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Survivorship: During and After Treatment
When a child or teen is diagnosed with cancer, families and parents will face and need to cope with many problems, including the impact of a child's cancer diagnosis and treatment on regular school routines. A child's cancer diagnosis and treatment can interrupt regular school routines. Many children are able to continue their education during treatment and then will go back to school full-time at the end of treatment. See Helping Your Child Manage School During Treatment for information on keeping up with school before treatment ends.
Most children are able to return to school full-time after they complete cancer treatment. Going back to school is a priority because it can give children a sense of normalcy and is an important part of their social and academic development. Some children feel excited about returning to school, while others feel upset or anxious. These are all normal reactions. Going back to school might be a challenge or a relief. It might give your child the comforting message that they have a future and potential for a full recovery from cancer.
The transition back to school can be just as hard for parents. Parents might think school is going to be overwhelming for their child. They might worry their child will get infections, become overly tired, or be teased for being different. All of these concerns are normal. Most pediatric treatment centers know that families might need help to make sure the transition goes smoothly. Children’s hospitals may have education coordinators and teachers that make sure your child has the right support at school.
This piece will guide you through key steps in planning for the return to school after treatment ends, some common problems after returning to school, and things you can do to help.
After your child is diagnosed and long before any plans are made for them to return to school, you might have talked your child’s teachers, school principal, and school counselor about the cancer and the treatment plan. When your child is ready to go back to school,it is important to communicate early with the school and the cancer care team early. Here are some of the steps you can take before treatment ends to help get ready:
Talk to the cancer care team about when they think your child will be able to return to school after the end of treatment.
Once you have a planned return date, ask the cancer care team what resources will help plan for school re-entry. The school re-entry services might include nurses, teachers, psychologists, social workers, and child life specialists. If there is a re-reentry program, ask them what they will do to support your child's return to school. They might be involved in meetings with the school, arrange visits to the classroom, or communicate special needs to the school and teachers.
Reach out to the school principal, teacher, nurse (if there is one), and school counselor to let them know when your child might return full-time. They might have forms for you and the cancer care team to complete.
Arrange a meeting with the principal, teachers, and school nurse to make sure everyone knows what to expect. The cancer care school re-entry team members might participate and help guide this discussion, depending on the kinds of support they provide.
Some children might not be ready to return to school for full days the first week, so it could be helpful to think about how long their school day should be in the beginning. It may take them a few weeks or a month to build up their energy levels after cancer treatment. Talk to your doctor and cancer care team about these needs before you meet with the school leaders.
Meeting the teacher, principal, and school nurse (if there is one) before the child goes back to school is very important and can help everyone know what to expect. If your cancer care team offers support for retuning to school, ask if they will be at the meeting. If they will not be present, ask them to help you write a letter explaining any expected changes in the child’s routine and future plans. You’ll want to write down these things for the school’s records:
Once your child returns to school, you might find that not everything goes as planned. Going through cancer treatment was a big change. It is not unusual for your child to need more support emotionally or academically. You might find there are new physical changes that cause problems, or that the emotional adjustment is a challenge. Some treatments can also affect how children learn and think. Be sure to ask your child every week or so about any concerns they are having after returning to school. Some might need to be addressed quickly, especially if your child is feeling upset about them. Other changes due to cancer treatment may surface later. For more information, see Late Effects of Childhood Cancer Treatment.
Finding excuses to miss school could be a sign that your child is struggling with some part of going back there. If your child is tearful before and after school or every Sunday night, that might be a sign that they are having a hard time with the change. Older kids and teens might not want to go back to school because they look different, or because their long absences have changed their social standing with friends. If your child does not want to go to school, it is important to understand what is bothering them. Here are things you can do to understand the reason they are avoiding going back.
Other children may have questions for your child about cancer. It can be hard for children to know what to say in these situations. It usually helps to talk with your child before they go back to school about what to say, so they are ready if it happens.
Physical problems after cancer treatment can affect a child’s ability to get around and perform at school the way they did before their cancer diagnosis. Schools might need to accommodate a child’s physical needs after cancer treatment. Here are some examples of physical problems and ways to handle them.
