Getting back into a school routine is important to children and adolescents. It maintains continuity in their education and their friendships, and it reinforces the idea that life will go on and they have a future. It can be daunting for the student to return to school, however, and it is important to consider what support they will need. With the family’s permission, a clinical nurse consultant or the oncology social worker may be able to visit the school to talk to staff about how the school can best support the student’s return.
Learn more about:
- Returning to school
- Return to school plans
- The returning student’s concerns
- Building resilience
- Making practical changes
- Palliative care
- Understanding learning impacts
- Outside School Hours Care
Returning to school
Encourage the student to return as soon as they feel up to it – Being accommodating and flexible to the student’s needs will help the student become involved as much as possible in day-to-day lessons and school activities, rather than avoiding school. Ideally, the school will help the student by facilitating partial attendance (such as half-days) at first and reducing or modifying work, such as assessment tasks. Keep in mind that ongoing medical treatment and follow-ups may continue to affect school attendance. The family’s medical team can provide documentation to support this, if required. It will be easier for the student to adjust to being back at school full-time if many short visits or half-days are kept up during active treatment. On some days, the student may just visit school at lunchtime so they can socialise with friends.
Plan for the individual needs of the student – Preparing for the student’s return is essential so that any adjustments, such as modified grading procedures, can be put in place. This relies on communication between the school and the student, their family and the treatment team. The school liaison person can coordinate communication with teachers, the school counsellor and other staff.
Ask the family whether any speech, occupational or cognitive assessments were completed during treatment and, if so, whether copies of the reports can be given to the school. If not, a school counsellor can conduct an educational assessment of the student and provide recommendations on how to meet the student’s individual needs. This may include further referrals, such as for occupational or speech therapy. Students may also need practical changes to accommodate their physical needs. It is important to treat the student as normally as possible, within the limits set by their condition.
Anticipate anxieties about returning to school – Returning to school can be daunting for both the student and parent after a prolonged absence, especially if the student has had to be held back a year and is entering a different peer group. The school counsellor or another appropriate member of staff can arrange a meeting with the student and parents to discuss their concerns about returning to school and how the school can help. Reassure the student that while things will probably feel different for a while, they will be supported to settle back into school. Identify people they can go to if they have a problem or feel lonely, especially during lunchtimes. Discuss with the student which trusted staff member they would like assigned. Add a peer buddy if your school is equipped to provide them with appropriate support.
It is natural for parents to have a wide range of feelings about their child returning to school. Some may be overprotective or stressed about the transition, while others may be relieved or pleased. If you have difficulty managing a parent’s reaction, talk to the student wellbeing coordinator or a school counsellor about how to handle the situation. With the parents’ permission, you could also contact the clinical nurse consultant from their treatment team for guidance. Sometimes parents need reassurance that their child’s physical and emotional needs will be supported.
Resilience allows children to cope with adversity – to bounce back. Although living with cancer can be undeniably difficult, in most cases young people can demonstrate maturity and wisdom beyond their age.
To help all students build resilience, teachers can:
For primary school students, visit KidsMatter to find out more about promoting resilience and for resources you can use in class. You can also ask your local education authority if they have any resources.
For secondary students, the ReachOut Schools portal has a Building Resiliency in Young People resource, which includes lesson plans. Or visit MindMatters for online modules to help secondary schools promote a positive environment and build resilience.
Return to school plans
A return to school plan can help with the student’s reintegration into school. It is prepared by the school with involvement from the student, their family and the health care team.
The plan can outline agreed expectations about attendance and schoolwork, any additional support the student requires, and what the school can do to support the student.
A return to school plan can be incorporated into the Individual Education Plan (IEP) or Individual Learning Plan (ILP). It is likely the student will also need practical support.
The returning student's concerns
When students have had a lot of time off school for cancer treatment, their worries may include social, academic, psychological and physical issues. Some common concerns are listed below, along with ways that school staff may be able to provide support. Use this list to start a conversation with your student about their particular concerns and take your lead from them.
Being the centre of attention – Students may worry about being stared at or being bombarded with questions about their absence or appearance. With the student and family’s permission, communicating with the school community before the student’s return can encourage sensitive reactions from peers. Preparing the student with simple responses to typical questions can also help.
Keeping up with schoolwork – Reassure the student that their being back at school is what’s important and that it will take time to catch up. Provide additional support through your school’s student wellbeing team, learning and support team or liaison person, or arrange a study buddy (peer support), tutoring or special assistance. Consider modifying grading procedures and assessments if appropriate.
