Educational Issues Following Childhood Cancer

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.

What increases the risk of educational problems?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
• Cancer treatment that results in reduced energy levels
• Cancer treatment that affects hearing or vision
• Cancer treatment that results in physical disabilities
• Cancer therapy that includes treatment to the central nervous system (see below)

Are children and teens with certain types of cancer at higher risk of developing educational difficulties?

Yes, children and teens with the types of cancer listed below 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)

What types of treatment place children and teens at higher risk for learning and memory problems?

• 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)

What testing is recommended?

Any young person who has had any of the above cancer treatments, or who is having difficulties in school, should undergo a specialized evaluation by a pediatric psychologist (neuropsychological testing) at the time of entry into long-term follow-up. Even if the initial neuropsychological evaluation is normal, it is important for parents and teachers to remain watchful. Further neuropsychological evaluations may be necessary if the child or teen 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.

What learning problems may occur?

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: