Childhood Cancer
Unless otherwise cited, the following information
has been gathered from a booklet called:
Helping Schools Cope With Childhood Cancer,
Current Facts and Creative Solutions (2011),
provided by the Children’s Hospital, London
Health Sciences Centre. It is an excellent resource
for families, health care providers and teaching staff
to help children diagnosed with cancer to continue
their education to the best of their ability.
This section will contain many medical terms but this will be the language
that families living with cancer probably will use much during the child’s
illness. School staff, who are involved in the education of a child with cancer,
will need to know these terms in order to better understand and communicate
with the child and his or her family.
illness. School staff, who are involved in the education of a child with cancer,
will need to know these terms in order to better understand and communicate
with the child and his or her family.
Definition
Cancer
is a group of diseases characterized by abnormal, rapid and
uncontrolled cell growth. Although childhood cancers tend to develop
more suddenly and often grow faster than adult cancers, they also
tend to respond better to treatment.
uncontrolled cell growth. Although childhood cancers tend to develop
more suddenly and often grow faster than adult cancers, they also
tend to respond better to treatment.
40% of all pediatric cancers are
leukemias, cancers of the blood cells, originating
from the bone marrow.
from the bone marrow.
Tumours of the brain and spinal
cord are the most common form of solid tumours in kids.
Lymphomas (Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma) are tumours in the lymph nodes, spleen or tonsils, made up from the uncontrolled growth of white blood cells called lymphocytes (Crosta, 2012).
Osteosarcoma is a bone tumour that often affects the bones of the arms and legs
Some types of cancers may be more likely diagnosed among very young children, for example, kidney tumours and neuroblastomas, which are tumours formed from a certain
kind of nerve cells called neuroblasts
(KidsHealth, 2011). Other cancers may form in connective tissue, reproductive cells or the liver.
Prevalence
About 1 in 400 children (o.25%) will be diagnosed with cancer before their 18th birthday. Fortunately, cancer therapies have improved so much that 80% of all children with cancer will have a survival rate of five years since diagnosis and most of these children will be considered cured.
disease-related cause of death
for children in the developed world.
Etiology
Exposure
to radiation and some genetic defects may
increase a child’s risk of developing cancer, but most
of the time there just is no reason or known cause for
increase a child’s risk of developing cancer, but most
of the time there just is no reason or known cause for
the
abnormal cell growth, causing the cancer.
Assessment
Children may have many different symptoms depending on the type of cancer and the location of the tumour. Solid tumours may cause pain, swelling or a loss of function in the area of the tumour. A child with leukemia may look pale, have a fever and excessive bruising. Lymphomas may cause swelling of the lymph nodes while a brain tumour may cause headaches, vomiting, weakness, vision problems or even seizures.
Children may have many different symptoms depending on the type of cancer and the location of the tumour. Solid tumours may cause pain, swelling or a loss of function in the area of the tumour. A child with leukemia may look pale, have a fever and excessive bruising. Lymphomas may cause swelling of the lymph nodes while a brain tumour may cause headaches, vomiting, weakness, vision problems or even seizures.
of them quite painful, to determine if
his or her symptoms are caused by
cancer, and if so, what type of
cancer
and to what extend the disease has
already progressed. Tests may
include blood work, x-rays, CT scans,
MRI scans, ultrasound, PET scans,
lumbar puncture
(also called Spinal Tap),
Bone Marrow Aspiration or biopsy.
Medical Intervention
Most cancer treatments take place in large hospitals. This means that most families will have
to travel away from home for certain lengths of time. In most cases, the goal of treatment will be to cure the child from the disease by destroying the fast-growing cancer cells. How this goal is to be achieved will depend on the type of cancer, the location and extend of the disease and how well the child is responding to treatment. The length of time that a child requires treatment will also vary from several months to several years.
Most cancer treatments take place in large hospitals. This means that most families will have
to travel away from home for certain lengths of time. In most cases, the goal of treatment will be to cure the child from the disease by destroying the fast-growing cancer cells. How this goal is to be achieved will depend on the type of cancer, the location and extend of the disease and how well the child is responding to treatment. The length of time that a child requires treatment will also vary from several months to several years.
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Chemotherapy: administering drugs
to destroy cancer cells by mouth,
injection or intravenously (IV) or via lumbar
puncture into the spinal fluid.
Chemotherapy may be given during a
hospital stay, at a day clinic or at home.
to destroy cancer cells by mouth,
injection or intravenously (IV) or via lumbar
puncture into the spinal fluid.
Chemotherapy may be given during a
hospital stay, at a day clinic or at home.
Radiation therapy: using
high-powered
radioactive particles to destroy cancer
cells, administered during
brief daily
treatments over a number of weeks.