Being left out or rejected – Let the student know that their classmates did miss their company, and explain that their peers may be shy initially, but will eventually be more welcoming. Prepare classmates for the student’s return before they arrive. Remind peers of the returning student’s right to privacy and about the dangers of comments on social media.
Being bullied or teased – Your school will already have policies to deal with bullying, discrimination and harassment. Closely monitor the reactions of other students – some peers can resent what they see as special treatment, but educating students about cancer in age- appropriate ways can help. It is also important to remind them about social media etiquette. Equip the student with cancer with strategies to respond to bullying behaviour.
Fitting in with other classmates – A student who looks different (because of weight gain or loss, hair loss or a physical disability, for example) might worry about their friends’ reactions. Talk with classmates honestly to help them understand the situation. Some students with hair loss may wear a head covering (cap or scarf) while their hair is regrowing. Others may have to adapt the school uniform. Ensure school staff know about any adaptations to avoid unnecessary embarrassment. If the student has to change clothes for school activities, you might be able to provide a separate changing area to give them extra privacy, especially if they are concerned about their peers’ reactions.
Feeling that their classmates are immature – After the experience of having cancer, many older students feel they have less in common with their peers. The latest celebrity gossip or music news can seem unimportant. This can affect the student’s ability to fit in and socialise. Try helping the student to find new interests to share with peers. Remember that while the returning student may seem to be older in some ways, they are still very young.
Getting sick again – After treatment has finished, it is common for a student and their family to be concerned about the disease returning (cancer recurrence). This concern can arise each time they have a check-up and may last for years. For some students, the treatment leaves them with a compromised immune system and they are highly susceptible to infections. Reinforce your school’s standard infection control measures and encourage general hygiene, such as handwashing, throughout the school. You could also consider including handwashing as part of the curriculum for younger year levels.
The principal can send a letter or email to all families emphasising the importance of not sending children with infectious diseases to school and asking parents to inform the school of any cases of measles or chickenpox as soon as possible so that the parents of the child with cancer can be alerted. The letter can explain that one of your students has lowered immunity after cancer treatment but need not mention the student by name. Cancer Council has prepared some sample letters for schools.
Making practical changes
A student with cancer will usually need some practical support related to their health care and psychological wellbeing. A written management plan prepared by the principal with the input of the student, their parents and their health care team helps to avoid misunderstandings. This individual health care plan (or student health support plan) should consider the student’s full range of learning and support needs, including treatment effects, care needs, and emergency signs and procedures. Many young people prefer not to draw attention to themselves. Talk to the student about ways they can discreetly signal their need for a break or physical assistance (e.g. by placing a white time-out card on the desk or using a hand signal).
Accessibility – Fatigue is a common side effect of cancer treatment, so when a student first returns to school, they may find it easier to manage if their classes are moved to easily accessible rooms. For secondary students, allow a window of time for movement between classes so they can avoid crowds.
In some cases, the cancer or its treatment can cause a physical disability. For example, a student may have had an amputation, they may need to use a wheelchair or they may have vision loss. School buildings may already be modified to ensure access for other students with physical disabilities, but you may need to provide permission to use more accessible toilets, access to a lift, or classrooms on the ground floor. The school may also need to organise an accessibility assessment of the school grounds.
If the student is weak and needs assistance with carrying books or pushing their wheelchair, the student’s individual health care plan (or student health support plan) should set out how this will be managed. If the student has reduced or impaired fine motor function, an occupational therapist may need to recommend ways the student can be supported in their writing activities.
Sensitivity to sunlight – Students receiving cancer treatment can be very prone to sunburn. To limit sun exposure, encourage the usual SunSmart guidelines of using sunscreen, wearing hats and ensuring access to shaded areas (for more information, call 13 11 20). On hot days, encourage indoor activities, but do so without isolating the student – for example, the student could go to the library with a few classmates.
Central venous access device – Some students will have a central venous access device (CVAD), which is a tube inserted into a vein in the neck, groin, chest or arm. It may be called a port, port-a-cath, central venous catheter, Hickman line, PICC line or central line. It allows medical staff to administer chemotherapy and other drugs, fluid or blood transfusions, or to draw blood.
All school staff, including those in charge of sports and sick bay, need to be aware of precautions and care while a student has a CVAD. Contact sports can cause the device to break or loosen, and some types should not be submerged in water because of the risk of infection. Ask the student’s parents what precautions the medical team have recommended, and discuss how the student can still participate in school sports, such as by recording results.
To minimise panic and any negative effects on the child or other students, the student’s individual health care plan (or student health support plan) should set out what action to take if there is a problem with the CVAD, e.g. a cap falls off, the line comes out or the site starts to bleed.
