Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

School after Cancer Treatment
Treatment for cancer during childhood or adolescence may affect educational progress due to prolonged absences
or reduced energy levels that frequently occur during or after treatment. In addition, some types of cancer may
require therapy to control or prevent spread of the disease to the brain and/or spinal cord (central nervous system).
This therapy can sometimes affect memory and learning abilities. Parents and teachers should be aware of potential
educational problems that may be related to cancer treatment. You/your child or teen may be eligible for special
accommodations at school which may also require specialized testing.
What increases the risk of educational problems?
Factors that may place children and teens 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 difficulties before the 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 (see below).

Are children and teens with certain types of cancer at higher risk of developing educationaldifficulties?
Yes, children and teens with the types of cancer listed below are more likely to have received treatments that may
affect learning and memory. Since treatments for these types of cancer vary widely, not everyone who was treated forthese cancers are at increased risk.
•Brain tumors•Tumors involving the eye or ear•

Acute lymphoblastic leukemia (ALL)•Non-Hodgkin lymphoma (NHL)What types of treatment place children and teens at higher risk for learning and memory
problems?
•Methotrexate—if given in high doses into the veins intravenously (IV) or injected into the spinal fluid [intrathecally(IT) or intra-ommaya (IO)]•

Cytarabine—if given in high doses intravenously (IV)•Surgery involving the brain•Radiation to the head/brain or total body irradiation(TBI)•Cisplatin or carboplatin (may affect hearing)

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

School After Treatment | Version 6.0 | October 2023 | Page 1 of 4

Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

What testing is recommended?
Any young person who has had any of the above cancer treatments, or who is having difficulties in school, should
undergo a specialized evaluation by a pediatric psychologist (neuropsychological testing) at the time of entry into
long-term follow-up. This type of testing will measure IQ and school-based skills, along with more detailed information
about how the child or teen processes and organizes information.
Even if the initial neuropsychological evaluation is normal, it is important for parents and teachers to remain watchful.
Further neuropsychological evaluations may be necessary if the child or teen begins having trouble in school ordevelops any of the problems listed in the section below. In addition, repeat testing is often recommended at times
when academic challenges are more likely to occur, such as at entry into elementary school, middle school, highschool, and during pre-college planning.
What learning problems may occur?
The brain is a very complex structure that continues to grow and develop throughout childhood and adolescence.
Some problems may not become apparent until years after therapy is completed. Common problem areas include:•

Handwriting•

Memory•Spelling••

Reading

Processing (ability to complete assignments thatrequire multiple steps)•

Vocabulary•

Planning•

Math•

Organization•

Concentration•

Problem-solving•

Attention span•

Social skills•

Ability to complete tasks on time

What can be done to help with learning problems?
If a problem is identified, special accommodations or services can be requested to help maximize the student’s
learning potential. The first step is to schedule a meeting with the school to develop a specialized educational plan,
this may include a 504 plan or an individualized education plan (IEP).Examples of strategies that are often helpful forchildren and teens with educational problems related to cancer treatment include:•Seating near the front of the classroom•

Assignment of a classroom aide•

Minimizing the amount of written work required••

Use of tape-recorded textbooks and lectures

Extra help with math, spelling, reading, andorganizational skills•

Use of a computer keyboard instead ofhandwriting•

Access to an elevator•

Extra time for transition between classes•

Use of a calculator for math•Duplicate set of textbooks to keep at home•

Modification of test requirements (extra time, oralexams instead of written exams)

