Page 0106

improving health;

‰ academic issues are important, but even more

significant are sustaining adequate peer relationships.

Maintaining friendships and routine interactions with

peers is essential to normal psychological development;

‰ because of the social component of the school

experience, attending school even for short periods of

time is preferable to homebound education;

‰ classmates should be prepared for the patient's return

in a manner appropriate for the child's age and school

situation.

With permission from the family, school personnel should be

contacted as soon as possible to let them know about the

patient's disease:

‰ in general, school communities associate childhood

cancer with immediate death, so they need to be

educated about the patient's disease: treatment, side

effects, anticipated days of school to be missed, prognosis

and special care;

‰ a manual for teachers including information about the

disease and how to cope with the ill pupil might be useful

- teachers should be assured that their role is to teach

and the hospital's role is to treat;

‰ the psychosocial professional should be involved with the

school contact to determine how the patient has done in

the past in school and to prepare for future work;

‰ if an extended absence from school is inevitable, school

personnel should be encouraged to maintain contact with

the patient and family via homebound teachers, audio

lessons, letters, tapes, etc.

Before the patient returns to school, the psychosocial

professional should talk with the patient/family regarding

concerns they have about his or her return.

‰ Issues that need special attention are any change in the

patient's physical appearance and specific ways the

patient can talk with peers about his or her illness; special

attention should also be placed upon the fact that the

PAEDIATRIC CANCER

108 CANCER CONTROL 2015

Before the patient returns to school,

the psychosocial professional should

talk with the patient/family

regarding concerns they have about

his or her return

childhood cancer is not contagious.

Patients with brain tumours or malignancies that

compromise central nervous system (CNS) integrity through

therapy (e.g., those receiving prophylactic radiation therapy),

can have special problems related to returning to school as

they commonly experience difficulties with cognitive

abilities. These patients are at risk for problems fitting in with

peers. They can become socially isolated and experience less

social acceptance.

‰ Neuropsychological testing before the patient returns to

school is recommended to facilitate appropriate

classroom placements and to develop appropriate

education programmes.

‰ Results must be carefully reviewed with parents and

school professionals to ensure their understanding of the

patient's cognitive abilities.

‰ In addition to an initial screening before the patient

returns to school, for all patients with brain tumour

follow-up neuropsychological assessment within six

months and one to two years after diagnosis is

recommended.

‰ School progress needs to be monitored after treatment

for these patients to appreciate fully the extent and

nature of late effects.

Death and dying

Today 30% to 40% of childhood cancer patients will die. In

developing countries rates of survival can be poorer.

Continuity of care and the opportunity to work with known

staff members is particularly helpful in the terminal phase of

the disease.

‰ Health-care teams should facilitate communication

between family and patient regarding death and dying

since they need more assistance to talk about these

issues. Particular attention should be paid to siblings and

grandparents to ensure that they have an opportunity to

discuss their feelings, ask questions, say goodbye and

understand the situation.

‰ Families should be able to share concerns about death

and affirm their relationships with one another to say

goodbye to the patient. Children with cancer often reach

an understanding of what death means at a much

younger age than their healthy peers.

‰ Silence can result in unnecessary suffering. While parents

may want to "protect" their son or daughter from the

knowledge that the illness is terminal, feelings of isolation

and abandonment can occur at a time when the need for

support and communication is the greatest.

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