Cancer in the school community

Cancer is a disease of the cells. Cells are the body’s basic building blocks – they make up tissues and organs. The body constantly makes new cells to help us grow, replace worn-out tissue and heal injuries.

Normally, cells multiply and die in an orderly way, so that each new cell replaces one lost. Sometimes, however, cells become abnormal and keep growing. In solid cancers, such as kidney cancer, the abnormal cells form a mass or lump called a tumour. In some cancers, such as leukaemia, the abnormal cells build up in the blood and bone marrow.

Not all tumours are cancer. Benign tumours tend to grow slowly and usually don’t move into other parts of the body or turn into cancer. Cancerous tumours, also known as malignant tumours, have the potential to spread. They may invade nearby tissue, destroying normal cells. The cancer cells can break away and travel through the bloodstream or lymph vessels to other parts of the body.

The cancer that first develops is called the primary cancer. It is considered localised cancer if it has not spread to other parts of the body. If the  primary cancer cells grow and form another tumour at a new site, it is called a secondary cancer or metastasis. A metastasis keeps the name of the original cancer, e.g. kidney cancer that has spread to the liver is called metastatic kidney cancer, even though the main symptoms may be coming from the liver.

There are more than 200 different types of cancer, each with its own name and treatment. Most areas of the body can be affected by cancer. Some cancers are more common than others.

Individualised treatment

Cancer is increasingly seen as a genetic disease because it is caused by abnormal changes in a person’s genes. An individual’s cancer cells are unique. This means that different people may receive different treatments, even if their cancer type is the same. Doctors will recommend the best treatment for an individual based on the type and stage of cancer, the person’s age and their general health.

Cancer and its treatment can have physical,  cognitive and emotional impacts. There are a number of ways for staff to help a student or colleague manage these impacts in the school setting.

People with cancer may have one type of treatment or a combination of treatments.

For some people treatment will cause significant side effects. However, not everyone will experience side effects. Some treatment side effects occur immediately; others appear weeks or months later. For more information, call Cancer Council 13 11 20.

How long will treatment take?

Some cancer treatments take a few months, others take a number of years. An initial phase of intensive active treatment may be followed by a longer period of maintenance treatment.

If cancer cells and symptoms reduce or disappear after treatment, the person is said to be in remission. Remission may last for a long period of time. If the cancer comes back after a period of improvement, it is called a recurrence or relapse.

Some people experience a recurrence of cancer after a period of remission. If this happens to someone in your school community, they may need  extended support from school staff.

Common cancer treatments

Chemotherapy

• Chemotherapy is the use of drugs to kill or slow the growth of cancer cells.
• The drugs are most commonly given through a vein (intravenously), but can also be given as tablets (orally), as a cream, or as injections into different parts of the body.
• Chemotherapy drugs circulate throughout the body. They particularly affect cells that divide rapidly, such as cancer cells or the healthy cells in a person’s mouth, stomach, skin or hair.
• Treatment may take several months. It is usually given in courses (cycles) over several weeks, with rest periods in‑between.

Side effects

• Side effects of chemotherapy depend on the drugs used and vary from person to person.
• They may appear rapidly (within a few hours) or later (2–4 weeks).
• Short-term side effects may include nausea, vomiting, tiredness, hair loss, mouth ulcers, sun sensitivity and lowered immunity.
• Long-term side effects may include problems with concentration, memory and thinking (cancer-related cognitive impairment). These can affect work or school performance for many years. Some chemotherapy drugs can cause infertility or heart problems.

Radiation therapy

• Radiation therapy uses a controlled dose of radiation to kill or damage cancer cells so they cannot multiply.
• It can be used to treat the original (primary) cancer or the symptoms of a cancer that has spread (metastasised).
• The radiation is specifically targeted at the treatment site to reduce the risk of damage to healthy cells.
• The radiation affects all cells in the area being treated, but cancer cells are the most affected.
• Treatment may be given daily for several weeks.

Side effects

• Side effects may appear throughout a course of radiation therapy, but particularly near the end or even several weeks after.
• Side effects will depend on the part of the body treated.
• Short-term side effects may include nausea, tiredness, hair loss and reddening of the skin near the area treated.
• Tiredness can persist for many weeks, especially after radiation to the head area.
• Long-term side effects may include sun sensitivity, learning difficulties, growth failure, thyroid problems, hair loss, infertility and (rarely) a second cancer later in life.

Surgery

• Surgery involves the partial or total removal of a tumour.
• Surgery for cancer sometimes requires removal of a part of the body (e.g. amputation).

Side effects

• The most common side effect is pain at the site of the operation.
• Other possible side effects include infections and reactions to the anaesthetic.
• Some kinds of surgery require prolonged rehabilitation such as physiotherapy.
• An amputation can change physical appearance and ability, and may require the use of mobility aids such as a wheelchair or prosthesis.
• Some surgeries cause bowel changes. Support and a private toilet may make this easier for the person to manage.

Immunotherapy

• Immunotherapy uses drugs to help trigger the immune system to fight cancer.

Side effects

• Side effects vary depending on the drug. Some may become serious and treatment may need to be stopped.
• They may include fatigue, allergic reactions, painful joints, skin rash and diarrhoea. These can vary in severity and duration.
• Immunotherapy can also cause inflammation in any of the organs in the body.

Targeted therapy

• Targeted therapy drugs attack specific particles within cells that let cancer grow.
• They may be used instead of or together with chemotherapy.

Side effects

• Side effects vary depending on the drug.
• They may include fevers, diarrhoea, allergic reactions, rashes and blood pressure changes.

Steroid therapy

• Steroid therapy uses corticosteroid drugs to reduce nausea or swelling.
• Steroids are also used to help treat some cancers and to increase the effectiveness of some chemotherapy drugs.
• They may be given orally or by injection.