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

School After Treatment | Version 6.0 | October 2023 | Page 2 of 4

Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

What laws protect the rights of students who have undergone treatment for cancer?
In the United States, there are three public laws that protect the rights of students with educational problems related tocancer treatment. These laws are:
The Rehabilitation Act of 1973 – Section 504
This legislation provides accommodations for students with a “physical or mental impairment which substantiallylimits one or more major life activities,” or students who have “a record of such impairment,” or who are “perceived
as having such an impairment” (The Rehabilitation Act, 1973). Qualifying conditions include chronic illnesses suchas cancer, as well as many other disabilities, including hearing problems, vision problems, learning disabilities,
speech disorders, and orthopedic handicaps. All childhood cancer survivors in the United States are eligible foraccommodations under this law, and all educational institutions receiving federal funding (including colleges anduniversities) are required to comply. Accommodations may include modifications in the curriculum (such as allowing
the use of a calculator and extra time for assignments or test-taking) and the environment (such as seating near thefront of the classroom or allowing extra time between classes).
The Individuals with Disabilities Education Act (IDEA)The IDEA legislation (PL 105-17) requires that public schools provide “free and appropriate education in the least
restrictive environment” for disabled students between the ages of 3 and 21 years of age. In order to qualify for special
education services under IDEA, the student must meet qualifications under at least one disability outlined in the law—
those that most commonly apply to students treated for cancer include “specific learning disability,” “traumatic braininjury,” or “other health impairment.” To access services under the IDEA legislation, parents must initiate the processby requesting that the student be evaluated for an “Individualized Education Plan” or IEP. The student will then undergo
an assessment process to determine what assistance is required. A conference is then held to discuss the resultsof the evaluation and, if the student qualifies, to determine an individualized plan to meet the identified specialized
educational needs. Services available under the IDEA legislation include tutoring, specialized classroom placements(such as a resource room), psychological services, adaptive physical education, physical, occupational and speech/
language therapy, and transportation services. All services and accommodations required by the student should bespecified in the IEP (the written document describing the special education program). The IEP should be reviewed andupdated on an annual basis to assure that it continues to meet the student’s educational needs.
The Americans with Disabilities Act (ADA)The ADA law (PL 101-336) protects against discrimination in employment, transportation, communication, government,and public accommodations for people with disabilities. It guarantees equal access to public spaces, event, andopportunities and may be particularly helpful for students seeking higher education or employment.
Where can I get more information?
Additional information is available from the Center for Parent Information and Resources www.parentcenterhub.org
American Childhood Cancer Organization, for the free publication: Educating the Child with Cancer, a Guide for Parentsand Teachers (phone: 1-855-858-2226, ext. 101) or www.acco.org
US Department of Education; Office for Civil Rights. Protecting Students with Disabilities www2.ed.gov/about/offices/list/ocr/index.html

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

School After Treatment | Version 6.0 | October 2023 | Page 3 of 4

Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

Written by Wendy Landier, PhD, CPNP, Children’s Hospital of Alabama, Birmingham, AL.
Reviewed by Casey DeBias, MSN, APRN, FNP-BC, CPHON; Christine S. Yun, MSN, PNP, CPON; and Kayla L. Foster, MD, MPH.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or youngadulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health
Links were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s
Oncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding amedical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate
criteria for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable
alternative follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The
Children’s Oncology Group recognizes that specific patient care decisions are the prerogative of the patient, family, and healthcare provider.
No endorsement of any specific tests, products, or procedures is made by Informational Content, the Children’s Oncology Group, or affiliated party or member of the Children’s Oncology Group.
No Claim to Accuracy or Completeness: While the Children’s Oncology Group has made every attempt to assure that the Informational Content is accurate and complete as of the date of publication, nowarranty or representation, express or implied, is made as to the accuracy, reliability, completeness, relevance, or timeliness of such Informational Content.
No Liability on Part of Children’s Oncology Group and Related Parties/Agreement to Indemnify and Hold Harmless the Children’s Oncology Group and Related Parties: No liability is assumed
by the Children’s Oncology Group or any affiliated party or member thereof for damage resulting from the use, review, or access of the Informational Content. You agree to the following terms ofindemnification: (i) “Indemnified Parties” include authors and contributors to the Informational Content, all officers, directors, representatives, employees, agents, and members of the Children’s Oncology
Group and affiliated organizations; (ii) by using, reviewing, or accessing the Informational Content, you agree, at your own expense, to indemnify, defend and hold harmless Indemnified Parties from any
and all losses, liabilities, or damages (including attorneys’ fees and costs) resulting from any and all claims, causes of action, suits, proceedings, or demands related to or arising out of use, review oraccess of the Informational Content.
Proprietary Rights: The Informational Content is subject to protection under the copyright law and other intellectual property law in the United States and worldwide. The Children’s Oncology Groupretains excursive copyright and other right, title, and interest to the Informational Content and claims all intellectual property rights available under law. You hereby agree to help the Children’s Oncology
Group secure all copyright and intellectual property rights for the benefit of the Children’s Oncology Group by taking additional action at a later time, action which could include signing consents and legal
documents and limiting dissemination or reproduction of Informational Content.

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

School After Treatment | Version 6.0 | October 2023 | Page 4 of 4