Teacher, parent, and child evaluative ratings of a school reintegration intervention for children with newly diagnosed cancer

Back to school - The teachers' worries and needs having a childhood cancer patient or survivor in their class

BACKGROUND

A cancer diagnosis during childhood or adolescence causes nursery and school absences to various degrees. Attending school and meeting classmates gives many children and adolescents some normality back. Nevertheless, it can cause fears and concerns among the teachers. We are currently lacking information about the fears and needs of teachers having a child or adolescent diagnosed with cancer or with a cancer history in their classes. With this study, we aim to close this knowledge gap and assess the teachers' fears, worries and information needs having a child or adolescent diagnosed with cancer in the class to develop a suitable information tool (flyer).

METHODS

We performed an online survey including teachers covering all grades from nursery to vocational school within the catchment area of our hospital. The survey included separate questions for experience with students still receiving active treatment and those in follow-up care. Answer options included tick boxes and open-ended questions, which we grouped thematically. We used descriptive analysis to describe the survey findings, resulting in a newly developed flyer.

RESULTS

In total 358 teachers participated in the survey, 80% were female, 63% worked in nursery or primary school. One quarter (26%) had experience with a student diagnosed with cancer. Most teachers with (81%) and without (85%) experience reported at least one concern. The top three concerns reported were: (1) how to inform the class, (2) the resilience of the student and (3) how to deal with the student and his or her family. The teachers preferred oral information by physicians or parents and written information equally. Information on resilience, guidelines with an emergency situation, and the need for cancer-specific information were considered important by about 75-94% of the teachers.

CONCLUSION

Most teachers reported concerns, which we cover in a newly developed information flyer. However, such a flyer cannot replace individual communication between health care professionals and teachers. The identified concerns are likely to be transferable to other school systems and countries.

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.

Optimization of School Reintegration for Pediatric Oncology Patients and Their Peers

Improved survival rates of pediatric oncology patients give them the opportunity to return to school. This can present a significant challenge, as returning students often become vulnerable to peer rejection. The objective of this double-arm descriptive study was to establish a framework from which to optimize a school reintegration intervention for the peers of pediatric oncology patients. Ultimately, the study aimed to promote increased knowledge, acceptance by peers, and a smooth transition back to school for childhood cancer survivors. We utilized age-appropriate surveys to evaluate the knowledge and concerns of 3rd to 8th-grade students in Michigan regarding friends with cancer and to identify concerns of pediatric oncology patients at an academic medical center regarding return to school during or after cancer treatment. The majority of 3rd to 8th-grade students correctly answered questions related to etiology, prognosis, side effects, and treatment of cancer. Respondents in 3rd to 5th grade were significantly more likely than 6th to 8th graders to endorse the perception that cancer is contagious (P = 0.0036). Fewer students who had a friend with cancer were worried that their friend might die, compared to those who did not have a friend with cancer (3rd to 5th graders [P = 0.0002]; 6th to 8th graders [P = < 0.0001]). Results suggest that peer intervention may be optimized via customization based upon student concerns rather than focusing on cancer education. Additionally, personalized interventions and assistance for patients should strive to reduce stigma and differentiation from other students.

School and educational support programmes for paediatric oncology patients and survivors: A systematic review of evidence and recommendations for future research and practice

OBJECTIVES

The Psychosocial Standards of Care (PSSC) in paediatric oncology prescribe the minimum standards for education support. It is unknown, however, if published education support programmes for children with cancer meet the PSSC standards for education support. Successful implementation of standards for education support is challenging but may be achieved with guidance. We aimed to (1) review education support programmes for childhood cancer patients and survivors against the PSSC standards and (2) provide practical recommendations for future research and implementation of education support programmes.

METHODS

We searched PsycINFO, PubMed, CINAHL, EMBASE, and Educational Resources Information and Center databases. We reviewed the education support programmes using five evaluation criteria derived from the PSSC and summarised the structure of identified programmes. We examined the features and limitations of programmes that met all evaluation criteria.

RESULTS

We identified 20 education support programmes in paediatric oncology, including peer programmes (n = 3), teacher programmes (n = 5), and school re-entry programmes (SRPs n = 12). We found that three SRPs met all evaluation criteria and that SRP components were timed according to the child's position on the cancer trajectory (e.g., diagnosis and treatment, school re-entry, and follow up throughout schooling). The supporting evidence of the programmes, however, is unclear due to the lack of adequately designed studies.

CONCLUSIONS

SRPs provide a promising structure for future education support programmes. We recommend strategies for developing and evaluating education support that adheres to the PSSC and adapts to international and local contexts.

PICU Follow-Up: The Impact of Missed School in a Cohort of Children Following PICU Admission

For children and their families, PICU admission can be one of the most stressful and traumatic experiences in their lives. Children admitted to the PICU and their parents experience sequelae following admission including psychologic symptoms and lower health-related quality of life. The impact of a PICU admission on school attendance and performance may influence these sequelae. The purpose of our study was to examine how community supports from pediatricians and schools influence school success after critical illness.

DESIGN

Parents were recruited during their child's admission to the PICU. Three months after discharge, parents completed follow-up questionnaires via telephone.

SETTING

PICU in an urban academic children's hospital.

SUBJECTS

Thirty-three parents were enrolled in the study, and 21 (64%) completed phone follow-up.

MEASUREMENTS AND MAIN RESULTS

Forty-three percent of children missed 7 or more days of school while admitted to the PICU. Sixty-seven percent of parents reported that their pediatrician did not ask about missed school, and 29% felt their child's grades worsened since admission. Twenty percent of respondents felt that their child's school did not provide adequate services to help their child catch up.

CONCLUSIONS

There are missed opportunities for care coordination and educational support after critical illness. The transition back to school is challenging for some children, as reported by parents who described inadequate support from the school after PICU hospitalization and a subsequent decline in their child's school performance. Additional studies are needed to develop proactive community supports to improve the transition back to school for a child after critical illness.

Hospital Based Psychosocial Support Program for Children with ALL and their Families: A Comprehensive Triad's Perspective

OBJECTIVES

To elucidate potential target areas of intervention and mechanisms for implementation of intervention for children with cancer during the treatment phase.

METHODS

Focused group discussion (FGDs) served as a primary source of providing phenomenal perspectives to explore the key objective. Eight focus groups of 45-60 min each were held with 5-9 members in each discussion. The participants were either patients, their caregivers or health care providers. The focus group audio recordings were professionally transcribed after all identifiers were removed. Employing a constructivist paradigm with a phenomenological approach, also known as emergent-systematic focus group design the study reported on families' experiences of childhood cancer as construction of objective reality. Investigator triangulation method was adopted to ensure trustworthiness.

RESULTS

Using constant comparison analysis, multistage process analysis was done which resulted in 849 codes, 32 subthemes, 20 themes and 5 domains. A total of 64 participants participated: 4 FGDs with parents of children with ALL (n = 31); 1 FGD with professionals working in the field of cancer (n = 10) and 3 FGDs with children with ALL (n = 23). Participant's mean age at the time of study was 10 y (+3.3) for children; 37 y (+4.93) for caregivers and 35 y (+3.5) for professionals. The number of participants and their age range at study varied slightly between the eight focus groups.

CONCLUSIONS

Caregivers presented care burden and compromised aspects of Quality of life (QOL). An effective and culturally sensitive psychosocial support for patients and their families during and post treatment, in addition to medical therapy, is strongly recommended.

