When someone in your school community is diagnosed with cancer, you are likely to encounter a range of reactions from students, families and colleagues. These general guidelines may help you pick up on signs of distress and provide age-appropriate support.
Learn more about:
- Early primary students (4–7 years)
- Later primary students (7–12 years)
- Secondary students (12–18 years)
- Parents and staff members (over 18 years)
Early primary students (4–7 years)
In the early primary years, students have a basic understanding of sickness. When someone they know has cancer, they may worry that they will catch the disease or that they caused it (e.g. by being naughty or thinking bad thoughts about the person).
At this age, most children are egocentric: they often think everything is related to them and may not yet empathise with others. They tend to notice (and comment on) physical changes. Young students may be just starting to realise that people, including parents or grandparents, can die.
- regression, e.g. stopping reading, starting to suck their thumb again
- comfort-seeking behaviours, e.g. using a security blanket or a special toy as a comfort object, thumb-sucking
- stuttering or baby talk
- withdrawing from conversations
- hiding behind a parent or significant adult when meeting other people
- fear of separation from others, especially at bedtime and going to school
- fear of the dark, monsters, animals, strangers and the unknown
- disturbed sleep, e.g. sleeplessness, wanting to sleep with a parent, sleepwalking or sleep talking, nightmares, bedwetting
- hyperactivity or apathy
- aggression, e.g. hitting or biting
- repeating questions about the same topic, even if it has been discussed several times
- commenting on physical changes and teasing if they don’t understand them
- listen to their feelings (expressed through speech or play) and be alert to their needs
- talk about cancer using picture books, dolls or stuffed animals
- read books together that explore anger, sadness and other feelings
- be honest (to their level of understanding)
- reassure them that they will be taken care of and will be safe
- if separation anxiety is a problem, ask them to look after something special for that person, so they know they will return
- provide brief and simple explanations, but use all of the cancer terminology they may encounter (see Cancer words for kids); repeat your explanations if necessary
- keep routines consistent where possible, and explain any changes to their schedule
- encourage them to have fun at school and enjoy their other activities; physical activity can help to release anxiety and tension
- assure them that they have not caused the cancer by their behaviour or thoughts, nor will they catch cancer
- continue usual discipline and limit-setting
Later primary students (7–12 years)
By the later primary years, most students are ready for more complex explanations of cancer and cells. Like younger children, they may feel responsible for causing the cancer of someone they know and may blame it on their own bad behaviour. Many are starting to comprehend the finality of death and its impact (especially if they have been exposed to death at a young age).
- irritability, anxiety, guilt, envy
- sadness, crying
- physical complaints, e.g. headaches, stomach-aches
- school refusal
- separation anxiety when going to school or away to camp
- hostile reactions, e.g. fighting or yelling
- poor concentration or daydreaming at school, possibly with a change in academic performance
- withdrawal from friends and family
- self-consciousness, feeling like the odd one out
- difficulty adapting to changes (such as a replacement teacher or new schedule)
- fear of performance, punishment or new situations
- sensitivity to shame and embarrassment
- trying to be extra good
- listen to their feelings (expressed through speech or play) and be alert to their needs
- use books to explain disease, cancer, treatment and potential outcomes
- assure them their behaviour or thoughts did not cause the cancer
- be honest
- reassure them about their care and schedule
- maintain clear rules and expectations
- assure them that the chances of someone else getting cancer are slim
- let them know how they can help a teacher, classmate, sibling or parent with cancer
- take time to listen and let them know you care about their feelings
- appoint a teacher, staff member or buddy to watch out for them
- if the prognosis is poor, ask for help from a social worker or psychologist to gently broach the topic of a parent, teacher or classmate dying
Secondary students (12–18 years)
By the secondary years, students are starting to think more like adults. As their ability for abstract thought develops, they recognise relationships between events, such as cause and effect. They now appreciate that people are fragile and can imagine what it might be like to have cancer.
