School counselors and survivors of childhood cancer: reconceptualizing and advancing the cure.
Subject: Cancer in children (Care and treatment)
Student guidance services (Methods)
Student guidance services (Health aspects)
Student counselors (Practice)
Author: Bauman, Stephanie San Miguel
Pub Date: 12/01/2010
Publication: Name: Professional School Counseling Publisher: American School Counselor Association Audience: Academic; Professional Format: Magazine/Journal Subject: Family and marriage; Psychology and mental health Copyright: COPYRIGHT 2010 American School Counselor Association ISSN: 1096-2409
Issue: Date: Dec, 2010 Source Volume: 14 Source Issue: 2
Topic: Event Code: 200 Management dynamics Canadian Subject Form: School counselling; School counselling
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 245254048
Full Text: School counselors increasingly will encounter childhood cancer survivors. This article explains why the cure for cancer consists of more than the eradication of the disease and includes the amelioration of academic, career, personal, and social concerns. Drawing on the research literature, the article discusses different stages of cancer survivorship and possible ways that school counselors may advance a cure for cancer as they meet the needs and encourage the development of every student survivor.

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Each school day in the United States, 46 young people, or the equivalent of two classrooms of students, learn they have cancer (CureSearch National Childhood Cancer Foundation, 2010). Over the course of a year, approximately 12,400 children and adolescents under the age of 20 are diagnosed with the disease (Keene, Hobbie, & Ruccione, 2007). To get a sense of the total number of children affected by childhood cancer, Kaffenberger (2006) used prevalence ratios and the U.S. Census Bureau population of school-age children in the United States in July 2003 and estimated that 810,000 children are affected. These statistics reflect the fact that cancer is one of the most common chronic illnesses in childhood.

Counselors have recognized the critical issues faced by individuals and families who are affected by the cancer experience at different points of the lifespan including childhood and adolescence (e.g., Curtis & Juhnke, 2003; Kaffenberger, 2006; Livneh & Antonak, 2005; Veach & Nicholas, 1998.) Noteworthy differences exist between the cancer experience of children and that of adults. For example, in comparison to adults, children are more likely to get cancers of developing organ systems like the blood, nervous system, and bones (Kenney & Katz, 2005). The most common types of childhood cancer are leukemias (acute lymphoblastic leukemia and acute myelogenous leukemia), brain tumors, and non-Hodgkin's lymphoma (Keene, Hobble, & Ruccione, 2007). In addition, although some childhood cancers (e.g., one form of the rare eye tumor retinoblastoma) seem to have a genetic component, how children get many forms of childhood cancer is not clear (Keeney & Katz, 2005). A final way in which the cancer experience of children may differ from that of adults is that up to 60% of children with cancer are treated in specialized cancer centers (Weiner, Simone, & Hewitt, 2003). Often, these cancer centers are located at a significant distance from where children being treated and their families live. Thus, in addition to the medical treatment itself, families may be dealing with a variety of issues related to being away from home, school, and places of employment, or to traveling between home and the specialized cancer treatment center.

Cancer remains a life-ending disease for some children; one fourth of children newly diagnosed with cancer will die of the disease within five years (Weiner, Simone, & Hewitt, 2003). In these cases, school counselors can provide emotional support to family members as well as to the classmates, student body, and staff of the deceased child's school (Keeney & Katz, 2005). Fortunately, given the success rate of new treatments for childhood cancer, three quarters of the children and adolescents diagnosed each year will improve (Keeney & Katz, 2005).

Kenney and Katz (2005) provided one definition of a survivor: "A person who has survived five years in a disease-free condition after the completion of therapy is considered cured" (p. 7). Keeney and Katz also explained that every year a person survives disease free after completing therapy, her or his chances of long-term survival increase dramatically. Perhaps the most encompassing definition of a survivor has been adapted from the National Coalition for Cancer Survivorship by the National Cancer Institute (2008): "An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also impacted by the survivorship experience and are therefore included in this definition."

