may face extra challenges in school that are related to their diagnosis and/or treatment.

After finishing cancer treatment, some children and teens may face extra challenges in school that are related to their diagnosis and/or treatment.

Treatments that may increase risk of learning and memory problems

  • Chemotherapy with methotrexate — if given in high doses intravenously (IV) or injected into the spinal fluid [(intrathecal (IT) or intra-Ommaya (IO)]
  • Chemotherapy with cytarabine — if given in high doses intravenously (IV)
  • Chemotherapy with cisplatin or carboplatin (may affect hearing)
  • Surgery involving the brain
  • Radiation to the brain, ear/midfacial area behind the cheekbones
  • Total body irradiation

A number of learning problems could result from treatments. Knowing the possible issues ahead of time can help teachers and parents know what to watch out for and look for signs of challenges.

Learning problems that may occur

Common problem areas include:

  • Attention
  • Inability to complete tasks on time
  • Concentration
  • Handwriting
  • Math
  • Memory
  • Organization
  • Planning
  • Problem-solving
  • Slowed processing speed (Ability to write and thinking is slowed. It takes longer for these students to write assignments/tests, take notes, and answer questions verbally.)
  • Reading
  • Social skills
  • Spelling
  • Vocabulary

What can be done to help survivors as students

Three laws in particular provide for services for children and adults with disabilities.

  • Section 504 — The Rehabilitation Act of 1973
  • Individuals with Disabilities Act (IDEA)
  • Americans with Disabilities Act

Section 504 – The Rehabilitation Act of 1973

All childhood cancer survivors who are experiencing learning problems are eligible for accommodations under this law in both K-12 schools and colleges and universities that receive federal funding. Accommodations are changes that make allowances for the child’s disabilities and help them learn better. This law provides accommodations for a student who has “a physical or mental impairment which substantially limits one or more major life activities." The student also must have a record of the impairment.

In K-12 schools, parents may request a meeting to discuss developing a 504 plan for the student. While most schools will be very willing to make accommodations to meet a student’s needs, a 504 plan puts these strategies in writing. It also provides documentation of the accommodations for future school years as well as for the ACT/SAT.

Examples of classroom accommodations include:

For students with handwriting challenges

  • Use of computer or voice recorder to complete written assignments
  • Use of a “scribe” to complete written assignments

For students with math challenges

  • Use of a calculator
  • Use of graph paper to help children line up numbers
  • Use of a math formula list

For students with attention challenges

  • Seating near the front of the classroom or in “low traffic” areas
  • More frequent checks by teacher that student is remaining on task
  • Extended time on tests
  • Taking tests in a separate quiet room

For students with processing speed challenges

  • Extra time on classwork and tests
  • Reduction in workload
  • Assistance with taking notes or use of the teacher’s notes/PowerPoints
  • Teacher should not call on these students in class to answer a question

For students with physical challenges

  • Extra time to travel between classes
  • Adapt physical education activities
  • Ensure that facilities are physically accessible

For students with reading challenges

  • Shortened required reading
  • Use of recorded texts or audio books
  • Teacher read-aloud of tests and directions

Individuals with Disabilities Education Act (IDEA)

The Individual with Disabilities Education Act is a federal law that requires schools to provide special education services for eligible students with disabilities. Under IDEA, "children with disabilities" must be formally evaluated, which includes educational testing.

The student must have been found to have 1 or more of the 13 recognized disabling conditions and need special education services to make progress in school. These conditions include:

  • Autism
  • Deaf-blindness
  • Deafness
  • Emotional disturbance
  • Hearing impairment
  • Intellectual disability
  • Multiple disabilities
  • Orthopedic impairment
  • Other health impairment (including ADHD)
  • Specific learning disability
  • Speech or language impairment
  • Traumatic brain injury
  • Visual impairment, including blindness

Students who qualify receive special education services as part of an Individual Education Program (IEP). These services may include:

  • Teaching or tutoring, such as specialized reading or math help
  • Counseling, including rehabilitation counseling (independent living and job training)
  • Occupational therapy, physical therapy, and speech/ language/ hearing support
  • Parent counseling and training
  • Psychological services
  • School health services
  • Social work services
  • Transportation services
  • Accommodations such as extra time for tests, reduced workload, etc.

Americans with Disabilities Act

The Americans with Disabilities Act requires equal access to public spaces, events, and opportunities for people with disabilities. These spaces include school buildings. Aids and services must be provided to individuals with vision or hearing impairments or other disabilities unless the aids and services cause an undue burden on the institution.

Physical barriers in existing facilities must be removed if the removal can happen without much difficulty or expense. If not, alternative methods of providing the services must be offered if those methods are readily achievable.

A student wearing headphones sitting and a computer and writing on a notebook

Accommodations in college

Section 504 also protects accommodations for college students with learning challenges.

Before starting college, the student should contact the school’s 504 coordinator. Students can usually find this information by visiting the college’s website and searching “Section 504” or “disability.” The office that handles these requests may be known as “disability services” or a similar name. Although they may not get all of the accommodations they were getting in high school, they should take a copy of the high school 504 Plan to the disability services office as documentation that they received those accommodations. This will be part of the packet of information to document the need for services.

The Individual with Disabilities Education Act (IDEA) ends with high school, so the IEP will not follow the student to college. All of the accommodations given under the IEP may not be available in college. But the IEP should be used as documentation of the accommodations that were given in high school and may be a “place to start” for discussions about what accommodations will be available in college.

Colleges will offer different types of support and vary in the documentation required to get services. Students should be well versed in their academic needs and able to communicate them to professors and administrators. The pediatric center’s school program, social workers, psychologists, and nurse care managers can assist students if they need help.

For more information, visit the U.S. Department of Education website.

Reviewed: June 2018