Examining a Statewide Educational Consulting Program for Pediatric Brain Injury

This study describes characteristics of students with acquired brain injury enrolled in a statewide educational consultation program and the program's support activities. Utilizing deidentified data from a statewide brain injury school consultation program, descriptive analyses of demographic and injury characteristics, including medical diagnosis (concussion/mild traumatic brain injury [TBI], moderate-severe TBI, and non-TBI), referral characteristics, educational placement, and the types of program activities were undertaken. 70% of students were referred for concussions/mild TBI and students were infrequently referred by medical professionals. Most students with concussion/mild TBI experienced recreational injuries (59%), while students with moderate/severe TBI commonly experienced road traffic injuries (48%). The greatest proportion of program team members' time was spent in consultation with school personnel (24%), communication with families (20%), and communication with school personnel (16%). Results suggest that the program addresses important communication and coordination needs among families, medical professionals, and educators and identifies opportunities to enhance program utilization.

The Effectiveness of a Hospital-Based School Liaison Program: A Comparative Study of Parental Perception of School Supports for Children With Pediatric Cancer and Neurofibromatosis Type 1

Childhood survivors of central nervous system (CNS) cancers (defined as cancers whose diagnosis or treatment affect the CNS) are at increased risk for educational related difficulties, as are children affected by neurofibromatosis type 1. This study evaluated the effectiveness of and satisfaction with a model of psychoeducation, consultation, and advocacy provided by a School Liaison Program (SLP) for families and schools of children with CNS-involved cancers compared with a control group of parents of children with a diagnosis of neurofibromatosis type 1 who did not receive school-based services. Results indicated significant between-group differences in parents’ belief that their child is meeting academic potential, with parents who received SLP services reporting greater satisfaction with their child’s progress, better understanding of their child’s learning needs, and an increased ability to access school supports. The strong, positive impact associated with the consultation, psychoeducation, and parental advocacy training provided by the SLP suggests that a similar model of care would potentially benefit other groups of children whose neurocognitive functioning is compromised by chronic medical conditions.

Results from a randomized trial evaluating a hospital-school transition support model for students hospitalized with traumatic brain injury

OBJECTIVE

To evaluate the utility of the STEP model, a systematic hospital-school transition protocol for children hospitalized for TBI.

SETTING

Five children's hospitals in Colorado, Ohio, and Oregon.

PARTICIPANTS

Hundred families of children with mild, complicated mild, moderate, or severe TBI.

DESIGN

Randomized controlled trial (RCT); participants were randomized while hospitalized to the STEP (a standardized hospital-school transition protocol for children treated for TBI) or usual care condition.

MAIN MEASURES

Questionnaire about child's special education eligibility status, support services, and academic accommodations; Achenbach Child Behaviour Checklist (CBCL); Behaviour Rating Inventory of Executive Function (BRIEF); Child and Adolescent Scale of Participation (CASP); Child and Adolescent Scales of Environment (CASE) Results: There were no significant effects, indicating that STEP participants did not differ from usual care participants on any study outcome at one month post-discharge or at one-year follow-up.

CONCLUSION

The lack of significant findings in this study does not imply that effective hospital-to-school transition programming is unnecessary. Rather, the findings raise important questions regarding timing and dosage/intensity of intervention, appropriate measurement of outcomes, and fidelity of programme delivery. The study highlights difficulties involved in the conduct of community-based RCTs in the paediatric TBI population.

Parent perspectives on the educational barriers and unmet needs of children with cancer

Childhood cancer challenges academic success and school engagement, yet little research has described these hardships. This study documented parental perspectives of the educational barriers and unmet needs of youth treated for cancer (n = 102). Treatment-related physical sequelae were noted as common problems interfering with school attendance and engagement. One-fourth of parents reported worse academic performance since diagnosis; however, many never had their child evaluated (63.3%) or enacted formalized educational accommodations (55%). Findings reflect educational challenges across the continuum of cancer care and survivorship, and highlight the importance of education of school staff on both acute and long-term effects of cancer treatment.

