The patient's socialization in the community and school during therapy

Childhood cancer patients at school

The aim of this study was to assess the school-related problems of childhood cancer patients. A cross-sectional questionnaire study for school-aged children with extracranial malignancies, in the area of Turku University Hospital serving around 1000000 people. Siblings, healthy pupils and teachers were studied as controls. 43 patients responded. None of the patients or controls was placed in special educational programmes. However, 30.8% of the patients, 15.7% of the controls and 3.7% of the siblings had required extra tutoring. The patients' results differed statistically from both the siblings' (P=0.022) and the controls' (P=0.041) results. The school marks in mathematics (P=0.05) and in foreign languages (P=0.06) tended to be worse for the patients than for the healthy controls. Bullying was reported by 31.7% of the patients, 10.9% of controls (P=0.0012) and 8.3% of the siblings (P=0.056). The biggest problem faced by the cancer patients was bullying-the patients reported approximately 3 times as much bullying as the healthy children did. It seems that there are still several aspects which need to be reconsidered when these children return to school or start their school-life as survivors of childhood cancer. Some proposals are presented.

Children with malignant disorders: the health and life situation of their parents examined over a 7-year interval

The parents of 31 children with malignant disorders were clinically examined and interviewed to characterize their life situation and somatic health during treatment of their child. The follow-up was for 7 years. Comparison groups were from the mean Finnish population matched for age, sex and occupation. The parents were generally healthy. Hypertension, headache and abdominal pain were the main symptoms. Sick leave and contact with a physician were less common than in the control population. The frequency of paramedical drug use was high but tranquilizers were used rarely. At the beginning the mothers had many symptoms indicating stress. Their attitude about their own state of health improved during the follow-up in spite of ageing. The spare-time physical activities of the parents increased during follow-up. Few marital conflicts and problems with the siblings were reported. The increment in economic burden caused by the child's disease was not regarded as essentially changing the family life.

A trajectory approach for education of the child/adolescent with cancer

Survival in childhood cancer has improved, but the child's learning capability and psychosocial adjustment are affected by intense therapy, the side effects, and psychosocial issues. The resulting problems of school attendance and performance need to be addressed by pediatric oncology nurses. This article describes an education intervention program that is based on a treatment trajectory with interventions that occur from diagnosis through long-term survival and are directed toward the patient/parent, school personnel, and classmates. Both anecdotal and empirical evaluations of the program are being completed. This program provides pediatric oncology nurses with a model for program development and resource materials.

Overall function in rural childhood cancer survivors. The role of social competence and emotional health

This study compared the functioning of 20 rural cancer survivors, aged 6 to 16 years, with that of 40 age- and gender-matched school peers. Social competence and emotional health were evaluated, along with academic performance and physical limitations. Eight measures were used: the teacher and parent Child Behavior Check Lists, the Health Resources Inventory, the Vineland Revised Scale of Social Maturity, the Piers-Harris Child's Self-Concept Scale, the Parcel and Meyers' Health Locus of Control, the Moos' Family Environment Scale, and the Functional Status II(r). Cancer survivors and controls had similar attitudes about self-esteem, family conflicts, physical functioning, social skills, independence, and sense of control over health. Both parents and teachers noted poorer social competence among the cancer survivors than among controls, but parents of survivors reported more behavior problems, whereas teachers stressed poorer school performance. Routine screening for emotional health, social competence, and academic performance should be part of the follow-up care of pediatric cancer survivors.

Impact of childhood cancer on return to normal schooling

Most of the research into the psychosocial impact of treatment for cancer in children has concentrated on effects on the family rather than on the children's return to school. Thus parents and teachers were questioned about the problems experienced by 117 children who returned to school after spending time in hospital. The children comprised 51 with cancer and two groups of control children (34 with chronic diseases such as renal disease and cardiac conditions and 32 with orthopaedic conditions such as thoracic scoliosis, club foot, and injuries resulting from trauma). Children in all three groups experienced problems on returning to school, the greatest number and variety occurring in the children treated for cancer and the fewest in the children with orthopaedic conditions. The variety of physical problems was greatest and the variety of academic problems was least, with psychological and behavioural problems intermediate. Several problems seemed to be related to drug treatment. Several children missed a considerable amount of full time education. Many teachers were unsure of the academic expectations and physical capabilities of children returning to school. To facilitate a smooth return to school for a child with cancer improved liaison is needed between the hospital, school, and home during the child's absence and teachers need to be better informed.

School-related behavior in children with cancer

Ninety-one children with cancer (thirty-seven with leukemia and fifty-four with solid tumors)--school aged (elementary and middle school), residing in Emilia-Romagna Region (Italy), and receiving treatment at the Department of Pediatrics (III), University of Bologna, from August 1973 to April 1987--took part in a study of school behavior as perceived by the teacher. The research was carried out through a 29-item forced-choice questionnaire based on the questionnaire proposed by Deasy-Spinetta for a similar study in the U.S.A. Results revealed that children with cancer have a school behavior scoring at levels significantly lower than controls. There are more difficulties for children attending middle than elementary school, for children on therapy than off therapy, and for children with leukemia than with solid tumors. In conclusion, the main obstacle to school performance seems to be lower attendance, which is mainly due to treatment and clinic visits and probably in part to an overprotection and an excessive concern on the part of physicians and parents.