ALL survivors would be expected to be in special education programs if the three- to fourfold increase in use of special educational programs among survivors of ALL documented by Haupt and colleagues can be applied to survivors treated after the mid-1980s (Haupt et al., 1994). Other survivors of childhood cancer may not experience neurocognitive late effects, but need special accommodations because of physical limitations that impede participation in school-related activities. Irrespective of education placement upon reentering school following diagnosis and treatment, childhood cancer survivors and their families, teachers, and classmates can benefit from special transition services.

SCHOOL REENTRY INTERVENTIONS

Children are often absent from their regular school during periods of treatment and generally receive at least some educational services at home or in the hospital. School districts nationally vary tremendously in their guidelines for providing such services, the amount of weekly teaching provided (from a few hours per week to daily contacts), and in the preparation and familiarity of teachers in these settings to meet complex educational needs during limited teaching contacts. A child’s educational experience may lack continuity if he or she goes back and forth between hospitalizations and home and/or school over the course of treatment.

A return to their familiar school and classmates following treatment can be a long- awaited event, but can also raise fears about peer teasing or the ability to resume a pre-cancer level of activity and function. A school with 500 to 1,000 students may have a student with cancer enrolled every few years, but given the rarity of new cases of childhood cancer, most teachers would not be expected to be familiar with the physical and psychosocial issues related to childhood cancer. Teachers may become more familiar with these issues as the number of childhood cancer survivors increases.

Organized educational programs for teachers and classmates have been successful in reducing problems associated with school reentry (Leigh and Miles, 2002). A well-defined and planned hospital/school program is necessary for hospitals, according to the International Society of Paediatric Oncology (SIOP) Working Committee on Psychosocial Issues in Pediatric Oncology (Masera et al., 1995). Programs vary in their approaches, but a general plan for school reentry has been described (Box 6.1).

Children may experience emotional, behavioral, or social problems at school reentry, may have physical needs (e.g., related to fatigue, mobility problems), and may have cognitive effects of treatment (Loman and Vincent, 2002). Children at highest academic risk include children with CNS-involved disease, a history of school problems, numerous or extended ab-



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