With increasing survival rates, school counselors not only will encounter childhood cancer survivors with greater frequency, but also will have opportunities to facilitate their adjustment. On one hand, school counselors and other school personnel may be subject to common myths and misconceptions about cancer (Keeney & Katz, 2005) or feel unprepared to meet the needs of the students whom cancer affects (Prevatt, Heifer, & Lowe, 2000). To complicate matters, much of the research about survivors of childhood cancer more frequently appears in medical and pediatric psychology journals than in education and counseling journals. On the other hand, as professionals with an ethical responsibility to address the academic, career, personal, and social needs of every student (American School Counselor Association [ASCA], 2004), school counselors do possess relevant qualifications and skills, including advocacy and collaboration (ASCA, 2005), to encourage the maximum development of the survivors in their schools. In order to begin a dialogue about school counselors and survivors of childhood cancer, this article first explains why the cure for cancer must be reconceptualized beyond a medical cure. It then reviews the Cancer Survivorship Outcome Continuum (Marcus et al., 1998) and follows that useful stage-model of cancer survivorship to organize a comprehensive review of the related literature on childhood cancer experience. In the process, this article suggests ways that school counselors can advance a cure for cancer as they encourage the development of survivors and meet their academic, career, and personal/social needs.

RECONCEPTUALIZING THE CURE

The cure for childhood cancer often is thought of solely in terms of the cure of the disease. Yet, in order to better serve survivors, school counselors must adopt a new and more comprehensive perspective about what constitutes a cure. Indeed, although treatment may eradicate cancer cells, it may have other sequelae (Kazak, 1994). Such complications, disabilities, or adverse outcomes that result from the disease process, the treatment, or both, have been known as "late effects" in the research literature (Weiner, Simone, & Hewitt, 2003).

The most frequently occurring late effects of childhood cancer are neurocognitive and psychological, cardiopulmonary, and endocrine issues that impact growth and fertility, musculoskeletal, and second cancers. Late effects are variable in terms of whether they will emerge, when they will emerge, and whether they will persist or can be resolved. Age at diagnosis, dosages of chemotherapy and radiation, and parts of the body exposed to treatment all factor into the likelihood of emergence. Survivors who are now approaching middle age are at greater risk of late effects of treatment than those treated more recently because treatment has changed over the years in order to minimize the likelihood of late effects. Weiner, Simone, and Hewitt (2003) concluded:

In acknowledgment of the range of possible outcomes, the cure for cancer is best understood as having psychological and social components in addition to the medical one (Kazak, 1994; Van Eys, 1991). Van Eys (1991) described a psychological cure as accepting one's past cancer and proceeding with normal development and schooling without disruption. Van Eys proceeded to describe a social cure as incorporating the cancer survivor into society without bias against the survivor's experience with cancer and its treatment. Similarly, Livneh and Antonak (2005) argued that long-term adjustment to chronic illness includes the pursuit of personal, social, and/or vocational goals, and the ability to navigate obstacles that are encountered along the way.

ADVANCING THE CURE ACROSS PHASES OF SURVIVORSHIP

Having argued for the importance of a more comprehensive understanding of a cure, this paper now focuses on understanding survivors and the nature of their survivorship experience. The first group of childhood cancer survivors was identified in the mid-1970s, when children treated for certain types of cancer like acute lymphoblastic leukemia began to experience long-term remissions (Kazak, 1994). Since then, vivid metaphors have been developed to convey the coexistence of negative and positive aspects of the experience of childhood cancer survivors. These metaphors include Damocles' noticing a sword precariously dangling above his head while being honored at a banquet (Koocher & O'Malley, 1981), closing an umbrella after a storm when additional showers may be in the forecast (American Cancer Society, 1996), and climbing a steep but beautiful mountain (The National Children's Cancer Society, n.d.).