Supporting Pediatric Cancer Survivors With Neurocognitive Late Effects

Educational difficulties are common for childhood survivors of central nervous system (CNS) cancers. Children who have been treated for brain tumors and those who have received treatments involving the CNS are at increased risk of developing neurocognitive late effects including difficulties with attention, executive functioning, speed of processing, and academic functioning. These children are also at risk for difficulties with social functioning and social isolation. This hospital’s School Liaison Program (SLP) provides ongoing psychoeducation, advocacy, and consultation services for parents, schools, and medical staff to address the educational needs associated with the late effects of treatment for pediatric CNS-involved patients. This article provides an overview of the SLP model of care and discusses parent-perceived quality and program effectiveness. In general, parents attributed SLP involvement to improved academic performance, home-school communication, and school-level understanding of unique student cognitive profiles and learning needs.

Study protocol: Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer (RESPECT)

BACKGROUND

During cancer treatment children have reduced contact with their social network of friends, and have limited participation in education, sports, and leisure activities. During and following cancer treatment, children describe school related problems, reduced physical fitness, and problems related to interaction with peers.

METHODS/DESIGN

The RESPECT study is a nationwide population-based prospective, controlled, mixed-methods intervention study looking at children aged 6-18 years newly diagnosed with cancer in eastern Denmark (n=120) and a matched control group in western Denmark (n=120). RESPECT includes Danish-speaking children diagnosed with cancer and treated at pediatric oncology units in Denmark. Primary endpoints are the level of educational achievement one year after the cessation of first-line cancer therapy, and the value of VO2max one year after the cessation of first-line cancer therapy. Secondary endpoints are quality of life measured by validated questionnaires and interviews, and physical performance. RESPECT includes a multimodal intervention program, including ambassador-facilitated educational, physical, and social interventions. The educational intervention includes an educational program aimed at the child with cancer, the child's schoolteachers and classmates, and the child's parents. Children with cancer will each have two ambassadors assigned from their class. The ambassadors visit the child with cancer at the hospital at alternating 2-week intervals and participate in the intervention program. The physical and social intervention examines the effect of early, structured, individualized, and continuous physical activity from diagnosis throughout the treatment period. The patients are tested at diagnosis, at 3 and 6 months after diagnosis, and one year after the cessation of treatment. The study is powered to quantify the impact of the combined educational, physical, and social intervention programs.

DISCUSSION

RESPECT is the first population-based study to examine the effect of early rehabilitation for children with cancer, and to use healthy classmates as ambassadors to facilitate the normalization of social life in the hospital. For children with cancer, RESPECT contributes to expanding knowledge on rehabilitation that can also facilitate rehabilitation of other children undergoing hospitalization for long-term illness.

TRIAL REGISTRATION

Clinical Trials.gov: file. NCT01772849 and NCT01772862.

School liaison program for children with brain tumors

A school liaison program that familiarized teachers with the implications of each child's brain tumor treatment with respect to learning, behavior, and socialization was implemented. The study explored the experiences of nine families and their teachers and health staff who participated in the program. The successes and challenges of the program were captured through interviews that were audio-taped and transcribed verbatim for data analysis. Individualized programs were negotiated between families and education staff to address behavioral, academic, and social needs of each child. Children were able to learn to their ability rather than be judged on the achievements of their respective grade levels. Parents reported that the program strengthened their advocacy skills and improved the children's social and learning achievements. Teachers reported an improved ability to provide more comprehensive educational programming suited to the child's needs. Overall, most children in the program achieved or exceeded their initial academic, social, and behavioral expectations. The school liaison program demonstrated significant potential to enhance the learning experience for children with brain tumors.

Psychiatric aspects of pediatric cancer

The diagnosis and treatment of children and adolescents with cancer has a tremendous and lasting effect on the patients, their families, and other individuals in their social network. It carries a host of psychological and behavioral ramifications, from questions of mortality to changes in levels of functioning in multiple domains. In this review the authors address the psychosocial and treatment-related issues that arise in children with cancer, with attention to the adjustment to cancer at different developmental stages, mood and anxiety issues, treatment-related psychiatric sequelae, and the challenges faced by childhood cancer survivors.

