Learning Problems after Treatment

Treatment for cancer during childhood or adolescence may affect educational progress due to prolonged absences or reduced energy levels that frequently occur during treatment. In addition, some types of cancer may require therapy to control or prevent spread of the disease to the brain and/or spinal cord (central nervous system). This therapy can sometimes affect memory and learning abilities. Parents and teachers should be aware of potential educational problems that may be related to cancer treatment so that children and teens at risk can be watched closely and given extra help if the need arises.

Factors that may place children and teens at increased risk for difficulties in school include:
  • Diagnosis of cancer at a very young age
  • Numerous or prolonged school absences
  • A history of learning problems before being diagnosed with cancer
  • Reduced energy levels
  • Cancer treatment that affects hearing or vision
  • Physical disabilities resulting from treatment
  • Cancer therapy that includes treatment to the central nervous system (see below)

Who is at Risk for Developing Educational Difficulties?

Children treated for the following types of cancer are more likely to have received treatments that may affect learning and memory. Since treatment for these types of cancer varies widely, not everyone who was treated for these cancers is at increased risk.
  • Tumors located in the eye or eye socket, head, or facial area
  • Acute lymphoblastic leukemia (ALL)
  • Non-Hodgkin’s lymphoma (NHL)

Treatments which Increase Risk for Educational Difficulties

  • Methotrexate – if given in high doses intravenously (IV) or injected into the spinal fluid (intrathecal – IT)
  • Cytarabine – if given in high doses intravenously (IV)
  • Surgery involving the brain
  • Radiation to any of the following areas:
    • Head or brain (cranial)
    • Brain and upper spine (craniospinal)
    • Eye or eye socket (orbital)
    • Ear
    • Face (including the sinuses, nose and mouth)
    • Total body (TBI)

Recommended Testing

Any young person who is having difficulties in school should undergo a specialized evaluation by a children’s psychologist at the time of entry into long-term follow-up. Even if the initial evaluation is normal, it is important for parents and teachers to remain watchful. Further evaluations may be necessary if the child begins having trouble in school or develops any of the problems listed below. In addition, repeat testing is often recommended at times when academic challenges are more likely to occur, such as at entry into elementary school, middle school, high school, and during pre-college planning.

Types of Educational Difficulties

The brain is a very complex structure that continues to grow and develop throughout childhood and adolescence. Some problems may not become apparent until years after therapy is completed. Common problems areas include:
  • Handwriting
  • Spelling
  • Reading
  • Vocabulary
  • Math
  • Concentration
  • Attention span
  • Ability to complete tasks on time
  • Memory
  • Processing (ability to complete assignments requiring multiple steps)
  • Planning
  • Organization
  • Problem-solving
  • Social skills

Help with Learning Problems

If a problem is identified, special accommodations or services can be requested to help maximize the student’s learning potential. The first step is usually to schedule a meeting with the school in order to develop a specialized educational plan. Examples of strategies that are often helpful for children and teens with educational problems related to cancer treatment include:
  • Seating near the front of the classroom
  • Minimizing the amount of written work required
  • Use of tape-recorded textbooks and lectures
  • Use of a computer keyboard instead of handwriting
  • Use of a calculator for math
  • Modification of test requirements (extra time, oral instead of written exams)
  • Assignment of a classroom aide
  • Extra help with math, spelling, reading, and organizational skills
  • Access to an elevator
  • Extra time for transition between classes
  • Duplicate set of textbooks to keep at home

Education Services for Children with Cancer

Special education covers all the special services children may need, from gifted programs, to children with special health care needs, to children with special learning needs. Making special educational services available to children with special needs is required by federal and state law. Some children with cancer may require a specialized education plan to meet their individual needs. Enrolling in special education services begins with an evaluation, used to create an Individualized Education Plan (IEP). An IEP may be appropriate for children who are out of school for an extended period of time due to illness.

Children who have already been receiving special education due to a learning disability, a developmental delay, or speech and/or language problems can also benefit from a new IEP that takes into account educational needs due to the illness. An IEP may also be useful for children who have been out of a regular school schedule and are about to return; during the transition, they may require extra assistance.

An IEP typically includes the following components:
  • Assessment of the child’s current level of educational performance
  • Impact of the illness on learning, thinking, energy/fatigue
  • Medical precautions and special needs (if any), for example: central venous access device, extra bathroom breaks, drinking water during class, snacks, limited sun exposure, modified physical education, etc.
  • Statement of goals to be achieved under the IEP
  • Statement of educational services that the child needs
  • Date the educational services will begin
  • Description of the extent to which the child will participate in regular education programs
  • Justification for the type of educational placement the child will have
  • List of individuals responsible for the implementation of the IEP
  • Objective criteria and evaluation procedures

To obtain an IEP and establish eligibility for special education services, you will need to deliver or send a request letter to the school principal that outlines the help you believe your child needs. This help could be as simple as assistance with schoolwork, help with going back to school, or extra help in the classroom.

Once the school has reviewed the letter, it will be forwarded to the school district’s Department of Special Education. Next, an evaluation of your child’s needs will be scheduled; school districts are required by law to conduct this evaluation within a reasonable period of time. After the evaluations are completed, an IEP Meeting will be arranged including the parents/guardians, the individuals who performed the evaluation, a representative from the Department of Special Education, the school administrator, teacher and a hospital representative (if you request this). The meeting will determine whether your child is eligible for special services, which specific services will be needed, and will provide the input for writing and implementing the IEP. Children with cancer qualify for special education services under the category of “Other Health Impaired (OHI)”

Keep in mind that the IEP is a working document which can be revised as your child's needs change, whenever you request it.