Side effects

• Side effects may include increased thirst and appetite, sleep problems, weight gain, behavioural changes, mood swings, stretch marks, acne, fluid retention, high blood glucose levels and muscle weakness.

Stem cell and bone marrow transplants

• A stem cell transplant is a long, demanding process that replaces stem cells destroyed by disease, chemotherapy or radiation. (Stem cells normally live in the bone marrow and give the body a constant source of blood cells.)
• It may also be called a bone marrow transplant, a peripheral blood stem cell transplant or a cord blood transplant (depending on the source of the
  stem cells).

Side effects

• Lowered immunity makes the person more likely to catch infections.
• The treatment may involve many months off school or work and prolonged isolation.
• The donor cells sometimes attack a patient’s normal cells, a complication called graft-versus-host disease. This can occur soon after the transplant or many months later, requiring more time off school or work.

Hormone therapy

• Certain hormones stimulate the growth of some cancers. Hormone therapy either blocks or removes hormones from the body to slow or stop the growth of cancer cells.
• It is mostly used for adults with breast, prostate, ovarian or thyroid cancer.

Side effects

• Side effects for men may include tiredness, weight gain, hot flushes, breast tenderness, depression and osteoporosis.
• Side effects for women may include blood clots, weight gain, generalised swelling, hot flushes and irregular menstrual periods.

Complementary therapies

• Complementary therapies are used alongside conventional treatments, and may help manage any side effects.
• They focus on physical and emotional wellbeing.
• Examples include acupuncture, yoga, massage, meditation and art therapy.

Side effects

• Side effects depend on what type of complementary therapy is used.

Alternative therapies

Alternative therapies are unproven therapies used instead of conventional treatment. They are often promoted as “cancer cures” without scientific testing. Examples include shark cartilage, magnet therapy and drastic diets.

Some alternative therapies may cause serious side effects or interfere with conventional cancer treatment. Cancer Council does not endorse the use of alternative therapies.

An estimated one in two Australians will be diagnosed with cancer by the age of 85. In Australia, more than 127,000 people are diagnosed with  cancer every year. People over the age of 50 are the most likely to be diagnosed with cancer, and children are the least likely. Unfortunately, however, some children and young people are diagnosed with cancer.

In adult men, the most common forms of cancer are prostate cancer, bowel cancer, melanoma, and lung cancer. Adult women are most often diagnosed with breast cancer, bowel cancer, melanoma, and lung cancer.

Cancer in children and adolescents

In Australia, about 1000 children aged 0–19 develop cancer every year, which means that at any time there are thousands of school students who have had cancer. Advances in diagnosis, treatment and follow-up care mean the overall five-year survival rate for children and adolescents is now more than 80%. This can vary depending on the age of the patient and their cancer type.

Cancers affecting children generally differ from those affecting adults. Childhood cancers commonly occur in different parts of the body and are not usually linked to lifestyle or environmental factors. They tend to be more responsive to chemotherapy, and children often tolerate the treatments better.

Some side effects from treatment may not show up until many months or years later. These are called late effects. This is particularly the case for a child who was treated at a young age. Any student who has survived cancer will need appropriate support for the rest of their school years.

Childhood cancers

The most common types of childhood cancer in Australia are:

• leukaemia – a cancer that affects the blood cells; the two main types are acute lymphoblastic leukaemia and acute myeloid leukaemia
• brain tumours – the most common types in children are gliomas (starting in the brain’s glial cells) and medulloblastoma (starting in the cerebellum, the lower back part of the brain)
• lymphoma – a cancer that develops in the lymphatic system; the two main types are Hodgkin lymphoma and non-Hodgkin lymphoma
• neuroblastoma – a cancer of the nerve cells involved in the development of the nervous system
• sarcoma – a malignant tumour that develops in the bone, muscle or connective tissue.

Some people wish to keep their cancer diagnosis private. There can be a number of reasons for this:

• Students may see school as a place to be themselves and carry on with life as normal. Because fitting in with peers can be so important, they may want to minimise anything that makes them seem different.
• Parents or family members may want to avoid gossip or probing questions. Sometimes they need more time to talk to relatives or decide on treatment.
• A colleague with cancer may want to continue working and focus on their day-to-day activities, or they may wish to keep their diagnosis private until they know how it will affect their work schedule.
• Some teachers worry that their students are too young to understand cancer.

These are legitimate concerns, and people’s rights should be respected. Unless there are overriding health and safety issues, the person with cancer or their parent must give consent before anyone is told about the diagnosis.

In most cases, however, it will be easier for both the person with cancer and the school if at least key staff are aware of the diagnosis. An informed teacher can accommodate the person’s needs; anticipate questions from students, colleagues or families; and help to distribute information (if consent has been given).

The reality is that even very young students have heard of cancer. Open and honest conversation about cancer reduces the risk of confusion and anxiety and helps children of all ages understand. Being open about the diagnosis can also reduce the chance of gossip and misinformation  circulating around the school community, particularly if treatment leads to changes in someone’s appearance (e.g. hair loss, amputation).

Any member of the school community who is provided with personal information about a student, student’s family or staff member, needs to treat the information sensitively and confidentially.

If a student has cancer, one of the most helpful things you can do is to appoint a particular staff member as the key point of contact in the school. It may be the student’s main teacher but could also be another teacher or a member of the learning and support or wellbeing teams. To help avoid further stress, it is important that the student and their family feel comfortable with and have a good rapport with this person, and that the arrangement is reviewed regularly.

The school liaison person can keep up to date with the family’s changing needs and communicate with other staff on their behalf. They can also liaise with the hospital school and other education professionals. This reduces the chance of messages being misunderstood or the family having to repeat information.

It can be difficult to gauge the right level of contact and how much support is needed and welcomed by a family. The school community plays a central role in the lives of some families, but for others – often those with strong family networks – it is not as important. A family may not want help from the school.

