Hodgkin's Disease, Part 2 — Restrictions and Implications for School

Physical, dietary and other restrictions

Patients with Hodgkin's disease (HD) do not have any dietary restrictions. The disease itself does not impose physical restrictions, but there might be some following surgery. Surgery is often necessary for a definitive diagnosis and to determine whether the tumor has spread to other sites. This procedure, called a "staging laparotomy", is frequently needed to identify the best choice for treatment. The child's activity might be limited temporarily, and school attendance could be curtailed for a few weeks.

Implications for school

The management of Hodgkin's disease involves several facets, and the possible implications for the child in school are significant. In order to ensure the student's success, educators must consider the physical, social and psychological issues associated with this diagnosis.

Physical

The physical aspects of Hodgkin's disease and its treatment must be addressed at school. The following are a few of the accommodations and adaptations that might be necessary for the child.

  • Due to the possibility of fatigue, a child with Hodgkin's disease might need to rest during the school day. This is best done in the nurse's office, or some other private location, to avoid isolating the child or creating the impression of unfair treatment.
  • Restroom privileges should be flexible and allowed as needed.
  • Exercise will benefit the child with Hodgkin's disease by increasing muscle strength. The child should be encouraged to participate in all physical activities at school. In order to remain aware of any changes in physical limitations, the school staff should maintain a close relationship with the child's parents and medical providers. For example, steroids might cause fluid retention, which would increase weight and decrease mobility. Because the physical capabilities can change daily, the child should be encouraged to set individual limitations on physical activity. However, these limitations must always follow the medical recommendations.
  • Physical stamina should be evaluated by the school nurse, and any modifications or accommodations that are indicated should be incorporated into the student's IEP.

Social and psychological concerns for the student with Hodgkin's disease can be significant. Due to frequent absences, frequent infections and limitations on physical activity, young people with Hodgkin's disease often feel excluded by their peers. They can feel marginalized from important social events as they flow in and out of school. To encourage healthy psychological, emotional and social growth, the school should consider:

  • With the consent of the child and parents, educate classmates about the implications of Hodgkin's disease and its treatment. The hospital school teacher can help with educational materials; presentations for other students; and assisting with the education of other educators, school staff and the community.
  • Encourage peers to stay in contact with their friend during absences from school. Cards, letters and phone calls can bridge the gap when classmates with chronic illnesses must be away from school and activities.
  • Seize this opportunity to teach the other students about the importance of supporting a friend, showing compassion and other essential life lessons.
  • Identify strong peers who can mentor the student with Hodgkin's disease upon returning to school. The student with Hodgkin's disease needs a friend willing to help with missed lessons and homework. That help can make a world of difference in creating a smooth re-entry to school.
  • Help the student find ways to excel in the school environment. Mentoring support could be included in the IEP to help the student develop self-confidence.
  • Include social work and counseling services as part of the IEP. It is essential that the student have someone at school who can act as an advocate in all educational matters, and also as a confidant. A young person with a serious illness will have many questions and problems that need answers. The student needs to discuss uncomfortable topics in a safe environment, such as worries about keeping up in school, difficulty socializing, problems being teased, worries about other family members, fears about the future and fear of death.

For more information

Part 1 — Introduction, Incidence, Symptoms and Treatment

http://www.cancer.gov/

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Contributed by:

Robert Trueworthy, M.D.
Professor
Chief of Pediatric Hematology and Oncology
University of Kansas Medical Center

Lavonne Ridder, ARNP, CPON
Clinical Nurse Specialist
Pediatric Hematology and Oncology
University of Kansas Medical Center

Kathy Davis, MSEd, PhD
Associate Professor
Project Director, Connected Kansas Kids
Director, KU Kids Healing Place
University of Kansas Medical Center