Theoretical frameworks and conceptual models have been developed to better understand cancer survivorship. These include approaches that are sociological, behavioral, cognitive, or focused on stress and coping (Jeffery, 2006). Further development, testing, and refinement of cancer survivorship theories are needed to advance cancer survivorship science (Jeffery, 2006). Meanwhile, Marcus and colleagues' (1998) Cancer Survivorship Outcome Continuum serves as one helpful framework to review the current literature on childhood cancer survivors and to consider practice implications for school counselors. Marcus et al. explained that cancer survivorship may be seen as a continuum with three phases: acute, re-entry, and extended survival. Each phase is guided by primary adaptational tasks that are resolved within the broader context of the survivor's personal, social, cultural, and sociopolitical environment. Cancer survivorship, however, is a fluid process; survivors may move back and forth between the stages because they are neither discrete nor linear. The following sections discuss the specific phases and related adaptational tasks. They also present ways school counselors may provide support to student survivors, with the caveat that the development of evidence-based clinical practice guidelines for the care of survivors of childhood cancer is a work in progress (Weiner, Simone, & Hewitt, 2003).

Acute Survival Phase

The acute survival phase begins at diagnosis (Marcus et al., 1998). How do parents or guardians discover their child has cancer? "The symptoms related to childhood cancer that prompt parents to seek care are often non-specific in nature and may be similar to those of the flu or other common ailments" (Weiner, Simone, & Hewitt, 2003, p. 37). The methods used to confirm diagnosis will vary with the type of cancer as will the method of treatment such as surgery, chemotherapy, radiation therapy, or a combination thereof. The actual length of treatment depends on the type of cancer and how widespread it is when diagnosed. Some children and adolescents will receive treatment over a period of months while others will receive treatment over several years (Keeney & Katz, 2005).

Adaptational tasks of the acute survival phase include coping with the diagnosis, treatment, and medical environment (Marcus et al., 1998). Although the medical team possesses the expertise and resources to help the child or adolescent learn more about their specific type of cancer, cope with the difficult aspects of treatment, and adjust to the hospital setting, school counselors still may be of assistance to the student during this phase. After the diagnosis, an overall goal is to provide as normal a life as possible for the child or adolescent and the family while getting through treatment (American Cancer Society, 1996; Thompson & Gufstafson, 1996). Given that the average age of a child diagnosed with cancer is six years old (CureSearch National Childhood Cancer Foundation, 2010), school often is something that provides a sense of normalcy. As a result, the establishment of open lines of communication and the formation of a partnership between the school, the child, his/her parents or guardians, and the health care team are essential. An effective partnership provides continuity during a chaotic time. Furthermore, it likely increases student's chances of maintaining social skills and academic abilities necessary for school success (Keeney & Katz, 2005). Thus, one way a school counselor certainly may facilitate adaptation during the acute survival phase is by serving as a member of the child's "home team" (Woznak & Goodheart, 2002) and supporting parents in their role as the primary advocates for their child as they deal with the complexities of both the school and the medical systems.

Another way a school counselor may be of assistance during the acute survival phase is by working in partnership with the student's medical team and caregiver(s) to prepare the survivor and the students and staff at the school for the survivor's return. The majority of children diagnosed with cancer will attend school at least some of the time during treatment (Leukemia & Lymphoma Society, 2005) and as early as four to six weeks following the diagnosis (Morgan, 2006). If the child is being treated at a hospital with an educational consultant or liaison that works with schools, a school counselor can encourage parents to arrange for that person to visit the school prior to the student's return to talk with the student's classmates, provide information, answer questions, and enlist their encouragement and support. Based on the student's preference and comfort level, this could be done either by the consultant or liaison alone or with the student with cancer present. One advantage to the student's involvement is that it conveys that it is acceptable to talk about cancer openly (Keeney & Katz, 2005). When an educational consultant or liaison from the medical team is not available to come to the school, school counselors can collaborate with the parent or caregiver, the survivor, the classroom teacher, and/or the school nurse to do a classroom presentation. Sample classroom presentations appropriate to different grade levels (e.g., Keeney & Katz, 2005) and other materials including videos tailored for various age groups are available through resources like the Leukemia and Lymphoma Society or the Lance Armstrong Foundation.

