very high. There is, for example, a three- to fourfold increase in the use of special education services among survivors of ALL, which likely translates into a third to a half of such survivors needing special education programs. Survivors at higher risk for neurocognitive late effects require monitoring for long-term neurocognitive deficits that may arise in the years following treatment. More needs to be learned of the educational needs of other groups of childhood cancer survivors and of the effectiveness of interventions designed to ameliorate the late effects of cancer and its treatment.

Many cancer centers have school programs to ease the return of childhood cancer survivors to school following their treatment. Ideally, planning for school reentry begins at diagnosis and involves a school liaison to ensure that educational environments are supportive and can accommodate any late effects. The school liaison’s role may include following the educational progress of survivors through transitions to college, employment, or vocational programs. Support to teachers and classmates may also be provided following the death of a child from cancer.

Three federal laws protect the educational and employment rights of individuals with disabilities: IDEA, the Rehabilitation Act of 1973, and the ADA. IDEA supports states to ensure the provision of free appropriate public education of children with disabilities. The Rehabilitation Act provides a broader set of protections for individuals of all ages with disabilities, to ensure that discrimination does not occur within any program in receipt of federal funds. The ADA prohibits discrimination of persons of disabilities in both public and privately supported agencies and business and requires that persons with disabilities receive reasonable accommodation. Of most direct relevance to children with cancer and their families is the IDEA and the protections afforded by the Rehabilitation Act of 1973. While legal protections appear to be comprehensive, required procedures are implemented and legal interpretations are made locally. Consequently, among parents, satisfaction with accommodations at schools varies, depending on the school’s level of cooperation, awareness of cognitive impairment in children with cancer, and resources available to provide the necessary interventions.


Armstrong D. F. 2002. Cognitive Late Effects of Childhood Cancer and Treatment: Issues for Survivors (IOM commissioned background paper) (

Haupt R, Fears TR, Robison LL, Mills JL, Nicholson HS, Zeltzer LK, Meadows AT, Byrne J. 1994. Educational attainment in long-term survivors of childhood acute lymphoblastic leukemia. JAMA 272(18):1427-32.

Hoffman B. 2002. Policy Recommendations to Address the Employment and Insurance Concerns of Cancer Survivors (IOM commissioned background paper) (

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