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As a teacher, you have a special role in helping a student with osteosarcoma readjust to school. You will also need to be prepared to answer the questions of other students. This section provides some tips and answers to specific questions that you might have.

For information on questions such as "What is osteosarcoma?", "What are the symptoms?", "How is it diagnosed?", and "What is the treatment for osteosarcoma?", refer to the Osteosarcoma Facts page.

• What are the special needs of students with osteosarcoma?
• What are the dietary and physical limitations for my student?
• How will treatment affect school attendance and the ability to keep up at school?
• How can I best be supportive of both the child and their parents?
• What should I tell the child's classmates?
• Where can I get more information?

What are the special needs of students with osteosarcoma?

The special needs of a student with osteosarcoma will depend on the extent of the student's tumor and the treatment that they receive. Someone who has had an amputation will have greater needs than someone who had chemotherapy but no surgery yet.

It is important that these children's lives remain as normal as possible, both in and out of school. However, it is likely that they will have some particular difficulties.

Setting up home tutoring on an "as needed" basis is a good thing to do right away, so that when the student is feeling well, a tutor can be available to help with schoolwork.

After the early treatment stages, the student may be able to gradually adjust to a normal school schedule, but not necessarily a full work load. You will need to be flexible and creative with assignments to help the student keep up enough to move along at the same pace of the class.

The psychologist evaluating the child should work with parents and teachers to develop reasonable expectations about the child's performance. Results of the evaluation should be used by school personnel to develop an Individualized Education Plan (IEP) if a child treated for cancer is experiencing school problems.

Be aware that there are several other reasons for school problems besides cancer treatment such as: behavioral problems, decreased attendance due to illness or other factors, poor motivation, emotional difficulties.

Parents and teachers should have frequent contact and work together to develop modifications in the classroom and in the curriculum to help the child. For example, seating the child in a quiet location to reduce distractions can help them sustain attention. Other helpful modifications include: using rewards to reinforce maintaining attention for longer and longer periods of time, alternating high-interest and low-interest tasks, giving frequent breaks, allowing extra time to complete assignments, reducing the length of assignments, and emphasizing recognition of material rather than free recall. Use repetition, rehearsal, and review to improve recall of material.

For students who had an amputation, you will need to help the student determine the best way to get around at school.

What are the dietary and physical limitations for my student?

If the bone with the cancer is so weak that it could break, limitations on activity made be in place from the time of initial diagnosis through completion of therapy. After surgery, the limitations on activity depend on the type of treatment used. Irradiated bone is more likely to break, so a student treated in this manner may have permanent restrictions on their activities. For those treated with surgery (either grafted from another site in the student's body or donor bone), it is not unusual for restrictions to be in place for several months while the bone heals. During this time, the student may use crutches, a wheelchair, or a walker.

Other physical restrictions may be the result of the chemotherapy treatments, rather than of the cancer itself. The possible side effects of this chemotherapy depend on the medications used and how the student responds to them. These medications affect processes, such as the production of blood cells. Common side effects of this include fever, increased susceptibility to infection, and increased risk of bleeding with trauma.

Chemotherapy may result in low blood counts (red blood cells, white blood cells and platelets), causing the student to be:

• Tired, so their physical activity may be restricted during this time.
• More likely to catch infections that are hard for them to fight off. If this happens, the student may be restricted from being in big crowds where they may more easily be exposed to germs. Many infections are carried on our hands, by germs from coughing, sneezing or just touching a surface that has germs on it. So, the student and their classmates should be encouraged to use good hand washing techniques.
• Developing bruises easily.

There are no particular diet restrictions due to osteosarcoma or its treatments.

How will treatment affect school attendance and the ability to keep up at school?

A student with osteosarcoma may have significant absences during the period of time which includes surgery and chemotherapy. Recovery from surgery, chemotherapy treatments, doctor appointments, laboratory tests and infections may all result in missed school. Typically, the most active part of treatment lasts about a year. During that period of time, a great deal of flexibility and creativity will be required to enable the student to stay caught up with his/his her class.

Modifications and accommodations will be necessary to create a physical and learning environment that is appropriate for the student with osteosarcoma. The student may temporarily utilize a wheelchair at school. Seating arrangements and desk type may need to be modified to accommodate the wheelchair. If on crutches, a secondary student may need early release from classes to provide extra travel time to get from class to class when the halls are not congested with other students.

How can I best be supportive of both the child and their parents?

Ongoing, effective communication between the family, school and hospital may result in better understanding and, thus, the ability to provide optimal support for the child.

What should I tell the child's classmates?

As long as you have obtained parent permission, it helps if you let the other children in the class know that the child has cancer and is receiving treatment. This allows you an opportunity to address any questions or worries of other classmates in an effective and sensitive manner.

You may want to let them know that the treatment may cause some unpleasant side effects but is often successful in treating the cancer. Classmates and other teachers need to be prepared for possible physical changes, such as hair loss or limb loss. If not explained truthfully and honestly, peers may come to conclusions about their friend's status that are inaccurate. Teasing and rejection are far less frequent concerns when classmates understand what their friend is experiencing. They must also be reassured that cancer is not contagious in any way and that the child will hopefully return to normal once the treatment ends. In some cases, the child may wish to be involved in telling schoolmates, so you should ask the child what they prefer.

Where can I get more information?

Back to School

A Web resource from Washington University's Department of Pediatrics. It has information for teachers and other school staff on the effects of cancer therapy as well as overviews of osteosarcoma and other childhood cancers. It also provides a guide for planning for a child's return to the classroom.

Outlook. Life Beyond Childhood Cancer

A resource for survivors of childhood cancer. However, the Web site has a section on school-related issues that discusses some of the "late effects" of cancer that may influence a child's ability to process, learn, and retain new information. This section provides information on learning problems and includes suggestions for parents and teachers on how to deal with "late effects".