Re-entry Survival Phase

"Life is never the same." Woodgate (2006) identified this core narrative after analyzing interviews of 39 children with childhood cancer and their families. During the re-entry survival phase, the focus shifts from the adaptational tasks of coping with the disease to the adaptational tasks of coping with a life changed by cancer (Marcus et al., 1998). When childhood cancer survivors and their families transition from treatment to long-term survival, some of the major issues that may need to be addressed include communication with the child or adolescent about the transition, the needs of other family members including the siblings and parents, health insurance, ongoing medical concerns, spirituality, grief and loss, emotional concerns, school concerns, and health promotion issues (The National Children's Cancer Society, n. d.). A top priority becomes bringing the childhood cancer survivor back into the mainstream of the life of the family, school, and community (American Cancer Society, 1996).

Notably, comprehensive long-term follow-up clinics for childhood cancer survivors have been established to aid in this time of transition. Typically staffed by a doctor familiar with late effects and a nurse coordinator, these clinics screen for an individual's risks of late effects, provide referrals to specialists, and provide wellness education. They may also offer services such as training in self-advocacy and assertive communication, information regarding insurance and employment rights, and methods to navigate healthcare systems (Klosky ct al., 2008). A partial list of survivor aftercare clinics is available in Keeney and Katz (2005) or from the Ped-One Resource Center (see Appendix). However, less than half of survivors attend these clinics, according to estimates. A continuing challenge is that, like the specialized cancer treatment centers, the follow-up clinics may be located at a significant distance from where survivors live (Weiner, Simone, & Hewitt, 2003). Consequently, having resources for survivors in their home communities and in their schools remains important.

The locus of this discussion turns first to educational issues and then to personal and social issues in the re-entry survival phase. School counselors must recognize that the learning of survivors of childhood cancer can be affected in many ways. Undoubtedly, numerous or lengthy hospitalizations can have a significant impact. Prevatt, Heffer, and Lowe (2000) noted that childhood cancer patients miss an average of more than 40 days of school per year during their initial treatment. They continue to miss an average of 20 days of school per year up to three years past treatment in part due to routine follow-up appointments. Bone marrow transplantation or relapses also affect attendance. The cumulative effect of school absences likely contributes to the fact that survivors of childhood cancer are more likely to repeat a grade in school than their peers (Gerhardt ct al., 2007). Other factors with the potential to detract from school performance include persistent fatigue, hearing or vision loss, fine or gross motor impairments, and social difficulties (Keene, Hobbie, & Ruccione, 2007). Parents or guardians and school personnel also may have attitudes that serve as barriers to learning. For instance, parents might be overprotective because behavioral patterns such as vigilance and extensive involvement that developed within the family during treatment may persist even if they are no longer productive or developmentally appropriate (Thompson, & Gustafson, 1996). School personnel may have low expectations (Alderfer, Navsaria, & Kazak, 2009; Thompson, & Gustafson, 1996) or treat a child as if he or she were fragile even when the doctors and parents feel that school is a safe and appropriate place for the child to be (Keeney & Katz, 2005).

For some survivors, educational issues may arise due to neurocognitive late effects. These changes in the brain's structure and development may appear sometime after treatment and subtly impair functioning (DeAngelis, 2003). More specifically, cancer and cancer therapy may lead to deficits in attention/concentration, working memory, and information processing (Buffer & Mulhern, 2005). Brain radiation, intrathecal methotrexate, high-dose systemic methotrexate, and brain surgery arc examples of treatments that increase risk of neurocognitive late effects (Keene, Hobbie, & Ruccione, 2007). Knowing about the possibility of neurocognitive late effects is important because deficits may not be detected immediately or their onset may be delayed. Buffer and Mulhearn (2005) warned, "One of the greatest dangers in not communicating these new problems to the patient's teachers is that the child's struggles in the classroom can be falsely attributed to attitude problems, daydreaming, a lack of motivation, or emotional maladjustment" (p. 73). In order to deal with neurocognitive late effects, researchers have explored the effectiveness of cognitive remediation (e.g., Butler & Copeland, 2002) and pharmacological intervention like methylphenidate, a traditional medication for attentional disturbances (Butler & Mulhearn, 2005).