If your school community includes diverse cultural groups, people will probably have different values and beliefs about health care. This will affect how they understand cancer and the level of stigma they attach to the disease. It can also influence how information is shared.

In some cultures, cancer can have different meanings and some people may not want to talk about it openly. Some cultures believe that cancer is contagious, caused by bad luck or is always fatal. They may not want to use the word “cancer”. Others may believe the cancer has been sent to test them.

When you talk about cancer, be respectful of different ways of coping. For example, you can ask what kind of support a colleague, family or student would like, rather than assuming you know the best way to help. If the person is uncomfortable discussing cancer or has privacy concerns due to cultural reasons, they will be able to let you know.

As well as being culturally sensitive in your discussions, you can help by directing people to Cancer Council 13 11 20 for information about cancer and cancer services. If needed, they can call the Translating and Interpreting Service (TIS) on 13 14 50 and ask to speak to Cancer Council. Using a
professional interpreting service maintains confidentiality. This can often be a better approach than using a family member or friend as an interpreter.

When a parent wishes to keep their own cancer diagnosis private, their children may be torn between respecting the parent’s wishes, and their own need for support. Organisations such as CanTeen may be able to help them.

A person’s understanding of cancer depends on their age, maturity level and experience with the disease. When someone they know is diagnosed with cancer, they may have a range of reactions. These reactions depend on their relationship with the person, their personality and temperament, and the support they receive.

For an outline of how children, adolescents and adults without cancer may understand the disease, how they might react to someone’s cancer diagnosis, and how you can talk to them about it, see ‘Different views of cancer’ below. Key treatment or testing milestones, including finishing treatment, can also prompt anxiety.

Be particularly alert for changes in behaviour. For example, a young child may regress to thumb-sucking, a sociable student may start to withdraw from peers, a top student’s grades may start to slip, or an even-tempered teacher may become moody. You can use these behavioural changes as a starting point for a supportive conversation. Provide opportunities for professional counselling if needed. Your school counsellor should be able to help.

Remember that each person is unique and these are broad guidelines. Although the experience of cancer is often challenging, many people are resilient and have positive reactions. For example, siblings of children with cancer often grow in compassion and empathy for the hardship of others.

When someone in your school community is diagnosed with cancer, you are likely to encounter a range of reactions from students, families and colleagues. These general guidelines may help you pick up on signs of distress and provide age-appropriate support.

Early primary students (4-7 years)

In the early primary years, students have a basic understanding of sickness. When someone they know has cancer, they may worry that they will catch the disease or that they caused it (e.g. by being naughty or thinking bad thoughts about the person). At this age, most children are egocentric: they often think everything is related to them and may not yet empathise with others. They tend to notice (and comment on) physical changes. Young students may be just starting to realise that people, including parents or grandparents, can die.

Possible reactions

• regression, e.g. stopping reading, starting to suck their thumb again
• comfort-seeking behaviours, e.g. using a security blanket or a special toy as a comfort object, thumb-sucking
• stuttering or baby talk
• withdrawing from conversations
• hiding behind a parent or significant adult when meeting other people
• fear of separation from others, especially at bedtime and going to school
• fear of the dark, monsters, animals, strangers and the unknown
• disturbed sleep, e.g. sleeplessness, wanting to sleep with a parent, sleepwalking or sleep talking, nightmares, bedwetting
• hyperactivity or apathy
• aggression, e.g. hitting or biting
• repeating questions about the same topic, even if it has been discussed several times
• commenting on physical changes and teasing if they don’t understand them

Suggested approaches

• listen to their feelings (expressed through speech or play) and be alert to their needs
• talk about cancer using picture books, dolls or stuffed animals
• read books together that explore anger, sadness and other feelings
• be honest (to their level of understanding)
• reassure them that they will be taken care of and will be safe
• if separation anxiety is a problem, ask them to look after something special for that person, so they know they will return
• provide brief and simple explanations, but use all of the cancer terminology they may encounter; repeat your explanations if necessary
• keep routines consistent where possible, and explain any changes to their schedule
• encourage them to have fun at school and enjoy their other activities; physical activity can help to release anxiety and tension
• assure them that they have not caused the cancer by their behaviour or thoughts, nor will they catch cancer
• continue usual discipline and limit-setting

Later primary students (7-12 years)

By the later primary years, most students are ready for more complex explanations of cancer and cells. Like younger children, they may feel responsible for causing the cancer of someone they know and may blame it on their own bad behaviour. Many are starting to comprehend the finality of death and its impact (especially if they have been exposed to death at a young age).

Possible reactions

• irritability, anxiety, guilt, envy
• sadness, crying
• physical complaints, e.g. headaches, stomach-aches
• school refusal
• separation anxiety when going to school or away to camp
• hostile reactions, e.g. fighting or yelling
• poor concentration or daydreaming at school, possibly with a change in academic performance
• withdrawal from friends and family
• self-consciousness, feeling like the odd one out
• difficulty adapting to changes (such as a replacement teacher or new schedule)
• fear of performance, punishment or new situations
• sensitivity to shame and embarrassment
• trying to be extra good

Suggested approaches

• listen to their feelings (expressed through speech or play) and be alert to their needs
• use books to explain disease, cancer, treatment and potential outcomes
• assure them their behaviour or thoughts did not cause the cancer
• be honest
• reassure them about their care and schedule
• maintain clear rules and expectations
• assure them that the chances of someone else getting cancer are slim
• let them know how they can help a teacher, classmate, sibling or parent with cancer
• take time to listen and let them know you care about their feelings
• appoint a teacher, staff member or buddy to watch out for them
• if the prognosis is poor, ask for help from a social worker or psychologist to gently broach the topic of a parent, teacher or classmate dying

Secondary students (12-18 years)

By the secondary years, students are starting to think more like adults. As their ability for abstract thought develops, they recognise relationships between events, such as cause and effect. They now appreciate that people are fragile and can imagine what it might be like to have cancer.