- denying fear or worry to avoid discussion
- hiding feelings – parents, teachers and friends may not see true reactions
- anger, rebellion
- withdrawal, apathy, depression, anxiety
- worry about being different and not fitting in
- becoming nervous in social situations
- wanting to be independent and treated like adults – may become more responsible
- regression, e.g. watching children’s TV shows, being dependent on parents
- critical view of the support offered by adults and friends
- friendship issues
- poor judgement and risk-taking, e.g. smoking, binge drinking, unsafe sex, abuse of illicit or prescription drugs
- self-harm, e.g. cutting, restricting diet
- physical symptoms caused by stress, e.g. stomach-aches, headaches
- difficulty concentrating in class, change in academic performance
- poor school attendance
- a desire to help others and raise funds or awareness about cancer
- listen to them, don’t talk at them; encourage them to discuss their feelings, but realise they might not want to talk or may prefer to confide in friends
- express your feelings so they know what they’re feeling is normal (e.g. share that you are worried or miss the person), but do not burden them with the task of taking care of you
- provide privacy, as needed; highlight the importance of respecting privacy and using social media appropriately
- encourage them to maintain activities and friendships at school, if possible
- don’t expect them to take on too many extra responsibilities at school
- allow them to have time with friends
- allow flexibility and special consideration with schoolwork
- provide in-school opportunities for them to learn more about cancer and receive support; don’t expect them to be cancer experts
- treat them with respect as an emerging adult; let them know you are thinking about them, but be discreet and respectful
Parents and staff members (over 18 years)
Because adults and some older students can think in abstract terms, they usually empathise with the person affected by cancer. They understand complex relationships between events and are likely to recognise the impact of a cancer diagnosis and treatment on all aspects of life (such as school and personal relationships).
- depression, anxiety
- withdrawal
- sadness about their own experiences with cancer
- physical symptoms such as headaches
- fear about their ability to cope
- feeling overwhelmed
- needing to talk with others about how they are feeling
- putting extra energy into work or distracting activities
- fluctuation in mood, especially around significant testing and treatment dates of the person with cancer
- keep in mind that different people will feel comfortable with different approaches
- take time to listen and let them know you care about their feelings
- if a student has cancer, principals can give staff simple and factual information and encourage them to seek further information as necessary; they can discuss strategies for supporting the child and their siblings, what information may be shared with students and their families, and how to talk to children about cancer
- if a staff member has cancer, they may choose to tell parents and students
- line managers can remind the person with cancer about any staff counselling services that they and their family can use, and discuss any requests for flexible working arrangements
→ READ MORE: When a student has cancer
Podcast: Explaining Cancer to Kids
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Claire Tobin, Principal Medical Advisor, Department of Education and Training, VIC; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s Hospital and Prince of Wales Hospital, Director of The Sydney Youth Cancer Service, and Conjoint Senior Researcher, University of New South Wales, NSW; Lisa Barrow, Clinical Nurse Educator, Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, VIC; Margo Bulic, Psychosocial Support Worker, CanTeen, ACT; Amber Copeland, 13 11 20 Consultant, Cancer Council Queensland; Donna Drew, Clinical Nurse Consultant, Paediatric Oncology/Palliative Care, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW; Allesha Fecondo, Education Consultant, Victorian Paediatric Rehabilitation Service, and Education Liaison, Ronald McDonald Learning Program, Ronald McDonald House Charities Australia, VIC; John Friedsam, General Manager of Divisions, CanTeen Australia, NSW; Pina Hutcheson, President, Catholic Primary Principals’ Association of WA; Cara Irvine, Year 8 Coordinator, Alfred Deakin High School, ACT; Andrew Long, Assistant Director, Policy and Research, Independent Schools Council of Australia, ACT; Dr Alistair Lum, Post-doctoral Research Fellow – Behavioural Sciences Unit, Sydney Children’s Hospital, University of New South Wales, NSW; Kristine Luszczynski, Learning Program Manager, Quality and Standards, Ronald McDonald House Charities Australia, NSW; Anita Neville, National Manager, Ronald McDonald Learning Program, Ronald McDonald House Charities Australia, VIC; NSW Department of Education, NSW; Mandy Roney, Consumer; Shannon Rush, Primary School Program Manager, Camp Quality, SA; Luke Wade, Education and Career Support Consultant, Redkite, QLD.
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