Some types of childhood cancer and certain treatments used to treat childhood cancer can affect a child’s ability to learn. Treatments that can affect learning include radiation therapy to the brain, brain surgery and certain types of chemotherapy.
Learning difficulties can also develop because of missing school, spending long times in the hospital, fatigue and not feeling well enough to focus. Some of these difficulties will be temporary and will go away in time. Others can be long-term or even permanent problems. Some children may develop learning problems as a late effect of childhood cancer treatment.
Types of learning problems
Learning difficulties that could occur include problems with:
- writing quickly or accurately
- attention span
- completing tasks on time
- completing assignments that require multiple steps (processing)
- problem solving
- social skills
- recalling something that was just read
- copying what someone else has written
- using calculators or computers
Learning problems may occur as a late effect of treatments for some childhood cancers, including:
- brain tumours
- tumours involving the head and neck, such as rhabdomyosarcoma
- acute lymphoblastic leukemia (ALL) if intrathecal chemotherapy was used
- non-Hodgkin lymphoma (NHL)
The risk of developing a learning problem is most strongly related to the cancer type and treatment given.
Surgery to the brain can affect brain function.
The brain is very sensitive to radiation. Children who receive radiation therapy to the head or to the whole body may be at increased risk of having learning problems. Children under the age of 2 who receive radiation therapy to the head are at the highest risk of having brain function affected. Children under the age of 5 are at very high risk and children aged 5 to 8 are at high risk.
High doses of the chemotherapy drugs methotrexate or cytarabine (Cytosar, Ara-C) can affect brain function. Brain function can also be affected when methotrexate is given directly into the spinal fluid (called intrathecal chemotherapy).
Other things that can affect learning include:
- treatment that results in a physical disability
- treatment that causes fatigue or low energy levels
- treatment that affects hearing or eyesight
- treatment that affects fine or gross motor skills (for example, being able to hold a pencil)
- the child’s age during treatment (children who are very young during their treatment have a greater risk for learning problems)
- many long periods away from school
- long times spent in hospital
- social problems
- learning difficulties that existed before the diagnosis and treatment of cancer
Signs and symptoms of learning problems often show up within a few years of treatment. They may or may not be a result of the treatment received. Tell your doctor or healthcare team if your child develops these symptoms after treatment for a childhood cancer:
- problems with reading or math
- problems with memory and attention
- poor hand-eye coordination
- development that doesn’t progress as expected over time
- behaviour problems
- frequent headaches
If you are concerned about a learning problem, speak to your doctor about a neuropsychological evaluation. This is usually done by a psychologist with special training who is familiar with cancer treatment and how it can affect learning.
The evaluation will include tests that help to uncover and understand how your child thinks and behaves. After the evaluation, the psychologist will suggest ways to improve learning.
Managing learning problems
If a learning difficulty develops, you can get help and your child can be accommodated in the classroom. After sharing the neuropsychological evaluation with the school, talk to the child’s teacher regularly about how things are going. Keep your child involved. As children get older, they can and should learn to speak up for themselves about what they need in order to learn best. Problems with learning can be handled in many different ways, including:
- sitting closer to the front of the classroom
- reducing the amount of written work in the classroom
- using digitally recorded textbooks and lessons
- using a computer to take notes instead of writing by hand
- using a calculator for math
- changing test requirements, such as getting extra time or having an oral exam instead of a written exam
- getting a classroom aide
- getting extra help with math, spelling, reading, organizational skills or any other problem areas
- having help or extra time to get to classes
- using an elevator to help reduce fatigue
- having a second set of textbooks at home
Problems with learning can be very frustrating for children and their parents. Try to remember that although certain skills and abilities are affected by cancer and its treatment, creativity and the ability to learn through hearing (rather than reading) are usually not. By focusing on these strengths and supporting them in their weaker areas of learning, parents and teachers can be sure that they are doing all they can to help the child re-enter school and progress in learning as much as possible.