Possible reactions

• denying fear or worry to avoid discussion
• hiding feelings – parents, teachers and friends may not see true reactions
• anger, rebellion
• withdrawal, apathy, depression, anxiety
• worry about being different and not fitting in
• becoming nervous in social situations
• wanting to be independent and treated like adults – may become more responsible
• regression, e.g. watching children’s TV shows, being dependent on parents
• critical view of the support offered by adults and friends
• friendship issues
• poor judgement and risk-taking, e.g. smoking, binge drinking, unsafe sex, abuse of illicit or prescription drugs
• self-harm, e.g. cutting, restricting diet
• physical symptoms caused by stress, e.g. stomach-aches, headaches
• difficulty concentrating in class, change in academic performance
• poor school attendance
• a desire to help others and raise funds or awareness about cancer

Suggested approaches 

• listen to them, don’t talk at them; encourage them to discuss their feelings, but realise they might not want to talk or may prefer to confide in friends
• express your feelings so they know what they’re feeling is normal (e.g. share that you are worried or miss the person), but do not burden them with the task of taking care of you
• provide privacy, as needed; highlight the importance of respecting privacy and using social media appropriately
• encourage them to maintain activities and friendships at school, if possible
• don’t expect them to take on too many extra responsibilities at school
• allow them to have time with friends
• allow flexibility and special consideration with schoolwork
• provide in-school opportunities for them to learn more about cancer and receive support; don’t expect them to be cancer experts
• treat them with respect as an emerging adult; let them know you are thinking about them, but be discreet and respectful

Parents and staff members (over 18 years)

Because adults and some older students can think in abstract terms, they usually empathise with the person affected by cancer. They understand complex relationships between events and are likely to recognise the impact of a cancer diagnosis and treatment on all aspects of life (such as school and personal relationships).

Possible reactions

• depression, anxiety
• withdrawal
• sadness about their own experiences with cancer
• physical symptoms such as headaches
• fear about their ability to cope
• feeling overwhelmed
• needing to talk with others about how they are feeling
• putting extra energy into work or distracting activities
• fluctuation in mood, especially around significant testing and treatment dates of the person with cancer

Suggested approaches

• keep in mind that different people will feel comfortable with different approaches
• take time to listen and let them know you care about their feelings
• if a student has cancer, principals can give staff simple and factual information and encourage them to seek further information as necessary; they can discuss strategies for supporting the child and their siblings, what information may be shared with students and their families, and how to talk to children about cancer
• if a staff member has cancer, they may choose to tell parents and students
• line managers can remind the person with cancer about any staff counselling services that they and their family can use, and discuss any requests for flexible working arrangements

Talking openly about the cancer diagnosis helps the school community adjust to the news, and understand what support the student needs. Ask the family what the student knows about the cancer and how the student has responded. Some families limit the information the child has about the cancer, especially if the child is young.

Schools have various ways of disseminating information to their community (e.g. newsletters, emails, websites, apps). Let the student and their family guide you about who in the school community needs to know and how much they can be told. The family, school staff members and the key liaison person can discuss the family’s wishes and school policies for sharing information.

Different families may need different communication styles. For example, some may want you, or one of your colleagues, to talk to their child’s classmates about cancer. Others may ask a clinical nurse consultant from the hospital to visit. Some may want the school to send a general letter to parents about cancer without mentioning the child’s name. The school’s parent association, such as the Parents and Citizens (P&C) or Parents and Friends (P&F), may be able to help the school communicate with families.

Be mindful of the student’s close friends, as they may be deeply affected by the news. It can be very reassuring for the student if their friends find ways to show their support.

Keeping in touch

School represents normal life to most students. Going to school is more than just education – it establishes a routine and provides an opportunity to socialise. A diagnosis of cancer is a major disruption for the student and leads to frequent absences from school.

Every situation is different. Not all families will want to maintain close contact with the school community, and a young child may not be able to respond to messages, depending on their age and symptoms. However, many students receiving treatment for cancer do want to maintain contact with classmates. Young people with cancer find it easier to return to school if friendships have been maintained throughout their absence. Regular communication can provide reassurance that they’ve not been forgotten by their friends and help to keep them engaged with their education.

The school community can keep in touch with a student in the hospital or at home by using technology such as Skype, email and the school intranet. Educational social networking portals such as Edmodo can allow you to communicate with the student and the hospital school about their schoolwork. Videoconferencing tools (such as Skype, WebEx, Google Hangouts or Adobe Connect) can also allow the student to participate in classroom lessons.

How to maintain contact

• Send postcards, letters, drawings or paintings.
• Make an audio or video recording of a school event, or of personal messages.
• Post a package of photos or small gifts.
• Email notes or photos.
• Consider age appropriate programs such as Monkey in My Chair.
• Create a website or blog about what is happening at school.
• Use social networking or videoconferencing such as Skype, FaceTime or Google Drive.
• Organise visits to the hospital by classmates, if approved by the student’s parents. The student may have reduced immunity, so reschedule the visit if anyone has a cold, cough or other viral or infectious illness.

Supporting families

When a child or adolescent is diagnosed with cancer, the family may experience emotional and financial strain, which can cause anxiety. One parent may have to take time off work so they can be with the child in hospital, while siblings are often left with just one parent at home. The changing family dynamics and stress can lead to relationship issues. In single-parent or separated families, the pressures can be even greater.

Families in regional schools face extra complications. The major centres for cancer treatment are usually in large cities, away from the family’s main support network. Often the student must travel great distances and stay away from home and school for long periods. One parent usually has to travel with the child, while the other parent stays home for work and to care for siblings.

School staff can link the family to school counselling services and offer support to any siblings who also attend the school. If your school has fees, the principal could consider how these can be adjusted to ease the family’s financial burden. Fellow school parents often play a key role in coordinating support when a child has cancer, particularly if there isn’t any extended family to help. With the family’s permission, they may organise a roster for meals, childminding or transport (such as taking siblings to school, sport or other activities), or set up a fundraising website. A group of parents may organise this help among themselves, or it could be coordinated by the school’s parent association, such as the P&C or P&F.