In addition to being alert to various barriers to learning, school counselors may facilitate the learning of children with chronic illness by participating as team members during Individualized Educational Plan (IEP) meetings, 504 plan meetings, or other student support meetings. Childhood cancer survivors have a higher incidence of special education placement; approximately 23% of childhood cancer survivors utilize special education services (Gorin & McAuliffe, 2008). In cases where students do not qualify for special education, Section 504 accommodations could be considered. Indeed, most children who have or had cancer will meet the Section 504 criteria of having a record of impairment that limits one or more major life activities including learning (Leukemia & Lymphoma Society, 2005). Based on extensive experience as an educational consultant for a pediatric hematology/oncology program to more than 90 schools, Morgan (2006) advised:

Familiarity with possible accommodations helps student support teams address observed student problems and counterbalance the effect of these concerns on learning. Cancer survivors may need physical accommodations to cope with the physical effects of treatment. For example, fatigue can be accommodated by being given a shortened school day or rest period, if needed. Hair loss can be accommodated by being allowed to wear a hat or scarf during the school day. Survivors may also need cognitive accommodations that help them cope with the effects of treatment on thinking and memory. Examples of possible cognitive accommodations include being given extra time for class work, homework, and exams, or having a homebound teacher who comes to the home to help collect and complete missed assignments (Leukemia & Lymphoma Society, 2005). Keeney & Katz (2005), the Leukemia and Lymphoma Society (2005), and Morgan (2006, 2007) are a few of the resources with helpful information about the range of possible accommodations and the rationale behind them.

In regard to personal and social issues, interest in the psychosocial adjustment of childhood cancer survivors was evident in Koocher and O'Malley's (1981) pioneering, comprehensive study of adjustment among 117 long-term survivors of childhood cancer and has continued to the present day. Koocher and O'Malley found that 47% of the 117 participants in their study experienced at least mild psychiatric symptoms based on impressions from clinical interviews. The Childhood Cancer Survivor Study (CCSS), a large retrospective cohort study sponsored by the National Cancer Institute, has continued to explore many questions about late effects among childhood cancer survivors (Weiner, Simone, & Hewitt, 2003). In a report from the CCSS on the health status of long-term survivors of childhood cancer, Hudson et al. (2003) concluded, "Although the majority of studies indicate that psychosocial functioning in childhood cancer survivors is very good, 10% to 20% of individuals show signs of psychological maladjustment, manifested as mood disturbances, behavioral disturbances, behavioral problems, and somatic distress" (p. 1584).

Within the literature on psychosocial adjustment of childhood cancer survivors and their family members is an interesting and growing body of research on post traumatic stress symptoms that is helpful in understanding how cancer-related distress may persist long after cancer treatment ends (Alderfer, Navsaria, & Kazak, 2009). Kazak, Kassam-Adams, Schneider, Zelikovsky, Alderfer, and Rourke (2006) noted that nearly all children, parents, and families experience a period of adjustment and challenge when faced with a significant and potentially traumatic medical event. In their research, 5% to 10% of survivors experienced symptoms of Post Traumatic Stress Disorder (PTSD) such as arousal, re-experiencing, and avoidance, but did not meet the criteria for a full diagnosis of PTSD or Acute Stress Disorder (ASD). This phenomenon has been named pediatric medical traumatic stress (PMTS). Even if an individual's symptoms did not meet diagnostic criteria for PTSD, the symptoms usually were considered important and clinically meaningful in the cancer survivor literature. Moreover, the implications of this line of research include prevention through the lessening of the traumatic impact of treatment as well as promising interventions such as brief, integrated cognitive-behavioral/family therapy that addresses family members' beliefs about cancer and how these beliefs impact family functioning over time (Alderfer, Navsaria, & Kazak, 2009; Kazak, Alderfer, Rourke, Simms, Streisand, & Grossman, 2004).

