What is Cancer

• There are many different kinds of childhood cancer.
• The common theme is that cells in the body grow out of control.
• The outlook is good with many types of pediatric cancer, and, on average, more than 80% of cases of childhood cancer can be cured.
• The cure rate varies depending on the type of cancer, how far it has spread, the age of the child, and other factors.
• Children may come to school or a child care center while they are receiving active treatment of cancer, or they may be diagnosed as having cancer while enrolled.
• If children who have cancer are well enough during therapy or between rounds of therapy, they may attend a child care program or school.
• Being with groups of children can provide a routine and the chance to interact with friends, which can be a welcome break from being in a hospital or from frequent visits to receive therapy in a clinic.

How common is it?

• Every year, 14 out of 100,000 children in the United States are diagnosed as having some form of cancer.
• The most common cancers are leukemia, lymphoma, and brain cancer.

What are some common characteristics of children who have cancer or of cancer as children present with it?

• Children who are undergoing chemotherapy or radiation to treat their cancer may have a suppressed immune system that can make them more vulnerable to infection. (See Abnormal Immunity: An Overview Quick Reference Sheet.)
• Some types of chemotherapy and radiation cause hair loss.
• Frequently, children who are receiving cancer therapy will have a central venous catheter in the arm, shoulder, or chest area that provides a way to withdraw blood from or give medications through a vein without sticking a needle into the skin again. It should be kept dry and protected. The catheter will eventually be removed.
• Some types of chemotherapy and radiation therapy may cause hearing loss.
• Some children who receive cancer treatment may limp or may need to use a supportive device to walk.

Who might be on the treatment team?

• Children with cancer are usually treated in special pediatric oncology centers.
• The doctors in those centers are pediatric hematologists-oncologists. Depending on the center, other team members may include specialized nurses, child life specialists, social workers, psychologists, and even teachers.
• They will treat the child along with the pediatrician/primary care provider in the medical home.
• Because children with cancer may need frequent hospitalizations, often child life specialists in the hospital help these children adapt. In addition, teachers in the hospital may help these children keep up with any lessons they miss.

What adaptations may be needed?

Medications

• Some children may be on low-dose antibiotics to prevent infection, but these are usually given at home.
• Children may also be on medications to help manage nausea and vomiting. Children with cancer should not receive medication for fever unless it is approved in their respective Care Plans.
• All staff who will be administering medication should have medication administration training.

Dietary Considerations

There is usually no special diet, but children who are recovering from weight loss caused by chemotherapy may be on high-calorie foods or shakes. Children with cancer may often need more water and should be allowed to keep a bottle of water with them.

Physical Environment and Other Considerations

• Good hygiene such as strict handwashing using soap and water or an alcohol-based product should be practiced. Children should also avoid exposure to infectious diseases, especially chickenpox and herpes (specifically, cold sores). Parents/guardians should be notified of outbreaks.
• All other children and staff should be fully immunized, including with influenza vaccine, to protect the child with cancer.
• Follow any guidance in the Care Plan about physical activity, but usually children who are well enough to attend a child care program or school will be able to participate in most activities. Extra rest might be necessary at times.
• Children with limb prosthesis resulting from cancer treatment may require limited participation in some types of physical activities and may need extra time to change classrooms.
• Other strategies for accommodating children with cancer include
  • Schedule a meeting with parents/guardians to go over the specifics of the child’s condition. Each case is unique.
  • Have the child briefly visit the child care center or school before the first full day of return, to meet with his or her teachers and caregivers and classmates.
  • The Care Plan will need to be updated frequently for a child who is still undergoing cancer treatments.
  • Make sure Care Plans are updated after each major hospitalization or change in therapy.
  • Explain to the other classmates about the child’s condition, especially if the child’s appearance has changed.
  • Children sometimes feel guilty that they somehow caused their conditions and may need reassurance that this is not so.
  • Immediately after chemotherapy or radiation, the child may be more tired or need to rest. This fatigue and weakness may resolve over a few weeks or be episodic with treatments.
  • The child may have frequent absences to undergo medical tests and treatments. As such, offer to keep in touch and plan to welcome the child’s return to the group.

What should be considered an emergency?

• Fever is a serious symptom and could be the first sign of a serious infection.
• The Care Plan should outline what measures to take if the child has a fever or another symptom such as bruising or bleeding, or fatigue and weakness that does not respond to rest.

What types of training or policies are advised?

Ask the child’s pediatric oncologist for suggested training resources.

What are some related Quick Reference Sheets?

Abnormal Immunity: An Overview

What are some resources?

• American Cancer Society: www.cancer.org, 1-800-ACS-2345 (1-800-227-2345)
• Children’s Oncology Group: www.childrensoncologygroup.org
• Nemours KidsHealth: “Childhood Cancer” http://kidshealth.org/en/parents/cancer.html
• Starlight Children’s Foundation: www.starlight.org, 310/479-1212

Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.

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The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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