If the student becomes unwell
- If a student with cancer complains of feeling unwell, particularly if their temperature is rising, contact their family.
- If a student who is still receiving active treatment or has a CVAD develops a fever of 38°C or above, it might indicate a serious infection and they usually need to go to hospital immediately.
- The student’s health care plan (or health support plan) should include the details of who the school should contact if the student becomes unwell and in what order. If in doubt, school staff can call 000 for guidance.
- If the student’s health care plan includes arrangements for the school to monitor the student’s temperature, parents may need to provide the school with a thermometer for their child.
Cancer in children can be unpredictable, so palliative care may be offered early in the course of the disease. Palliative care aims to optimise wellbeing by addressing the child’s physical, practical, emotional, spiritual and social needs. It does not mean that their family or medical team have given up hope or that the child is dying.
Some children attend school while they are receiving palliative care. For children with cancer and their families, school can offer a sense of connection, normality and routine throughout a time of great upheaval. Depending on their health and energy levels, the student may attend school full-time or part-time.
In some cases, the attendance may be primarily social, with the student visiting for lunch breaks or favourite classes. The school community can play an important role in supporting the student’s independence, dignity and determination.
Understanding learning impacts
A student returning to school may have to manage the effects of cancer treatment on their academic performance. Parents of students with cancer have reported significant effects on writing, mathematics, handwriting, confidence, exam performance, memory, concentration and physical education. Some of these impacts may be delayed, appearing months or even years after treatment has ended.
– Rebecca, mother of a secondary student with cancer
It is important to recognise that cancer treatment can change the way the student learns and that the student may need extra educational support throughout all the years of their schooling. In particular, some students develop long-term difficulties with executive functioning. This affects the ability to plan, organise, form abstract concepts, practise self-regulation and initiate action. The student may have trouble taking notes or copying information, remembering things, concentrating, getting started on activities, or completing tasks on time. In some cases, the student’s struggle to manage these challenges can lead to a lack of engagement with education or disruptive behaviour in the classroom.
In many school systems, specialist learning support staff help classroom teachers to address the additional educational needs of students. They may be part of a learning and support team (sometimes known as the program support group). This team is made up of all those involved in the student’s education, including parents, the principal or other school leader, the class teacher and the school. In some cases, the team may decide to create a formal plan, which may be known as an Individual Education Plan (IEP) or Individual Learning Plan (ILP).
Parents or guardians have an important role to play in discussing and planning for their child’s needs. You can refer them to Learning curve: education and socialisation after childhood cancer, a series of booklets for different ages produced by the Victorian Paediatric Integrated Cancer Service. Your school will need to work together with the parents and student to develop realistic expectations about what can be achieved academically.
Adjustments to support learning
In addition to any adjustments to accommodate physical needs (see Making practical changes), schools may need to make temporary or permanent adjustments to manage the returning student’s changes in academic performance and behaviour. These adjustments can be listed in the student’s IEP, ILP or return to school plan, and may include:
- seating them towards the front of the class
- organising an in-class buddy or teacher assistant to help with note taking or recording assignment due dates
- providing catch-up work in different key learning areas
- offering extra tutoring
- adapting work so the student can manage the load
- discreetly allowing extra time for homework and assessment tasks, and increasing time limits in tests or exams
- providing a model or scaffold that shows the steps in a task
- giving verbal prompts and written reminders
- helping the student organise thoughts using graphic organisers and mind maps
- allowing the student to work without interruption as much as possible
- revising the number or types of subjects taken by the student.
- encouraging rest breaks in class to help the student focus and manage fatigue.
Students may also need special consideration for physical education classes. This will be obvious if the student’s treatment has involved a visible change such as an amputation, but also needs to be considered when the student is managing fatigue from chemotherapy or radiation therapy.
Sexuality, fertility and body image
The upper primary and secondary school curriculums for health and physical education, and for science, may include the topics of fertility and sexuality. Some cancer treatments can seriously affect fertility and sexual function, so these topics may need sensitive handling. Likewise, if you’re planning lessons about body image, consider the impact cancer treatment may have had on your students (e.g. amputation, surgical scars), and whether you need to adapt your lesson plan.
Outside School Hours Care
A student with cancer may start attending before and after school care once they are well enough, particularly if both parents have returned to work. The opportunity for social interaction can be especially valuable. OSHC staff supporting a student with cancer can refer to the advice on this page. They may also have a special role to play in supporting a student whose sibling or parent has cancer. The parents are likely to be preoccupied with the treatment and, in some cases, it may be the first time the student has used the OSHC service.