Feasibility of a school reintegration programme for children with acute lymphoblastic leukaemia

Despite children with acute lymphoblastic leukaemia missing a significant amount of school, little empirical literature guides the optimal content, setting and timing of a school reintegration programme. We examined the feasibility of a 4-month school reintegration intervention by: (1) developing collaboration with a community-based advocacy organisation; (2) developing intervention modules and observable end points; and (3) determining how the study achieved recruitment expectations. Eight families with children aged 6-12 years diagnosed with acute lymphoblastic leukaemia and parents were enrolled in the study. An experienced advocate implemented a series of eight modules over a 4-month period (twice per month) with the families. Participants completed pre-post measures. Successful collaboration with the advocacy organisation and the development of an intervention module series were achieved. Recruitment aims proved more difficult: enrolment was extended when recruitment for the original 1- to 6-month post-diagnosis window proved difficult. The advocate was able to complete between three and seven of the modules (mean = 5.2, standard deviation = 1.5). Families preferred clinic-based intervention. Challenges faced and lessons learned include: (1) advocacy organisations may be useful resources for school reintegration interventions; (2) school reintegration interventions must be flexibly applied; and (3) measurement end points constructed to gauge programme effectiveness.

Psychiatric aspects of pediatric cancer

The diagnosis and treatment of children and adolescents with cancer has a tremendous and lasting effect on the patients, their families, and other individuals in their social network. It carries a host of psychological and behavioral ramifications, from questions of mortality to changes in levels of functioning in multiple domains. In this review the authors address the psychosocial and treatment-related issues that arise in children with cancer, with attention to the adjustment to cancer at different developmental stages, mood and anxiety issues, treatment-related psychiatric sequelae, and the challenges faced by childhood cancer survivors.

Psychosocial dimensions of cancer in adolescents and young adults

Psychosocial research examining the impact of cancer on adolescents and young adults has focused mostly on domains relating to family, psychological/emotional impact and social effects. An overview of the evidence-based literature available in each of these domains is presented to highlight the trends and provide a basis for clinical application. A review of the research literature was conducted to summarize what is known regarding the psychosocial dimensions of cancer in adolescents and young adults. Key elements critical to the psychosocial adaptation of the adolescents and young adults with cancer, as well as later effects of the cancer experience, are discussed in terms of clinical implications. A case example is utilized to demonstrate the application of what has been investigated empirically in regard to psychosocial dimensions of cancer in young adults and adolescents. Studies have identified various psychosocial challenges that adolescents and young adults experience when faced with cancer. Further research, incorporating the effects of treatment stage and developmental level of the patient on specific psychosocial dimensions of the cancer experience, is needed. Evidence-based information regarding the influence and interaction of family, psychological and emotional state, and social status of adolescents and young adults with cancer can aid clinicians when developing psychosocial assessment and treatment approaches for these patients.

Psychosocial issues in adolescents with cancer

Cancer in adolescents is uncommon and when it occurs raises a number of unique challenges for both the patient and their families. Adolescence is a period of time of significant physical and emotional changes and a diagnosis of cancer during this time has a major impact on their psychological and physical development. In this review we will look at the psychosocial issues facing adolescents who have cancer. We will address adolescent development, issues related to informed consent and assent, initial responses to the diagnosis of cancer, quality of life and the experience of the adolescent with cancer, psychological adjustment, support systems, body image issues, sexuality, education, hope, and treatment compliance.

When a parent has cancer: a community based program for school personnel

Little information has been published on interventions designed to help school personnel respond to challenges faced by a family dealing with parental cancer. The current study describes the development and piloting of a program that educated school professionals about cancer's impact on families, and effective ways of supporting families facing parental cancer. The program was implemented at four sites; 244 participants completed self-report questionnaires before and after the program assessing knowledge and anxiety about helping families. t-tests indicated that after the program, participants rated themselves as significantly more knowledgeable and confident about helping families with parental cancer. These differences represented large effect sizes. Post hoc comparisons revealed that initial knowledge and knowledge change varied by profession, having had personal experience with cancer, and having worked with several families facing cancer. Participants reported learning about how to reach out and listen to families' needs. These results are extremely encouraging; plans for further program refinements and evaluation are discussed.

