Psychosocial adjustment of five-year survivors of childhood cancer.

This study assessed the psychosocial adjustment of 31 childhood cancer patients five years after diagnosis compared with their school peers. The children were aged 8 to 18 years at the time of the study. No significant difference was found in self-rated measures of anxiety and self-esteem. However, there were significant differences in teacher ratings of concentration, academic progress, and popularity with peers and in parent and teacher ratings of behavioural adjustment (Rutter Scales A and B), indicating that the survivors of childhood cancer were at increased risk of problems. Relationships between behavioural adjustment scores and child, family, and illness variables were investigated within the cancer-survivor group. No significant relationship was found with illness variables or social class. Significant associations were found between behavioural adjustment and parental psychological distress, parental coping strategies, children's perceptions of their own scholastic competence, and their relationships with peers. In addition, children who had shown considerable problems in school work one year after diagnosis were more at risk for behavioural problems at this later state. The findings have implications for the provision of support to childhood cancer patients, their families, and their teachers that may help to prevent later problems in adjustment.

Absence from school related to cancer and other chronic conditions.

Absence from school during the first year after starting major treatment for cancer or chronic or orthopaedic conditions was examined. Retrospective data were collected on 72 children and obtained from hospital records, school registers, and interviews with parents and teachers. Median initial absences caused by treatment were 91, 29-5, and 15 days for cancer, chronic, and orthopaedic patients respectively. The mean proportions of the remaining school time in the year occupied by absences caused by treatment and those not caused by treatment were respectively 17% and 17% for oncology patients, 8% and 12% for chronic patients, and 2% and 11% for orthopaedic patients. The only significant factor associated with the amount of absence caused by treatment was the type of illness. Increased absence not caused by treatment was associated with the amount of treatment time and the patient being a girl. The proportion of absence not caused by treatment decreased if the mother was educated beyond the age of 18. The possible reasons for and effects of excess absence are discussed.

Impact of childhood cancer on return to normal schooling.

Most of the research into the psychosocial impact of treatment for cancer in children has concentrated on effects on the family rather than on the children's return to school. Thus parents and teachers were questioned about the problems experienced by 117 children who returned to school after spending time in hospital. The children comprised 51 with cancer and two groups of control children (34 with chronic diseases such as renal disease and cardiac conditions and 32 with orthopaedic conditions such as thoracic scoliosis, club foot, and injuries resulting from trauma). Children in all three groups experienced problems on returning to school, the greatest number and variety occurring in the children treated for cancer and the fewest in the children with orthopaedic conditions. The variety of physical problems was greatest and the variety of academic problems was least, with psychological and behavioural problems intermediate. Several problems seemed to be related to drug treatment. Several children missed a considerable amount of full time education. Many teachers were unsure of the academic expectations and physical capabilities of children returning to school. To facilitate a smooth return to school for a child with cancer improved liaison is needed between the hospital, school, and home during the child's absence and teachers need to be better informed.