What does this mean for school counselors? How can they be of assistance in regard to the psychosocial concerns of the re-entry survival phase? School counselors are knowledgeable about school- and community-based interventions that address the needs of students and their Families (Milsom, Goodnough, & Akos, 2007). In some circumstances, school counselors may employ some intervention strategies themselves. For instance, in one of the first comprehensive reviews on the implications of childhood cancer survivors in schools, Gorin and McAuliffe (2008) emphasized the importance of helping students manage changes in their social circle. In addition to going into the student's classroom to set the stage for his or her return, school counselors can assist by providing other types of support to the individual student. Role-playing social skills, offering social skills classes, or otherwise encouraging friendships with schoolmates may prove helpful in the school context. In other circumstances, school counselors can encourage survivors to work with one of the previously mentioned follow-up clinics that specialize in comprehensive follow-up care for survivors of childhood cancer. They also can refer survivors and their family members to other helping professionals in their communities. Appropriate referrals may include individual counseling or family counseling for issues such as anniversary reactions to the date of diagnosis, the last day or treatment, or five years without cancer; grief and loss; anxiety; depression; guilt about survival; post-traumatic stress; and crisis management (Antonak & Livneh, 2005; Keene, Hobbie, & Ruccione, 2007). School counselors can encourage families to check into groups designed for survivors, parents and caregivers, or siblings through their child's treatment center, follow-up clinic, or through organizations such as Candlelighters. These types of groups 'allow members to share common fears, concerns, needs, and wishes. In the process, participants can gain not only insight, but also validation and social support (Livneh & Antonak, 2005). Notably, technology has broadened the notion of community, so school counselors can encourage survivors to investigate ways to connect with others through online resources geared towards survivors and their families (Keene, Hobble, & Ruccione, 2007). In addition, many sources of information exist for survivors, their families, and those who care for and about them. These include Web sites and teleconferences offered by organizations such as CancerCare, the Leukemia and Lymphoma Society, and the National Children's Cancer Society (see Appendix). In some instances, teleconferences are available as text transcripts that are readable on-line or printable, or as audio that can be listened to online or can be downloaded to a computer, MP3, or iPod.

Extended Survival Phase

With long-term survival comes the extended survival phase. When survivors move on and cope with life after cancer, the adaptational tasks are the search for personal meaning in the cancer experience and the integration of that meaning into life in general. Marcus et al. (1998) asserted, "All people with cancer, at any stage and regardless of prognosis, face issues of loss, acceptance and personal meaning of the illness at some level" (p. 474). Reflecting specifically on childhood cancer survivors, Keene, Hobbie, and Ruccione (2007) noted, "As survivors grow and mature, their understanding of what happened to them when they had cancer unfolds and expands. The past is viewed from the perspective of an older individual with a broader world view, more education, and firmer values" (p. 12).

Further research is needed to determine the extent to which psychological growth and meaning attributed to the cancer experience exists among survivors of childhood cancer (Weiner, Simone, & Hewitt, 2003). Researchers who have interviewed childhood cancer survivors have found that survivors report positive changes such as psychological maturity, greater compassion and empathy, new values and priorities, new strengths, recognition of vulnerability and struggle, and a deeper appreciation of life (Parry & Chesler, 2005). In an examination of educational and occupational outcomes among survivors of childhood cancer and peers during the transition from adolescence to emerging adulthood, Gerhardt et al. (2007) concluded, "Our overall findings of resilience among these survivors indicate that they are leading productive lives and making a similar transition to early adulthood in educational and occupational domains compared with peers" (p. 452). For instance, graduation rates and receipt of honors were similar, as were survivors' intentions to pursue future educational opportunities. In short, the childhood cancer experience may figure into a student's developing identity and may yield many possible outcomes, including thriving.

The school counselor's role may be more limited in the extended survival phase when compared to the acute survival and re-entry phases. Nonetheless, practice implications exist, especially for those who work with survivors who are adolescents. School counselors who work with this age group know that primary developmental tasks for these students include formulating an identity or self concept, increasing independence, and exploring educational and career options (Gerhardt et al., 2007). Career counseling is an appropriate intervention (Keeney & Katz, 2005). Survivors will benefit from exploring career interests and goals, determining what is needed to reach that goal, designing a plan for post-secondary options, identifying individuals in the field of interest who can offer guidance and support, and determining what accommodations might be needed (Morgan, 2007). The development of skills in advocating for themselves as individuals or for survivors as a group will ensure they can overcome barriers to education and employment (Keene, Hobbie, & Ruccione, 2007). Although research on career development and childhood cancer survivors is limited, Kosine, Steger, and Duncan (2008) described a strengths-based, purpose-centered approach to career development that might lend itself to the needs of childhood cancer. It promotes identity formation by providing opportunities for exploration (e.g., structured group discussion) and helps students make a connection between their career goals and ways they are able to serve the community.