Family impact of neurodevelopmental late effects in survivors of pediatric cancer: review of research, clinical evidence, and future directions

Children and adolescents who have survived childhood cancer are vulnerable to late effects of their disease and treatment experience, including both physical and psychological sequelae. The neurodevelopmental (ND) sequelae (e.g., difficulties with attention, memory, information processing, and other executive functions) faced by children surviving central nervous system (CNS) cancers or CNS treatments can have a range of effects on their psychological adjustment and quality of life as they reintegrate into school and social settings. Survivors facing such difficulties may be influenced by their family environment, and these struggles may in turn impact the perceived burden of their parents and family system, suggesting a bidirectional framework for understanding the impact of ND late effects within the family. The current study summarizes the following: Findings of family outcomes in children with ND late effects of cancer treatment; evaluation of methodological and measurement issues; the importance of examining bidirectional family-child influences; and implications for future survivorship research and clinical care addressing the role of ND late effects from a systems perspective.

School re-entry after a cancer diagnosis: physician attitudes about truth telling and information sharing

BACKGROUND

School re-entry for children with cancer hallmarks a return to age-appropriate activities; a process fraught with adjustment challenges. The paediatric oncologist is in a pivotal role of setting the tone and providing direction to the child, family, and other members of the health care and school team about this process. Understanding physicians' attitudes and behaviours regarding school re-entry will provide insight into these practices.

METHODS

A four-part survey (general attitudes, patient factors, work cultures and respondent characteristics) was developed and mailed to the members of US and Japanese paediatric oncology professional societies. Japanese (n=362) and US (n=350) paediatric oncologists comprised the study sample; the average respondent was a male in his mid-forties providing clinical care>or=5 hours/week practising for about 15 years. Responses to a hypothetical scenario reflecting the range of how school re-entry issues for a child on treatment may be handled was the outcome variable in this report.

RESULTS

US physicians (284/350, 84.5%) endorsed telling everyone (the school officials and classmates) about a child's diagnosis and treatment to facilitate the transition back to school. In contrast, only 93/359 (25.9%) of the Japanese respondents endorsed telling everyone. Japanese physicians were more likely to endorse telling everyone if they believed it was the physician's responsibility to tell children the truth at diagnosis (P<0.001), if they did not believe that awareness of cancer dashes hope (P=0.002), and were not influenced by type of cancer the child had (P=0.003).

CONCLUSIONS

Differences in US and Japanese paediatric oncologist responses in return to school issues may reflect larger cultural issues such as: benefits and disadvantages to telling the child that he/she has cancer; hospitalization practices; and the availability of school re-entry programs. More needs to be learned about how children, their families and schools prefer to have re-entry issues handled during and after treatment and how these approaches affect the child's re-entry into school.

Psychosocial Functioning in Pediatric Cancer

OBJECTIVE

To describe the emergence of pediatric psycho-oncology and to summarize research on psychosocial aspects of childhood cancer and survivorship.

METHODS

To review research into illness communication and informed consent, procedural pain, late effects, psychological distress, coping and adjustment, and special risk populations. Methodological challenges, appropriate methodology, and directions for future research are discussed.

RESULTS

The past 30 years have seen change from avoidance of communication about cancer to an emphasis on straightforward discussion of diagnosis and prognosis. Behavioral research has led to interventions to reduce procedural distress. Late effects have been observed in social functioning. Although average levels of distress in survivors of pediatric cancer are typical, subsets of more vulnerable patients and family members exist. Factors predicting positive and negative coping have been identified.

CONCLUSIONS

As the numbers of pediatric cancer survivors increase, psychosocial researchers will be better able to conduct longitudinal studies not only of adjustment and its predictors but also of the impact of the emerging medical treatments and interventions to ameliorate late effects of treatment. Additional funding, improving methodology, and multi-institutional cooperation will aid future pediatric psycho-oncology investigators.