Surgery: sometimes planned
in combination with chemotherapy
or radiation, to remove the tumour or as much
of the tumour as is
possible. Sometimes, surgery may involve the amputation of
a body
part to remove the entire tumour.
stem cell or Bone Marrow Transplant: replacing the cancerous blood cells with healthy
donor stem cells (new immature blood cells), collected from the child him or herself or
donated by a family member or unrelated donor. A bone marrow transplant requires
intensive chemotherapy or radiation to destroy any cancer cells circulating in the child's
body followed by the infusion of the healthy stem cells. Because this level of
chemotherapy or radiation will also destroy the child's immune system, the child is at extremely high risk of infections. He or she will have to stay in isolation in the hospital
for four to six weeks followed by months of recovery in isolation at home.
Central Lines: Because children’s
and
more painful to access a child’s
vein for the administration of drugs,
fluids, blood products or nutrients. To
make this easier, most children will
have a central line inserted, consisting
of a small tube tunneled under the skin
towards the neck and into one of the
large veins. Treatment can be injected
into the access point of the catheter.
Supportive care: treatment that prevents, controls or relieves
side
effects or complications of the cancer treatment such as antibiotics
to prevent or treat infections, special mouth rinses to prevent mouth
sores, anti-nausea medications for nausea and vomiting or even
blood
transfusions. Psychosocial support provides counseling to the
family to
help them cope and psychological assessment and treatment
for the child as
needed. A dietitian helps by addressing special
nutritional needs.
Therapy:
Physiotherapy, occupational therapy and speech and
language therapy may be
required as a result of the consequences
of cancer. For example, when the
child has a brain tumour, needs
an amputation or has complications from
drug therapy.
Developmental Consequences
“Perhaps most importantly, childhood cancer occurs
in a
developing human being. Children continue to grow
physically,
emotionally, socially and cognitively
during the
challenges of treatment” (p. 3).
Physically: Mobility challenges may result from brain tumours, amputations
and other surgeries or as a side effect from treatment while some children
experience sensory loss, including hearing or vision loss. Some treatments
may also cause damage to the nerves affecting fine motor skills. Some physical effects may not show up until later, for example infertility, decreased heart and lung functioning, changes in growth, decreased bone density, or a higher risk of developing
cancer later in life.
ride with many ups and downs and
unexpected turns and twists. One strong
emotion is fear; fear of death,
fear of the
unknown, fear of pain and fear of social
rejection. Another
strong emotion may be
guilt for causing the family all this trouble
or even
guilt that he/she brought this
disease upon him/her self. Another
one is
stress due to the necessary
changes in family routines, finances, and
the need for alternative care for siblings.
changes in family routines, finances, and
the need for alternative care for siblings.
Socially: Spending time away at a
treatment centre means time
away from friends and family and missing out
on activities, for
example, school trips. Side effects such as hair loss,
fatigue,
unexpected bleeding, nausea and vomiting, weight changes and
mood
changes all can be very distressing to the child and his or
her family.
They also impact the social activities of the child as
well as his or her
acceptance at school.
Cognitively: Absenteeism may make it difficult for a child to keep
up with
school work or to catch up when returning to school.
Learning ability
itself may sometimes be affected due to a brain
tumour, brain surgery or
as a side effect of treatment.
Educational Implications
Even
with all the challenges a cancer diagnosis entails, school attendance provides
a sense of normalcy for the child and his or her family as well as a sense of
hope for a future life. It
will be important for school staff to prepare an educational plan for the student that takes into consideration all the physical, emotional, social and academic needs even during those times when it is not possible for the child to be in school. Communication with the parents will be very important, both to exchange important information as well as to provide emotional support to each other.
will be important for school staff to prepare an educational plan for the student that takes into consideration all the physical, emotional, social and academic needs even during those times when it is not possible for the child to be in school. Communication with the parents will be very important, both to exchange important information as well as to provide emotional support to each other.
Physical
needs:
Observation: All children,
including those with cancer, need to be observed
for unusual physical symptoms such as pain, excessive bruising or fatigue,
‘clumsiness’ or sensory problems. These should be reported to the family.
Of particular concern for children with cancer are signs of fever which may
signal an infection. A fever needs to be reported to the family right away,
not just at the end of the school day.
for unusual physical symptoms such as pain, excessive bruising or fatigue,
‘clumsiness’ or sensory problems. These should be reported to the family.
Of particular concern for children with cancer are signs of fever which may
signal an infection. A fever needs to be reported to the family right away,
not just at the end of the school day.
Handwashing: Excellent hand
hygiene may
prevent infections, not only for a child with
cancer, but for
everyone. Talk to parents
when there is an increased level of contagious
illnesses circulating at the school. The parents
may wish to ask their child’s
doctor if their child
can continue to attend school. Chickenpox is
of
particular concern to a child with cancer.
Central lines: These do not need to be a major concern at school.
Care should be taken not to bump the
catheter and external parts
should be kept clean, dry and covered with a
dressing.
Modifications to physical education activities may be necessary
to
prevent bumps to the line.
Exercises: It may be possible to incorporate physiotherapy exercises
into gym class for all the children.
Exercises: It may be possible to incorporate physiotherapy exercises
into gym class for all the children.
