Guidelines for School/Education

 SIOP Working Committee on Psychosocial Issues in Paediatric Oncology


Integration into school is a critical and essential part of the normal psychological and social development of any child. Children affected by a chronic illness such as cancer are not only entitled to attend school, but they must be stimulated to obtain a full recovery attendance at school.

With this in mind, the SIOP Psychosocial Committee dedicated the meeting in San Francisco (October 1993) to the educational programs of different hospitals that form one of the topics reported in the official document of this group.

In San Francisco, lengthy discussion followed 20 oral presentations from different world centres. A general consensus was reached on how to approach schooling and education in the paediatric oncology community. It was considered mandatory to have a well-defined and planned hospital/school program. The program for children suffering from cancer, based on the need for an open communication at their own appropriate level of development (age), should include the following issues.

School in hospital

The management of children with cancer requires the participation of a multidisciplinary team (physicians, psychiatrist and/or psychologist, nurses, social worker, teachers, recreation specialists), and the intervention must have the purpose of educating the child. Also, depending on his or her clinical condition, the child should be kept alert and occupied with play therapy.

In-hospital teachers must be chosen with care from among individuals who are sensitive to the needs of ill children, who are able and willing to follow the educational programs of each individual child’s school of origin, and who are sufficiently flexible to be able to substitute a play program when the child is too ill to study. Teachers must be as well trained and as stable as possible.

School re-entry program

Once the child is ready to return to normal school, the program for which parental approval will be necessary must include several points discussed below.

Channels of communication must be opened between the hospital personnel and the teachers of the school of origin. Personnel must explain the child’s specific medical condition to the teachers and must be ready and willing to explain the illness to the child’s classmates (when possible, one of the doctors from the centre should be present)*. Furthermore, a manual for teachers including information about the disease and how to cope with the ill child should be prepared. Teachers should be assured that their role is to teach and the hospital’s role is to treat. This frees the teachers from unnecessary worries, anxieties, or depression over the child’s physical problems. Suggestions should be given to the teachers for ways of helping the child to adjust in school and to reduce his or her anxiety about the illness. An atmosphere should be created where the child feels free to express his or her concerns. The program should support teaching methods that would help the child with cancer to keep up with classmates even while ill at home (e.g. fax, two-way radio or telephone, video or audio lesson.

Personalised education program

Children with cancer respond differently to various treatment protocols. It is incumbent on the hospital/school team (1) to determine the specific competence and needs of each individual child through one of the many educational instruments available for the purpose, and (2), to set in motion a personalised education program if the child requires extra help, with all of the necessary resources.

Every paediatric cancer program should dedicate sufficient resources to guarantee an appropriate educational support for every child with cancer. Good schooling and play therapy are not expensive.

Final comment

The reintegration of the child with cancer into school is an essential part of the total treatment program. It starts during the period of diagnosis, continues during the period of treatment, and is extended after the completion of treatment. Only co-operation among the family, care team, and educators, in addition to a well-structured program, can help in achieving this goal and preventing serious negative outcomes.

* Sometimes parents or the child itself want to explain the illness to the classmates. Teachers should stimulate and support them in doing that (the editors).

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