Childhood brain tumors: children's and siblings' concerns regarding the diagnosis and phase of illness

Our objective was to identify commonly reported problems and helpful resources important to children with brain or spinal cord tumors and siblings during phases of illness. Affected children and siblings from 40 families responded to a regional survey. Items encompassed four general content areas: health care provider interactions, medical information/education, health care utilization, and psychosocial. Children rated individual items as helpful, a problem, and for importance; relative frequencies were derived. One-third or more affected children reported important problems: hospitalization/surgery--help with schoolwork; hospital discharge--help with changes in physical activity, appearance, moods, special needs at school; adjuvant treatment--Internet information, help with moods; and remission--socializing. One-third or more siblings reported important problems: diagnosis--information about etiology and prognosis, manner of physician and parents in providing information; hospitalization/surgery--information about prognosis, help with schoolwork; hospital discharge--help with schoolwork; adjuvant treatment--help with changes in sister or brother's appearance, physical activity, moods, and information about the treatment; end of life--treatment of sister's or brother's pain, information about dying, family harmony, support from friends, help with schoolwork, and preparation for the death. Consideration of problems and helpful resources will provide the framework for developing and evaluating intervention strategies at each phase of illness.

Peer relations of youth with pediatric conditions and health risks: promoting social support and healthy lifestyles

Peer relations and close friendships play important roles in youngsters' emotional development and take on special significance when a child or adolescent has a chronic disease. This article reviews the key ways that peer relations have been examined in youth with chronic pediatric conditions and specifically focuses on (1) the role of peers and close friends as a source of support, (2) friends' influence on treatment adherence, and (3) peers' and friends' impact on health-promoting and health-risk behaviors. In general, youngsters with chronic conditions do not have more problems in their peer relations than other youth, although children with medical conditions that are stigmatizing or that involve the central nervous system (CNS) may encounter peer difficulties. Social support from friends and classmates appears to facilitate youngsters' disease adaptation and may help with the lifestyle aspects of treatment regimens. Adolescent peer-crowd affiliations (e.g., "brains," "jocks") that are linked with health-promoting behaviors may prove beneficial to youngsters' disease management and health. The findings underscore the need for helping children and adolescents disclose their medical condition to peers in positive ways and for including youngsters' close friends in the treatment process and in school-reentry programs after extended medical care. Additional research is needed to develop strategies for incorporating youngsters' peers and friends into the medical management of youth with chronic pediatric conditions.

The school experience of the child with cancer

OBJECTIVE

To review literature investigating school absence, behaviour problems and social relationships of children with cancer on return to school. Additionally, we reviewed interventions aimed at promoting successful school re-entry for children with cancer, and increasing classmates and teachers understanding of childhood cancer.

METHODS

Electronic searches were used to identify studies examining the effects of school re-entry on children with cancer.

RESULTS AND CONCLUSIONS

School absences are higher for children with cancer than healthy children and those with other chronic conditions. Although there is mixed evidence about whether children have significant behavioural problems, studies involving social relationships generally conclude that children with cancer are more sensitive and isolated than peers, according to both peer and teacher report.

The needs of children and adolescents with cancer for information and social support

Research has indicated that information and social support may have helped children and adolescents with cancer to cope with their illness and lead normal lives. However, recent researchers have reported that youths with cancer express a clear interest in receiving more information and social support. This study reviewed research on information and social support for children and adolescents with cancer to understand their needs. Young patients with cancer showed high uncertainty about cancer. Besides, adolescents with cancer were more in conflict with their parents than healthy youths. Discussions on future plans or death are difficult for young people with cancer. They also are frequently absent from school over time. Moreover, they want to make healthy friends. To fulfill the needs of these youths, nurses should be aware not only of individualized information and social support, but also of these factors from an ecologic perspective. Further qualitative research is required to identify the needs of youths with cancer and resolve these issues.