If your child is having problems with fatigue or weakness
If your child is having problems with appetite, thirst, or using the bathroom
Most children adjust well to school after cancer treatment. But cancer and its treatments can cause emotional and cognitive (ability to think and reason) changes, which can affect your child at school. You can help your child by watching for problems, so they can be dealt with as soon as possible, before they become hard to manage. Some changes after treatment that affect learning can last a few months, others may last longer. Children can experience something called chemo brain that can make is hard to focus, complete tasks or remember things. Some treatments have long-term effects on learning, so it is important to get help as soon as problems with schoolwork come up.
Sometimes children who have had cancer treatment will have learning problems and need extra help. Most children who are at risk for learning problems from cancer treatment will benefit from testing, often called neuropsychology testing, to understand their individual learning needs. This kind of testing may be offered by the school psychologist or counselor at no cost to the parent or at the cancer treatment center where your child was treated. Neuropsychology testing usually covers assessments of reading, writing, math skills, memory, comprehension, attention, concentration, and fine motor skills. If your child has had radiation to the brain, you may want to ask for testing, whether you notice a problem or not.
If your child needs extra help learning, keep in mind that all children have a right to education in the least restrictive environment. This means that your child should be with other non-impaired children as much as possible. If parents have an issue with the school and the education their child is getting, they have the right to request a third party mediator to settle disagreements.
After getting all the results, the school can develop an Individual Education Plan (IEP) or a 504 plan for your child.
Individualized Education Programs (IEPs) and 504 plans both help people with disabilities get services that support their learning. They both are part of federal laws that apply to all public schools.
IEPs are for students who have disabilities and need special help with their education. They are available for students ages 3 to 21 years and end at high school graduation. An IEP falls under the Individuals with Disabilities Education Act (IDEA). There are certain requirements that must be followed with IEPs, such as planning meetings at least once a year and evaluations every three years.
To qualify for an IEP:
While cancer isn’t listed as a covered disability, cancer and cancer treatment can cause problems that might affect a child’s ability to learn. Some examples include:
Sometimes, cancer qualifies as a covered disability listed as “other health impairment.”
If a child is eligible for an IEP, a team that includes a parent work together to create a special education plan and learning goals for the year. This team may include:
They may also talk about accommodations, or the services and resources needed to meet the learning goals. Accommodations don’t change what student learns, but they can change how the services or resources will help the student get their work done. Learning plans, goals, and accommodations are specific to each student.
Some examples of accommodations are:
504 plans are for anyone of any age with a disability to protect them from discrimination. They apply to schools, colleges, employers, hospitals, and any organization that gets money from the government.
A 504 plan in a school is meant to make sure students have fair access to education by removing barriers that might limit their ability to learn. They are different from IEPs because they have a different definition of what a disability is. Unlike IEPs, 504 plans do not include a specific education plan or learning goals. A child that doesn’t qualify for an IEP may still be able to get a 504 plan.
To qualify for a 504 plan:
If a student is eligible for a 504 plan, a team that includes the parent work together to find services that support a student’s ability to learn. This team may include:
Like IEPs, 504 plans provide accommodations that are specific to the person.
Here are a few tips for deciding if an IEP or 504 plan is right for your child:
Here are some resources for more information on IEPs and 504 plans:
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Brand S, Wolfe J, Samsel C. The impact of cancer and its treatment on the growth and development of a pediatric patient. Curr Pediatr Rev. 2016 Nov 15.
Children's Oncology Group. School Support. Accessed at https://childrensoncologygroup.org/index.php/home/48-coping-with-cancer/school-support on May 18, 2023.
Lee, A. The Difference Between IEPs and 504 Plans. Understood.org. Accessed at www.understood.org/articles/the-difference-between-ieps-and-504-plans on May 18, 2023.
National Center for Learning Disabilities. Learn the law: ADAAA & section 504. NCLD. Accessed at www.ncld.org/get-involved/learn-the-law/adaaa-504 on May 18, 2023.
Thompson A, Christiansen H, Elam M, et al. Academic continuity and school reentry support as a standard of care in pediatric oncology. Pediatr Blood Cancer. 2015; 62: S805-S817.
Last Revised: May 23, 2023
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