CONCLUSION

Adaptation to childhood cancer does not end with the biological eradication of the disease because childhood cancer is a chronic disease with other sequelae including possible academic, career, personal, and social concerns. Due to their professional knowledge and skills, school counselors can assist the increasing number of survivors and their families with specific adaptational tasks. During the acute survival phase, school counselors who arc skilled in collaboration serve as members of the child's home team. They partner with the child's medical team to provide some sense of normalcy during a most unsettling time and to help the child return to school. During the re-entry survival phase, school counselors advocate for the academic, personal and social development of survivors. They keep watch for various barriers to learning and participate in the development of IEPs or 504 plans. School counselors also help student survivors manage changes in their social circles as well as develop new sources of social support and information. During the extended survival phase, school counselors bear in mind that students affected by childhood cancer may not only survive, but also thrive. They provide career counseling and otherwise help students explore their developing identity when the opportunity presents itself. Ultimately, by assisting with adaptational tasks during different stages of survivorship, school counselors advance a comprehensive cure for cancer that addresses academic, career, personal, and social concerns. Each young person who has faced the diagnosis of cancer, battled the disease, and emerged victorious truly is remarkable. To honor them, school counselors must help childhood cancer survivors enjoy continued growth and development, fully engage in school, and face the future with hope and confidence.

APPENDIX

Childhood Cancer Survivorship Resources

Keene, N., Hobbie, W., & Ruccione, K. (2007). Childhood cancer survivors: A Practical guide to your future (2nd ed.). Sebastopol, CA: O'Reilly & Associates, Inc.

Keeney, S. N., & Katz, E. R. (2005). Cancervive parent's and teacher's guide for kids with cancer. Los Angeles: Cancervive.

Leukemia and Lymphoma Society (2005). Learning and living with cancer: Advocating for your child's educational needs. [Brochure.] White Plains, NY: Author.

The National Children's Cancer Society (n.d.) The mountain you have climbed: A parent's guide to childhood cancer survivorship. [Brochure]. St. Louis, MO. Author.

Woznak, L. A., & Goodheart, C. D. (2002). Living with childhood cancer: A practical guide to help families cope. Washington DC: American Psychological Association.

American Cancer Society www.cancer.org

Candlelighters Childhood Cancer Foundation www.candlelighters.org

CancerCare www.cancercare.org

CureSearch National Childhood Cancer Foundation www.curesearch.org

Lance Armstrong Foundation www.livestrong.org

Leukemia and Lymphoma Society of America www.leukemia-lymphoma.org

National Cancer Institute www.cancer.gov

The National Children's Cancer Society www.children-cancer.org

Ped-One Resource Center www.acor.org/ped-onc/treatment/surclinics.html

Planet Cancer www.planetcancer.org

Supersibs www.supersibs.org

Teens Living with Cancer www.teenslivingwithcancer.org

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Stephanie San Miguel Bauman, Ph.D., is an associate professor in the Department of Educational Leadership and Counseling Psychology, Washington State University Tri-Cities. E-mail: sbauman@tricity.wsu.edu
Because late effects arise following an interaction
   between the individual with cancer, the
   cancer, and the specifics of treatment, there is
   no clear map between a particular type of cancer
   or a specific treatment and an expected
   spectrum of late effects. Each factor must
   be considered in anticipating outcomes.
   Understanding late effects is further complicated
   by the constant evolution of treatments; they
   are, in effect a moving target (p. 48).


If the child is being academically successful in the
   classroom and just needs accommodations in
   regard to his medical condition, then I find that
   he can be adequately served with a 504 plan.
   However, if the child is struggling academically
   due to missing a lot of time from school, falling
   behind in his schoolwork, and becoming skill
   deficient, or showing signs of cognitive late
   effects that call for specialized instruction and
   teaching strategies, then I recommend an IEP
   under special education or IDEIA (p. 9).
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