Helping with schoolwork

It is natural for a parent to feel anxious about how the student is going to keep up with their schoolwork. Students may also worry about falling  behind, particularly if that might mean being separated from their peer group when they do return to school. Talk to the student and the parents about their expectations, and how you can help maintain some form of ongoing learning. An Individual Education Plan (or Individual Learning Plan) can provide some direction and guidance to ensure the student doesn’t fall behind.

Any school-aged student who has an extended hospital stay will be enrolled in a hospital school or hospital education service that caters for all school aged students. A hospital school aims to provide continuity of education to make the return to school as easy as possible and to boost a young person’s spirits and self-esteem. To do this, the hospital school may contact the student’s regular school to discuss the educational program. This helps ensure that the learning taking place in hospital is aligned with their regular schoolwork. Students attend a classroom or, if necessary, are visited on their ward by a teacher. Some hospitals may provide other services to assist with learning needs, such as play, music or art therapy.

More children and adolescents are now receiving treatment as outpatients. This can make it difficult for them to visit the hospital school, but they may not be well enough to attend their regular school. If you know the student is spending long periods of time at home, liaise with the family and the hospital school to ensure they have educational support and peer contact. The class teacher can also work with the student and family to set up a work program they can complete at home, including opportunities for the student to connect with their class.

If the student transitions to high school or another new school, staff may share information about the student’s learning needs so that the appropriate plans can be put in place.

Ways to support an absent student

• Provide the hospital school with curriculum outlines and a list of textbooks.
• Send copies of worksheets and projects to the student at home or at the hospital school.
• When the student returns schoolwork, acknowledge their efforts and provide them with feedback.
• Make sure the student receives school newsletters and handouts.
• Let the hospital school know if the student needs an extension or remediation program.
• Facilitate online access to assignments or websites with information about school activities.
• Find creative ways (such as Skype or video calls from class) to link the student with the school, especially if they are away from home or in isolation.
• Understand that the student may be so unwell during their treatment that they may not be able to continue with their schoolwork.

Redkite

Redkite is a national charity that supports children and young people with cancer, and the people who care for them. They offer:

• financial assistance to help young people aged up to 24 years achieve their work and study goals, and to help young people whose education has  been disrupted by a sibling’s cancer treatment
• coaching assistance to help 15–24 year olds diagnosed with cancer at any age get back on track with work, study or training
• free information, support and counselling, for young people diagnosed with cancer, their families and support networks. This includes teachers and other education staff who would like advice on supporting a student.

You can help by making parents aware of Redkite’s support services or by referring a student yourself. For more details, call 1800 REDKITE (1800 733 548), email support@redkite.org.au or visit their website.

Ronald McDonald Learning Program

Provided by Ronald McDonald House Charities Australia, the Learning Program helps seriously ill children and adolescents, as well as the parents and professionals who support them. The program includes various services:

• individual tuition helps students catch up on their missed schooling
• Education Liaison Coordinators support the ongoing education of students at all children’s hospitals in Australia
• EDMed, a free accredited professional development unit for teachers, helps schools meet the educational needs of children with cancer.

To find out more, visit their website, call 1300 307 642 or email rmhc@rmhc.org.au.

Hospital-based programs

Some hospitals have specialised programs to prepare students for the return to regular school. These programs liaise and collaborate with families, schools, hospital schools and oncology units to keep the child connected to their learning, their peers and their school community. Talk to your student’s hospital about the educational services and programs they provide.

Monkey in My Chair

This charity supports younger children while they are absent from school by providing a large toy monkey to sit in the absent child’s chair. The absent child also has a monkey. The class includes the monkey in all normal class activities and excursions, and photos are sent between children. For more information, visit their website.

Supporting the student’s classmates

If you are telling students about a classmate’s cancer, parents need to be aware that their children may come home upset, worried or with questions. The principal can send an email or a note home to prepare the parents.

You can expect a range of responses from students to the news. It’s important to remember that everyone reacts differently to a stressful situation, and age and personality will influence this. Some students may be visibly upset. Others could be angry, confused or annoyed. Some may have no outward reaction to the news, which doesn’t necessarily mean they’re not listening or that they don’t care. Others may look to help in any way that they can.

Give the students opportunities to share how they’re feeling or ask questions. They might ask some difficult or sensitive questions, such as if they can “catch” cancer or if their classmate will die. Think about how you will respond to these questions ahead of time and approach the class in a sensitive manner.

In some cases, a member of the patient’s treatment team (such as the clinical nurse consultant), a local community nurse or an organisation like CanTeen may visit the school to explain what is happening to their classmate, and how the student will look and feel when they return. Geographically isolated schools may be able to access support over the phone or internet.

Try to establish beforehand if some students are more likely to be upset because of their friendship with a classmate with cancer. If a student  becomes very distressed, they may need to speak with a counsellor or teacher with whom they feel comfortable. Contact the parents to let them know about their child’s distress.

Regularly inform classmates about the student’s progress. This will help to keep the class connected and prepare them for the student’s return. Events such as fundraising for cancer charities may help channel the thoughts and energies of older classmates.

Siblings of students with cancer may need particular support because of the disruption they experience. They may sometimes feel forgotten, or believe they are responsible for what is going on.

Common questions from classmates

• How did they get sick?
• Can I catch it?
• If you can’t catch it, how do you get cancer?
• How many people get cancer?
• Will they miss school?
• What am I supposed to say or do?
• How can I be a friend to someone with cancer?
• Should I share things that are bothering me? They seem silly or trivial compared to what my friend is going through.
• Can people die from cancer?

