School reintegration for children and adolescents with cancer: The role of school psychologists

Improving the Quality of Life of Cancer Survivors in School: Consensus Recommendations Using a Delphi Study

Successful school re-entry is important for children following cancer treatment. However, this process is a challenge for teachers. Objectives: To identify (1) the difficulties and needs that teachers have in helping youth cancer survivors be successful in school, (2) the most effective resources that teachers are currently using for helping them, and (3) the ideal contents for a program that could help teachers in this area. Methods: Twenty-eight teachers participated in a Delphi study. Results: A lack of knowledge regarding how to best help and having to deal with the student’s problems were identified as difficulties. Specific training, psychological support, and advice from health professionals were the most commonly reported needs. Maintaining contact with the family and the students and providing personalized attention were viewed as the most useful resources. Finally, knowledge about the disease itself and how to facilitate successful school re-entry were identified as important program components. Conclusion: The findings provide important new information regarding the lack of both resources and support for teachers who seek to help youth cancer survivors. The findings can be used to inform the development of an intervention to help teachers become more successful in facilitating successful school re-entry.

Sense of School Belonging and Paediatric Illness: A Scoping Review

The experience of hospitalization leads children to move away from their everyday life, such as school attendance. Participating in school activities and relating with classmates are important experiences in children's development and promote a general sense of school belonging. A scoping review was conducted on the sense of school belonging (SoSB) of school-age children with medical conditions. The review concerned four specific research questions: (a) How is SoSB studied and indexed? (b) Has research on this topic changed over time? (c) What methods and techniques are used to study this topic? and (d) What role does SoSB play in the life of pupils with medical conditions? Four databases were searched: PubMed, Scopus, PsycInfo, and Education Source. The abstract and full-paper screening process identified 10 articles. A qualitative line of argument metasynthesis highlighted numerous interesting aspects: SoSB is a psychological need for pupils with a medical condition and information and communication technologies (ICT) offer an opportunity to promote SoSB and make pupils feel greater levels of well-being, less pain, and fewer negative emotions. Promoting SoSB is important for fostering a better quality of life for children with illness, helping them feel more normal and part of the class, despite not being present; hospital and regular schools should engage in creating connection opportunities for pupils with medical condition and their classes.

Psychological functioning and psychosocial issues in pediatric kidney transplant recipients

Research demonstrates that psychological factors are important for positive transplant outcomes, though there is little literature that synthesizes these factors in a comprehensive model among pediatric kidney transplant patients. This review analyzes psychological and psychosocial factors related to medical outcomes and overall well-being post-transplant by utilizing the PPPHM and referencing the existing literature on risk and resilience. Pediatric kidney transplant recipients are more susceptible to mental health concerns such as depression, anxiety, and ADHD, as well as developmental and neurocognitive delays, compared to healthy peers. Complex medical care and psychosocial needs for patients have implications for family functioning, parental and sibling mental health, and youth readiness to transition to adult care. It is important to carefully monitor patient functioning with empirically validated tools and to intervene in a multidisciplinary setting as early as possible to identify patients at risk and reduce potential negative impact. Psychologists are uniquely trained to assess and address these issues and are a valuable component of multidisciplinary, culturally competent care. While research in this expansive field is improving, more data are needed to establish gold standard approaches to mental health and psychosocial care in this population.

Tools of the trade to address schooling related communication needs after childhood cancer: A mini-review with consideration of health disparity concerns

Over the last 60 years, success rates in treating childhood cancers have grown dramatically from 10% to greater than 85%. Negative effects of treatments, however, place survivors at risk for neurocognitive deficits that can make school challenging. Evidence shows that receiving special education services can benefit affected children. However, communication and knowledge gaps among families and service providers can present access challenges. This mini-review considers the literature on communication between medical providers, families, and school professionals and identifies recommended tools for improving success and efficiency. Additional recommendations are made regarding improving access and adoption of such tools including the need for adaptations and expansions of available resources to address health disparity concerns for an increasingly linguistically and culturally diverse population.

Short-term perspectives of parents and teachers on school reintegration of childhood brain tumour survivors

Objective: To discover short-term changes in perspectives of parents and teachers of childhood brain tumour survivors on school reintegration, in order to reveal similarities and differences between them over time. Methods: Semi-structured interviews were conducted with parents and teachers of five children at the start and the end of a 1-year period following the child's school re-entry. Results: Thematic analysis of data resulted in three main themes: 'the child's performance and wellbeing', 'the school's attitude and approach' and 'communication and working together'. Parental concerns about child-specific changes and the school's approach to the child could either decrease or increase over time. Teachers remained focused on assessing their pupil's learning potential and finding ways of appropriate support. Their different perspectives on communication and working together became more pronounced. Conclusions: This study emphasizes the importance of clear communication and collaboration, coordinated follow-up and availability of healthcare professionals during the child's school reintegration.

