Some treatments for childhood cancer can increase the risk of changes in cognitive (thinking) function.
These changes may aect concentration and memory. For some childhood cancer survivors, cognitive
eects can lead to learning problems at school.
FAST FACTS
Side-Efect Management:
Efects of Childhood Cancer Treatment on Learning
Childhood leukemia and lymphoma patients may receive
therapy that aects the central nervous system (CNS). The
CNS includes the brain and spinal cord. Therapies that aect
the CNS increase the risk for cognitive (thinking) eects
including educational issues. Examples of these therapies
include
• Methotrexate or cytarabine—if given in high doses
intravenously (IV) or injected into the spinal fluid
(intrathecal [IT])
• Total body irradiation (TBI), prior to a stem cell
transplantation
Significant cognitive eects are more often associated with
treatment plans that include radiation to the brain or brain
surgery, which are not routinely used to treat childhood
leukemia or lymphoma.
For some childhood cancer survivors, cognitive eects
can lead to learning problems that can aect performance
in school.
SIGNS OF LEARNING PROBLEMS
Concentration and memory problems may begin during
treatment or become noticeable months or years after
treatment. These can be short-term or long-term problems.
The signs of learning problems include
• Problems with memory
• Diculty staying focused
• Diculty processing information or learning as quickly
as peers
• Diculty completing multi-step tasks
• Not doing well in school, compared to past performance
• Problems with organization, planning, studying and/or
time management
• Diculties with hand-eye coordination
Children with learning problems caused by cancer treatment
can still learn and develop new skills, but it may take
them longer than their peers and they may need special
accommodations or additional instruction. Learning issues
that a child had prior to cancer treatment may become more
apparent after treatment.
Other factors can also contribute to cognitive issues and
can be treated separately. These problems include poor
nutrition, dehydration, anxiety, depression, fatigue and
insomnia. Treating these separately may help improve
cognitive (thinking) function.
MANAGING LEARNING PROBLEMS AT SCHOOL
Going to school is a big part of feeling normal for children
and adolescents, but going back to school after cancer
treatment can also bring new challenges for your family.
It is important to identify the areas of learning where your
child may struggle. Then you can work together with the
healthcare team, teachers and school sta to provide support
and resources to help your child be successful in school.
Neuropsychological Testing. Children who are at risk
for cognitive eects or who are having diculty in school
should have neuropsychological testing done by a licensed
pediatric neuropsychologist (an expert in the way the
brain works ) to check for possible learning challenges.
Discuss the need for neuropsychological testing with your
child’s healthcare team, who can refer you to a pediatric
neuropsychologist.
School Psychological Assessment. Neuropsychological
testing is often not covered by insurance and can be
expensive. A school-based assessment may also be an option
(or may be a requirement of the school) to help determine
your child’s educational needs. These assessments are usually
performed to determine if your child is eligible for special
education programs. Generally, school-based assessments
are less eective than neuropsychological testing at linking
cancer treatment with learning or behavior problems. Ask your
child’s school administrators for more information.
Meeting Your Child’s Educational Needs. With the help of
the healthcare team, inform teachers and school sta about
your child's educational needs before he or she returns to
school. Work together with the healthcare team, teachers
and school sta to develop a program tailored to your child's
specific needs. The program may include
• Special accommodations—accommodations can be
made to meet a child's educational needs, such as
allowing for additional time to complete class work or
take exams. Children may qualify for special help under
federal laws.
The mission of The Leukemia & Lymphoma Society (LLS) is to cure leukemia, lymphoma, Hodgkin’s disease and myeloma,
and improve the quality of life of patients and their families. Find out more at www.LLS.org.
FF14 10M 5/20
Side-Efect Management: Efects of Childhood Cancer Treatment on Learning
• Long-term planning—plans can be developed to help a
child through school transitions from middle school to high
school and into adult life.
• Cognitive behavioral therapy—certain cognitive therapies
can help children develop strategies to address learning
problems. For example, one strategy may be breaking
down complex problems into smaller tasks.
All childhood cancer survivors may be at risk for behavioral,
emotional or social problems regardless of cognitive eects.
If you notice changes in your child’s behavior, speak to your
child’s healthcare team and ask for a referral to a mental
health professional.
LAWS THAT HELP PROTECT CHILDREN WHO HAVE
EDUCATIONAL NEEDS
The following three federal laws help protect the rights of
students with disabilities including those with educational
needs resulting from cancer treatment:
• The Individuals With Disabilities Education Act (IDEA)
o Under IDEA, public school children with disabilities
may receive an Individualized Education Plan (IEP)
that outlines a formal plan to accommodate a child's
individual needs.
• The Rehabilitation Act of 1973 – Section 504 Plan
• The Americans With Disabilities Act (ADA)
For more information about the transition back to
school and laws that help protect children, visit
www.LLS.org/booklets to view Learning & Living with
Cancer: Advocating for Your Child's Education Needs.
MANAGING LEARNING PROBLEMS AT HOME
The following are some things you can do at home to help
your child manage cognitive side eects:
• Get organized by making sure everything has a place in
your home and get rid of clutter.
• Stick to a schedule. Children need structure to feel a
sense of control.
• Be patient with your child and allow extra time to
accomplish tasks.
• Minimize distractions when your child is working on
homework. For example, put away phones and electronics.
•
Encourage your child to exercise his or her brain by
reading, playing educational or memory games, or by doing
something creative such as drawing or playing music.
• Encourage your child to be physically active. Ask the
healthcare team for an exercise program.
• Provide foods that promote healthy brain functioning
such as fish, dark leafy greens, fresh fruits and
vegetables and whole grains.
• Maintain a regular sleep schedule so your child can get
the recommended amount of sleep for his or her age.
• Teach your child to avoid alcohol, smoking or “vaping,”
and other drugs, which can alter his or her mental state.
GET ONE-ON-ONE SUPPORT.
The Leukemia & Lymphoma Society team consists
of master’s level oncology social workers, nurses
and health educators who are available by phone
Monday–Friday, 9 a.m. to 9 p.m. (ET).
INFORMATION SPECIALISTS
• Call 800.955.4572
• Visit www.LLS.org/InformationSpecialists
CLINICAL TRIAL NURSE NAVIGATORS
• Call 800.955.4572
• Visit www.LLS.org/CTSC
Questions To Ask Your Child's
Healthcare Team
• What are the possible cognitive eects of
my child’s treatment(s)?
• When are cognitive eects likely to happen?
• Are there any changes, signs or symptoms I
should tell my child’s pediatrician about right
away?
• What can I do to ease the symptoms of my
child’s cognitive eects?
• Will my child have diculties in school because
of the cognitive eects?
• Can my child be referred for neuropsychological
testing?
• Will insurance cover the cost of testing by a
neuropsycologist? If so, under what conditions?
• When would it be appropriate for my child to
be re-tested for cognitive eects?
• What accommodations at school do you
recommend for my child?