Returning to school

Getting back into a school routine is important to children and adolescents. It maintains continuity in their education and their friendships, and it reinforces the idea that life will go on and they have a future. It can be daunting for the student to return to school, however, and it is important to consider what support they will need. With the family’s permission, a clinical nurse consultant or the oncology social worker may be able to visit the school to talk to staff about how the school can best support the student’s return.

Encourage the student to return as soon as they feel up to it – Being accommodating and flexible to the student’s needs will help the student become involved as much as possible in day-to-day lessons and school activities, rather than avoiding school. Ideally, the school will help the student by facilitating partial attendance (such as half-days) at first and reducing or modifying work, such as assessment tasks. Keep in mind that ongoing medical treatment and follow-ups may continue to affect school attendance. The family’s medical team can provide documentation to support this, if required. It will be easier for the student to adjust to being back at school full-time if many short visits or half days are kept up during active treatment. On some days, the student may just visit school at lunchtime so they can socialise with friends.

Plan for the individual needs of the student – Preparing for the student’s return is essential so that any adjustments, such as modified grading procedures, can be put in place. This relies on communication between the school and the student, their family and the treatment team. The school liaison person can coordinate communication with teachers, the school counsellor and other staff.

Ask the family whether any speech, occupational or cognitive assessments were completed during treatment and, if so, whether copies of the reports can be given to the school. If not, a school counsellor can conduct an educational assessment of the student and provide recommendations on how to meet the student’s individual needs. This may include further referrals, such as for occupational or speech therapy. Students may also need practical changes to accommodate their physical needs. It is important to treat the student as normally as possible, within the limits set by their condition.

Anticipate anxieties about returning to school – Returning to school can be daunting for both the student and parent after a prolonged absence, especially if the student has had to be held back a year and is entering a different peer group. The school counsellor or another appropriate member of staff can arrange a meeting with the student and parents to discuss their concerns about returning to school and how the school can help. Reassure the student that while things will probably feel different for a while, they will be supported to settle back into school. Identify people they can go to if they have a problem or feel lonely, especially during lunchtimes. Discuss with the student which trusted staff member they would like assigned. Add a peer buddy if your school is equipped to provide them with appropriate support.

It is natural for parents to have a wide range of feelings about their child returning to school. Some may be overprotective or stressed about the transition, while others may be relieved or pleased. If you have difficulty managing a parent’s reaction, talk to the student wellbeing coordinator or a school counsellor about how to handle the situation. With the parents’ permission, you could also contact the clinical nurse consultant from their treatment team for guidance. Sometimes parents need reassurance that their child’s physical and emotional needs will be supported.

Return to school plans

A return to school plan can help with the student’s reintegration into school. It is prepared by the school with involvement from the student, their family and the health care team.

The plan can outline agreed expectations about attendance and schoolwork, any additional support the student requires, and what the school can do to support the student.

A return to school plan can be incorporated into the Individual Education Plan (IEP) or Individual Learning Plan (ILP). It is likely the student will also need practical support.

If the student becomes unwell

• If a student with cancer complains of feeling unwell, particularly if their temperature is rising, contact their family.
• If a student who is still receiving active treatment or has a CVAD develops a fever of 38°C or above, it might indicate a serious infection and they
  usually need to go to hospital immediately.
• The student’s health care plan (or health support plan) should include the details of who the school should contact if the student becomes unwell and in what order. If in doubt, school staff can call 000 for guidance.
• If the student’s health care plan includes arrangements for the school to monitor the student’s temperature, parents may need to provide the school with a thermometer for their child.

Building resilience

Resilience allows children to cope with adversity – to bounce back. Although living with cancer can be undeniably difficult, in most cases young people can demonstrate maturity and wisdom beyond their age.

To help all students build resilience, teachers can:

• create a supportive environment
• value all contributions from students
• set clear expectations and rules
• encourage students to accept responsibility
• praise sustained effort and perseverance
• prompt students to think and act independently
• model and teach empathy and caring
• teach students how to resolve conflict.

For primary school students, visit be you to find out more about promoting resilience and for resources you can use in class. You can also ask your local education authority if they have any resources. For secondary students, the ReachOut Schools portal has a Building Resiliency in Young People resource, which includes lesson plans. Or visit be you for online modules to help secondary schools promote a positive environment and build resilience.

The returning student’s concerns

When students have had a lot of time off school for cancer treatment, their worries may include social, academic, psychological and physical issues. Some common concerns are listed below, along with ways that school staff may be able to provide support. Use this list to start a conversation with your student about their particular concerns and take your lead from them.

Being the centre of attention – Students may worry about being stared at or being bombarded with questions about their absence or appearance. With the student and family’s permission, communicating with the school community before the student’s return can encourage sensitive reactions from peers. Preparing the student with simple responses to typical questions can also help.

Keeping up with schoolwork – Reassure the student that their being back at school is what’s important and that it will take time to catch up. Provide additional support through your school’s student wellbeing team, learning and support team or liaison person, or arrange a study buddy (peer support), tutoring or special assistance. Consider modifying grading procedures and assessments if appropriate.

Being left out or rejected – Let the student know that their classmates did miss their company, and explain that their peers may be shy initially, but will eventually be more welcoming. Prepare classmates for the student’s return before they arrive. Remind peers of the returning student’s right to privacy and about the dangers of comments on social media.

Being bullied or teased – Your school will already have policies to deal with bullying, discrimination and harassment. Closely monitor the reactions of other students – some peers can resent what they see as special treatment, but educating students about cancer in age-appropriate ways can help.  It is also important to remind them about social media etiquette. Equip the student with cancer with strategies to respond to bullying behaviour.

Fitting in with other classmates – A student who looks different (because of weight gain or loss, hair loss or a physical disability, for example) might worry about their friends’ reactions. Talk with classmates honestly to help them understand the situation. Some students with hair loss may wear a head covering (cap or scarf) while their hair is regrowing. Others may have to adapt the school uniform. Ensure school staff know about any adaptations to avoid unnecessary embarrassment. If the student has to change clothes for school activities, you might be able to provide a separate changing area to give them extra privacy, especially if they are concerned about their peers’ reactions.

