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CONCERNS

Returning Child's Concerns
Classmate Concerns

Returning to school is a big step in a child's cancer treatment. It can be exciting for the child to return to his or her normal routine, but it can also be a time of adjustment for the class. As the child's teacher, it can help to have an understanding of the common concerns returning children and classmates have when dealing with school reentry.

Returning Child's Concerns
Children returning to school during or after cancer treatments are likely to feel nervous about their interactions with classmates or worry about how much schoolwork they have missed. These concerns can be greater if a child has missed a lot of school or has undergone drastic physical changes as a result of treatment. Below are some common concerns with tips to help you address them with the child.

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• Teasing and Peer Acceptance
  Physical changes that result from treatment, such as hair loss, skin discoloration, or changes in body weight, can be embarrassing for children. Classmates unfamiliar with cancer and cancer treatments may ask insensitive questions. Teasing is another common, and unfortunate, response to these differences. All of this can compound the anxiety a child may feel about explaining to classmates why he or she has missed school.
  
  Keep open lines of communication with all students in the class, particularly the child, as well as the child's parents. This can encourage students to come to you with questions and may help make the child more comfortable talking to his or her classmates. The child may wish to wear hats or scarves to cover hair loss; if your school does not allow children to wear hats, consider talking to the principal to make an exception in this case. As much as possible, try to pay attention to the child's moods and social interactions, and notice changes that may indicate that the child is having problems with classmates. Your role is not to monitor the child for psychological difficulties, but rather to help the child easily resume his or her normal school experience.
  

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• Limitations on Physical Activity
  In addition to the social difficulties children may face due to changes in physical appearance, fatigue and nausea are other common side effects of cancer and cancer treatments. This can result in limitations to a child's typical activities, such as physical education classes or other highly active games.
  
  Make a plan with the child, his or her parents, and the school nurse to have a place where the child can rest during the school day if fatigue or nausea becomes overwhelming. It can also help if the child knows that he or she can participate in other activities during recess or physical education classes. If appropriate, invite other classmates to join the child in these activities so that he or she will not feel isolated during these times.
  
  
• Changes in School Performance
  Prolonged school absences are common when a child is undergoing cancer treatments, which can cause a child to miss schoolwork and fall behind in lessons. Even after returning to school, the fatigue that often accompanies treatments may leave the child with little energy for keeping up with homework. Also, it is important to be aware that cancer and cancer treatments can make it difficult for a child to concentrate in class or learn new material. Typical learning difficulties can include trouble with reading, writing, math, memory, organization skills, and remembering visual information, all of which can negatively affect a child's performance in school.
  
  If appropriate, modify the scope of work for the child to reflect his or her abilities at this time. Work with the child's parents to come up with a plan to notify one another if the child's schoolwork is not up to his or her usual standard. There are certain accommodations schools must make for children with disabilities, including chronic conditions such as cancer; visit Legal Information for an overview. It can also help to assign a classmate to work as a study partner with the child, to help him or her catch up on schoolwork missed while the child was out having treatments.

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Classmate Concerns
When a child returns to school during or after cancer treatment, it can be stressful for classmates, too. In most cases, peers are understanding and supportive of the returning child, but they will likely be curious and have questions. Some classmates may be scared and treat the returning child differently. Below is a list of questions and concerns commonly asked by school-age children. You can use this as a reference when talking to students about their classmate with cancer. These questions also appear on the Kids' FAQs page. Visit Teachers' FAQs for more detailed information.

• What is cancer?
  Cancer is the name of a group of illnesses that affects different parts of the body. Cancer changes the way cells work in the body by making some cells grow faster than normal. When this happens, cancer cells hurt the body's healthy cells.
  
  
• What kinds of cancers do children get?
  Even though cancer is a rare disease, leukemia is the most common type of cancer that affects kids. Leukemia changes the cells in the blood.
  

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• How do children get cancer?
  Doctors and scientists aren't sure why some cells become cancer cells and others don't. They do know that it is rare for kids to have cancer. It is no one's fault when kids get cancer.
  
  
• Can you catch cancer from someone else?
  No. You can't catch cancer from someone who has it, like a cold or the flu. You can't get cancer from touching or playing with someone who has it.
  
  
• How do children with cancer get better?
  Special doctors take good care of children with cancer. Parents, nurses, and many other adults help, too. Children with cancer go to the doctor and sometimes to the hospital to get treatments. The types of treatment are called chemotherapy, radiation, and surgery.
  

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• Do children with cancer have to do anything special to take care of themselves?
  Aside from the special treatments planned by the doctors, children with cancer have to be careful not to get too close to people who have a cold or the flu. They especially have to be careful not to catch the chickenpox. Cancer and cancer treatments make it easier to catch these kinds of illnesses, and they can be serious for children with cancer.
  
  
• Sometimes, children with cancer have a tube in their body. What is that for?
  The tube helps children with cancer get the medicine they need without getting stuck by a needle every time. Doctors place a tube in the body and put the medicine in the tube. The tube is sometimes called a central line. Children with one of these tubes need to be very careful to make sure not to bump it or get it wet.
  
  
• Why do some children with cancer lose their hair?
  Some of the medicines used to treat cancer are very strong. These medicines kill cancer cells, which grow quickly. Other cells in the body also grow quickly, like hair cells. The medicines can kill the hair cells, too. That is why kids with cancer sometimes lose their hair. When the treatments are over, the hair will grow back.
  

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• Can children with cancer be cured?
  There are very good treatments for children with cancer. Most children with cancer will go into remission, which is when doctors can't find any more cancer in the body.
  
  
• Why do children with cancer have to miss school?
  Kids with cancer will usually have to go to the doctor or hospital to get their treatments. This can mean missing a lot of school. Also, some of the treatments can make kids feel very tired or sick. If this happens, your classmate may need to stay home from school and rest.
  
  
• How will cancer change my classmate?
  Sometimes, kids coming back to school after cancer treatment look different than before they left. They might not be able to play as much at recess or after school. They might be behind in school from missing classes. But, in all the important ways, your classmate with cancer is still the same person he or she was before getting sick.
  

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• What can I do to help my classmate return to school after cancer treatment?
  You can help by being nice to your classmate. It can be scary to have cancer, and the treatments might make your classmate feel tired and sick. Offer to help your classmate catch up with schoolwork. Invite him or her to play with you. And ask your friend questions about how he or she feels or how you can help. You can also get some good ideas by checking out My Classmate Has Cancer.

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