Rest: Provide an area
where the child can rest when needed.
Nutrition: The school’s
snack and/or lunch breaks may not
accommodate the changing nutritional needs of
a child with
cancer. Appetite may be increased or decreased. The child
may need
to be allowed to eat more frequent, smaller meals
during the day.
Sun Sensitivity: Staying in the
shade and using sunscreen and
hats in the sun is common sense for anyone, but
especially for
some children with cancer whose medications increase their
sensitivity
to the sun.
Classroom
environments: may need to be adjusted to
accommodate changes in a child’s mobility.
Resources: Physicians,
nurses, physiotherapists, occupational
therapists, speech and language
therapists and dietitians all can
help determine the specific physical needs of
the child and how
to best meet these needs.
Emotional
needs:
Reassure the
child that getting sick is not his/her fault and is not a punishment.
Inappropriate
behaviour from a child with cancer should be understood but not accepted.
Make sure the
child has a trusted ‘go to’ person at school to talk to if needed.
Social workers,
psychologists, child life workers in the hospital, pastors, support
groups and
child and youth workers can all help to meet the emotional needs of
children
with cancer.
Social
needs:
Encourage the
student’s peers to keep in touch when the child
is not in school. This can be
done through sending letters or
cards, keeping a class journal and of course
using the internet.
It can even be possible for students in the hospital to be
present
in the classroom using a computer with webcam. If allowed,
classmates
can also be encouraged to visit their friend in person.
Educate the
school children about cancer,
hair loss and other possible side effects in
children with cancer. Discuss ways that
they can help a child with cancer.
Remember
to ask permission from
the child and/or his or her family
when talking about a
specific child.
Rules about wearing hats may need to
be
changed, not only for the child with
cancer, but for all children. In this way,
one child wearing a hat will not stand out.
Encourage
classmates to spend time with
the child doing quiet activities when
needed.
Academic
needs:
A communication
book that travels with the child will be helpful to keep teachers,
parents and
hospital staff up to date on what the class is working on at school
and what the child is accomplishing at the hospital or at home.
Using a computer
with webcam, the student may be able to
follow lessons in the classroom from
the hospital or from home.
Some hospitals
have on-site teachers to teach the children in the hospital.
Home-based instruction
must be arranged by the school as needed.
The child may
need to be formally identified as a special needs student,
particularly if
there is a risk of neurological complications from the cancer
or the treatment.
These complications may not become evident right away,
but may present as a
gradual slowing in development over time compared
to classmates. Psychometric assessments may be available to the student
as part of his or her follow-up care. The child may need accommodations
for fine motor skills, for example printing, as a result of some medications.
Some students
may be able to successfully take on-line or correspondence
courses,
particularly with additional teacher support.
Accommodation of
Assessment of learning may be required.
Additional Concerns
Some children at school may be dealing with cancer,
even though
they do not have cancer themselves. Having a family member with
cancer can be very stressful for a child. Planning for a child with
cancer at school should also address the needs
of his or her brothers and sisters.
They
worry, feel sad, or miss their
family members. They may feel
jealous or angry of all the attention
their sick sibling is getting or even
guilty that somehow they have
wished this disease upon him
or her. Sometimes siblings
may hide their feelings to
‘protect’ their already
stressed parents or they
may start to act out to get
attention. It may also be difficult
for siblings to have other students
at school ask them about their ‘dying’
brother or sister.
they do not have cancer themselves. Having a family member with
cancer can be very stressful for a child. Planning for a child with
cancer at school should also address the needs
of his or her brothers and sisters.
They
worry, feel sad, or miss theirfamily members. They may feel
jealous or angry of all the attention
their sick sibling is getting or even
guilty that somehow they have
wished this disease upon him
or her. Sometimes siblings
may hide their feelings to
‘protect’ their already
stressed parents or they
may start to act out to get
attention. It may also be difficult
for siblings to have other students
at school ask them about their ‘dying’
brother or sister.
Although most children with cancer do get better in
time, some
children do not respond to treatment and will receive palliative care.
The purpose of palliative care is to keep the child as comfortable
as possible and maintain the best possible quality of life until death.
The child may choose to continue attending school as a way to do
something normal and to be with friends. It will be important to know
what the student’s wishes as well as the parents’ wishes are regarding
information shared with the student and his or her peers. Grief counselors
and consultants from different organizations can help provide support
to school staff and students during this difficult and emotional time.
children do not respond to treatment and will receive palliative care.
The purpose of palliative care is to keep the child as comfortable
as possible and maintain the best possible quality of life until death.
The child may choose to continue attending school as a way to do
something normal and to be with friends. It will be important to know
what the student’s wishes as well as the parents’ wishes are regarding
information shared with the student and his or her peers. Grief counselors
and consultants from different organizations can help provide support
to school staff and students during this difficult and emotional time.
References
Crosta, P. (2012) What is Lymphoma?
Lymphoma Symptoms, Causes and Treatments
KidsHealth