Feeling that their classmates are immature – After the experience of having cancer, many older students feel they have less in common with their peers. The latest celebrity gossip or music news can seem unimportant. This can affect the student’s ability to fit in and socialise. Try helping the student to find new interests to share with peers. Remember that while the returning student may seem to be older in some ways, they are still very young.

Getting sick again – After treatment has finished, it is common for a student and their family to be concerned about the disease returning (cancer recurrence). This concern can arise each time they have a check-up and may last for years. For some students, the treatment leaves them with a compromised immune system and they are highly susceptible to infections. Reinforce your school’s standard infection control measures and encourage general hygiene, such as handwashing, throughout the school. You could also consider including handwashing as part of the curriculum for younger year levels.

The principal can send a letter or email to all families emphasising the importance of not sending children with infectious diseases to school and asking parents to inform the school of any cases of measles or chickenpox as soon as possible so that the parents of the child with cancer can be alerted. The letter can explain that one of your students has lowered immunity after cancer treatment but need not mention the student by name.

Making practical changes

A student with cancer will usually need some practical support related to their health care and psychological wellbeing. A written management plan prepared by the principal with the input of the student, their parents and their health care team helps to avoid misunderstandings. This individual health care plan (or student health support plan) should consider the student’s full range of learning and support needs, including treatment effects, care needs, and emergency signs and procedures. Many young people prefer not to draw attention to themselves. Talk to the student about ways they can discreetly signal their need for a break or physical assistance (e.g. by placing a white time-out card on the desk or using a hand signal).

Accessibility – Fatigue is a common side effect of cancer treatment, so when a student first returns to school, they may find it easier to manage if their classes are moved to easily accessible rooms. For secondary students, allow a window of time for movement between classes so they can avoid crowds.

In some cases, the cancer or its treatment can cause a physical disability. For example, a student may have had an amputation, they may need to use a wheelchair or they may have vision loss. School buildings may already be modified to ensure access for other students with physical disabilities, but you may need to provide permission to use more accessible toilets, access to a lift, or classrooms on the ground floor. The school may also need to organise an accessibility assessment of the school grounds.

If the student is weak and needs assistance with carrying books or pushing their wheelchair, the student’s individual health care plan (or student health support plan) should set out how this will be managed. If the student has reduced or impaired fine motor function, an occupational therapist may need to recommend ways the student can be supported in their writing activities.

Sensitivity to sunlight – Students receiving cancer treatment can be very prone to sunburn. To limit sun exposure, encourage the usual SunSmart guidelines of using sunscreen, wearing hats and ensuring access to shaded areas. On hot days, encourage indoor activities, but do so without isolating the student – for example, the student could go to the library with a few classmates.

Central venous access device – Some students will have a central venous access device (CVAD), which is a tube inserted into a vein in the neck, groin, chest or arm. It may be called a port, port-a-cath, central venous catheter, Hickman line, PICC line or central line. It allows medical staff to administer chemotherapy and other drugs, fluid or blood transfusions, or to draw blood.

All school staff, including those in charge of sports and sick bay, need to be aware of precautions and care while a student has a CVAD. Contact sports can cause the device to break or loosen, and some types should not be submerged in water because of the risk of infection. Ask the student’s parents what precautions the medical team have recommended, and discuss how the student can still participate in school sports, such as by recording results.

To minimise panic and any negative effects on the child or other students, the student’s individual health care plan (or student health support plan) should set out what action to take if there is a problem with the CVAD, e.g. a cap falls off, the line comes out or the site starts to bleed.

Sexuality, fertility and body image

The upper primary and secondary school curriculums for health and physical education, and for science, may include the topics of fertility and sexuality. Some cancer treatments can seriously affect fertility and sexual function, so these topics may need sensitive handling.

Likewise, if you’re planning lessons about body image, consider the impact cancer treatment may have had on your students (e.g. amputation, surgical scars), and whether you need to adapt your lesson plan.

Palliative care

Cancer in children can be unpredictable, so palliative care may be offered early in the course of the disease. Palliative care aims to optimise wellbeing by addressing the child’s physical, practical, emotional, spiritual and social needs. It does not mean that their family or medical team have given up hope or that the child is dying.

Some children attend school while they are receiving palliative care. For children with cancer and their families, school can offer a sense of connection, normality and routine throughout a time of great upheaval. Depending on their health and energy levels, the student may attend school full-time or part-time.

In some cases, the attendance may be primarily social, with the student visiting for lunch breaks or favourite classes. The school community can play an important role in supporting the student’s independence, dignity and determination.

A student returning to school may have to manage the effects of cancer treatment on their academic performance. Parents of students with cancer have reported significant effects on writing, mathematics, handwriting, confidence, exam performance, memory, concentration and physical education. Some of these impacts may be delayed, appearing months or even years after treatment has ended.

It is important to recognise that cancer treatment can change the way the student learns and that the student may need extra educational support throughout all the years of their schooling. In particular, some students develop long-term difficulties with executive functioning. This affects the ability to plan, organise, form abstract concepts, practise self-regulation and initiate action. The student may have trouble taking notes or copying information, remembering things, concentrating, getting started on activities, or completing tasks on time. In some cases, the student’s struggle to manage these challenges can lead to a lack of engagement with education or disruptive behaviour in the classroom.

In many school systems, specialist learning support staff help classroom teachers to address the additional educational needs of students. They may be part of a learning and support team (sometimes known as the program support group). This team is made up of all those involved in the student’s education, including parents, the principal or other school leader, the class teacher and the school. In some cases, the team may decide to create a formal plan, which may be known as an Individual Education Plan (IEP) or Individual Learning Plan (ILP).