Addressing Career-Related Needs in Adolescent and Young Adult Cancer Survivors: University Career Service Professionals' Experience and Resources

Many adolescent and young adult (AYA) survivors are transitioning not only from patient to survivor but also transitioning to the workforce. AYA survivors report many career-related concerns. Career service professionals are well positioned to provide targeted resources. A survey of 40 career service professionals at colleges and universities in the United States revealed that although they have had experience working with AYA survivors, most do not feel adequately trained or aware of survivors' unique needs. However, they are highly receptive to specific resources for AYA survivors. Maximizing connections between career service professionals and AYA survivors may help address survivors' career-related concerns.

"From Snail Mode to Rocket Ship Mode": Adolescents and Young Adults' Experiences of Returning to Work and School After Hematopoietic Cell Transplantation

PURPOSE

Resuming normal activities, such as work and school, is an important dimension of psychosocial recovery in cancer survivorship. Minimal data exist regarding adolescents or young adults' experiences of returning to school or work after cancer. The purpose of this study was to explore the processes of resuming work and school among adolescents and young adults after hematopoietic cell transplantation (HCT).

METHODS

In-depth interviews were conducted with 18 adolescents and young adults, who were 15-29 years when they underwent HCT and 6-60 months post-transplant at study enrollment. Interview transcripts were systematically analyzed using Grounded Theory methodology.

RESULTS

Participants described the context in which they attempted to return to work or school, specific challenges they faced, and strategies they developed in these environments. Feeling left behind from their peers and their pre-diagnosis selves, participants described "rushing" back to school and work impulsively, taking on too much too quickly while facing overwhelming physical and cognitive demands. Factors motivating this sense of urgency as well as barriers to successful and sustainable reentry in these settings are also addressed.

CONCLUSION

Findings are discussed in the context of important opportunities for clinical management, age-appropriate interventions, and implications for future research. A better understanding of psychosocial late effects, specifically related to school and work trajectories after cancer, is critical to survivorship care for adolescent and young adult cancer survivors.

Attending school after treatment for a brain tumor: Experiences of children and key figures

Reintegration into school is a milestone for childhood brain tumor survivors, as well as for their parents, teachers, and healthcare providers. We explored their experiences following the school re-entry by conducting semi-structured interviews. Thematic analysis resulted in four main themes: “school performance,” “psychosocial well-being,” “support and approach,” and “communication and collaboration.” Children were pleased to return to school despite confrontation with adverse outcomes. Parents, teachers, and healthcare providers identified current and future concerns and challenges, as well as opportunities for academic and personal development. Their experiences highlight the importance of coordinated and systematic follow-up in close collaboration with healthcare providers.

How to Increase the Quality of a Suffering Experience: Lessons Derived From the Diary Narratives of a Dying Adolescent Girl

Personal narratives are assumed to be primary sources of the essential meaning of lived experiences of dying. In this study, I analyzed the personal diary of Miraç Fidan, a terminally ill adolescent with advanced cancer who kept a diary until her death at the age of 15. Miraç’s Diary, also published as a book, was subjected to hermeneutic phenomenological narrative analysis. Inferences were drawn regarding the following basic elements: (a) The dynamics in which Miraç lived and (2) her perceptions of herself, her immediate environment, and her experiences. Suffering seems to be the main experience dominating Miraç’s life, which I examined with regard to two dimensions: suffering caused by inevitable factors and suffering caused by preventable/changeable factors. The results suggest that if various causes among contextual factors are neutralized, then the quality of the existential experience determined by the inevitable factors would increase.

How teenagers continue school after a diagnosis of cancer: experiences of young people and recommendations for practice

Aim: To understand how teenagers experience school following a diagnosis of cancer, and to offer recommendations for practice. Methods: Using visual interviewing at three time points, 12 participants (13–16 years) from England discussed school experiences during the year following their diagnosis. Interpretative phenomenological analysis provided in-depth assessment of their individual experiences. Results: One main theme emerged: regulation and calibration. Remaining engaged in school allowed teenagers to maintain noncancer versions of themselves as well as incorporating new cancer experiences. Six subthemes emerged: examinations/grading, school community, miscommunications, peers, altered appearances and normality. Conclusion: A total of 13 recommendations are offered for the development of education support to young people with cancer, covering the role of the school, the young person and their peers, flexibility and timing.

A School Passport as Part of a Protocol to Assist Educational Reintegration After Medulloblastoma Treatment in Childhood

BACKGROUND

Medulloblastoma is the most common malignant brain tumour in children and is treated with a combination of surgery, radiotherapy and chemotherapy. These children frequently experience long-term cognitive, social and physical sequelae, which significantly affect school reintegration.

AIM

This study aimed to explore school-return experiences to create a more structured school reintegration protocol for children postmedulloblastoma.

METHODS

A cohort of nine patients who had completed treatment and for whom full neuropsychometric data were available was included in the study (median time since diagnosis 8 years). Data were collected using qualitative parental questionnaires, semistructured interviews with teachers (n = 12) and healthcare professionals (HCPs) (n = 6) involved in their school reintegration. Thematic analysis was employed. A focus group with five HCPs was then used for data validation.

RESULTS

This study uncovered the following four main subjects: (1) Information sharing; (2) education and empowerment (of educational professionals (EP) and parents); (3) communication between parents, HCPs and EPs; and (4) long-term difficulties.

DISCUSSION

Implementation of a standardised protocol delivered within the structure of a school passport document would aid uniform follow-up. The proposed multistage protocol includes early communication and reintegration planning followed by meetings at school re-entry. Follow-up meetings are suggested to reduce information loss and reassess the child's needs. Hospital support at school transitions, inclusion of school data in long-term clinical follow-up and long-term rehabilitation are also recommended. Each stage would be supported by school passport documentation and would facilitate school and parental empowerment, paramount to the long-term sustainability of successful schooling.

Child and family adjustment following pediatric solid organ transplantation: factors to consider during the early years post-transplant

Adjusting to life after transplant can be challenging to pediatric solid organ transplant recipients and their families. In this review, we discuss a number of important factors to consider during the first 2-3 yr after transplant (defined as the "early years"), including transitioning from hospital to home, returning to physical activity, feeding and nutrition, school reentry, potential cognitive effects of transplant, family functioning, and QOL. We highlight steps that providers can take to optimize child and family adjustment during this period.

The impact of a cancer diagnosis on the education engagement of teenagers - patient and staff perspective

PURPOSE

Engagement with education during treatment is an important and complex issue for practitioners and an important psychosocial need of teenagers with cancer. There is limited research currently available specifically concerning the education of teenagers with cancer. This paper reports the outcomes from a patient and a practitioner questionnaire study which explore prominent issues and experiences in educational engagement for this population.

METHOD

Eighty-eight teenage cancer patients completed a questionnaire about their education experiences since diagnosis. Forty oncology practitioners completed an online questionnaire on experiences of education engagement of teenage patients. Questionnaires were developed from a systematic research review conducted by the authors and included; peer relationships, school attendance, reintegration and long term effects of cancer on attainment.

RESULTS

Among teenagers there was a significant relationship between successful maintenance of peer groups, successful reintegration into school and positive ratings of the education support. Teenagers who reported school as their primary source of support had significantly more successfully maintained peer groups. Practitioners rated peer support as the most important factor in education satisfaction for patients and stressed the need for collaborative planning between hospital, school and home.

CONCLUSIONS

Collaborative education planning should be initiated on diagnosis and aim to include non-academic variables, such as peer groups, which can influence successful maintenance of education. Further research is needed to understand the relationship between education engagement and teenagers' cancer experiences as a whole, as well as gaining a more in depth understanding of how teenagers experience their education after a diagnosis of cancer.

Cognitive consequences of the treatment of medulloblastoma among children

Progress in the treatment of medulloblastoma has resulted in increased survival among children. However, effective treatment, especially radiation therapy, produces negative consequences in the cognitive development of children, in terms of decreased intelligence quotients. Determining the factors underlying this decrease may influence the types of rehabilitation needed by children who undergo treatment for medulloblastoma. We review recent research on the impact of some factors that may underlie the cognitive deficits of pediatric and adolescent survivors, i.e., verbal comprehension, perceptual organization, attention, and processing speed. We assess eight pediatric survivors of medulloblastoma treatment with surgery, radiation, and chemotherapy. Children were assessed twice after diagnosis, using the Wechsler Intelligence Scale for Children-Third Edition. A large decrease in cognitive capacity was evident, as measured by intelligence quotients and factor indices. A raw score analysis of 12 subtests was performed, indicating a slower acquisition of functions and knowledge in the domains of verbal comprehension, perceptual organization, social perception, and psychomotor skills. We discuss issues of social reintegration, and propose that the rehabilitation of pediatric patients must include a program for social reinsertion, in addition to psychoeducational support.