Parents or guardians have an important role to play in discussing and planning for their child’s needs. You can refer them to Learning curve: education and socialisation after childhood cancer, a series of booklets for different ages produced by the Victorian Paediatric Integrated Cancer Service.

Your school will need to work together with the parents and student to develop realistic expectations about what can be achieved academically.

Adjustments to support learning

In addition to any adjustments to accommodate physical needs, schools may need to make temporary or permanent adjustments to manage the returning student’s changes in academic performance and behaviour. These adjustments can be listed in the student’s IEP, ILP or return to school plan, and may include:

• seating them towards the front of the class
• organising an in-class buddy or teacher assistant to help with note taking or recording assignment due dates
• providing catch-up work in different key learning areas
• offering extra tutoring
• adapting work so the student can manage the load
• discreetly allowing extra time for homework and assessment tasks, and increasing time limits in tests or exams
• providing a model or scaffold that shows the steps in a task
• giving verbal prompts and written reminders
• helping the student organise thoughts using graphic organisers and mind maps
• allowing the student to work without interruption as much as possible
• revising the number or types of subjects taken by the student
• encouraging rest breaks in class to help the student focus and manage fatigue.

Students may also need special consideration for physical education classes. This will be obvious if the student’s treatment has involved a visible change such as an amputation, but also needs to be considered when the student is managing fatigue from chemotherapy or radiation therapy.

Giving students factual information about cancer increases their understanding and reduces the risk of gossiping and bullying. Most students want to be supportive, but need the tools and knowledge to do so effectively.

Before starting a discussion with your students, consider their age and maturity and anticipate any difficult questions they might ask. You might practise what you will say, or ask the family how they would like you to approach the class.

Planning a lesson about cancer

In some cases, a lesson or class discussion about cancer can help students understand their classmate’s condition. Depending on the content, this  may support the curriculum for health and physical education and/or for science – check with your local education authority.

There are a number of books about cancer that you can share with your students. Staff from the student’s hospital school may be able to recommend other age-appropriate resources about cancer that you can use in class. With the permission of the student’s parents, you could also ask if a clinical nurse consultant or other member of the medical team can visit the school to talk to students and staff. Camp Quality offers a Primary School Education Program and CanTeen runs When Cancer Comes Along, an education program for students in years 9 and 10 about cancer and its impacts.

Books about cancer

For younger children

• Butterfly Kisses and Wishes on Wings Ellen McVicker (author) Nanci Hersh (illustrator)
• In the Rainbow Tracey Newnham, 2018
• Nowhere Hair Sue Glader, 2010 Thousand Words Press
• Cynthia Hartman Nomota, 2004

For older children and adolescents

• Wait… Did you say ‘Cancer’? series CanTeen, 2013
• The Fault in Our Stars* John Green Penguin Books, 2012 * Also a movie
• The Honest Truth Dan Gemeinhart Scholastic Press, 2015

Hosting a cancer awareness and education day

While it is important to integrate information about cancer into the core curriculum, your school may also consider hosting a cancer awareness and education day. Many awareness days include a fundraiser, such as buying ribbons or coming to school out of uniform in exchange for a gold coin donation. However, your school does not have to collect funds.

Ask the person with cancer (or their family) if they are comfortable with the idea. While the information can be presented in a very general way, families may want to ensure certain details are kept private. Consider how best to inform all parents and students about the upcoming event.

The cancer awareness and education day could involve brief in-class discussions or lessons from teachers. Younger students could draw pictures or write stories. Older students may want to hang posters, make presentations about cancer, or set up a stall to distribute information.

Arranging a puppet show

For a cancer awareness day in a preschool or primary school, you may want to arrange a visit from the Camp Quality Primary School Education Program. This free program explains cancer to children through an interactive puppet show that addresses the challenges of living with cancer and the importance of friendship. It is a useful tool for introducing the topic of cancer in an age appropriate way that provides the school community with a shared language for honest and open discussion.

If you are hoping to book a Camp Quality puppet show, plan well in advance. The puppets are very busy, but your State Coordinator will do their best  to book you in as soon as possible. Camp Quality will provide you with a template letter so you can inform all parents of the planned visit.

Camp Quality also provides free resources that can be used in the classroom after the performance and may be useful when planning a lesson about cancer.

Dealing with teasing and bullying

A school climate that promotes respectful relationships is likely to support student wellbeing and discourage inappropriate behaviour, such as  teasing and bullying.

Schools are legally obliged to develop and implement strategies to prevent harassment and victimisation of students, including those with cancer. Schools also need to respond appropriately if an incident occurs. Consult your school’s antibullying or anti-harassment policy for general guidelines.

The best way to prevent bullying is to be as open as possible about a student’s cancer. Young people may have little understanding of what a student with cancer is going through and what treatment involves. This may make them feel frightened.

The more classmates know about cancer, the more likely they are to be supportive. Discuss the benefits of openness with the student and family and make sure you have their permission to share information about the student’s situation.

It’s important to be aware that some students may feel resentful when a student with cancer returns to class. They may believe their peer is receiving undue special treatment. You can explain that the student needs extra support related to their health but still has to follow the same school rules as everyone else. Try to maintain a normal classroom atmosphere.

For general information on creating a supportive school culture, you can explore the resources at the Student Wellbeing Hub.

Guiding classmates

It is not uncommon for the classmates of a student with cancer to feel helpless and unsure about what to do or say when they are with the student. Sometimes students will look to teachers or their parents for guidance on how to act, but at other times you might simply notice that the students are feeling uncomfortable. There are various ways that you can help the students to become more at ease, including:

Listening – Be prepared to listen to students’ concerns.

Facilitating discussion – Encourage students to talk about what cancer is, its treatments and possible side effects. This will help prepare students for any physical or emotional changes in their classmate.

Answering questions – Discussing the facts openly helps reduce anxieties and uncertainties. If you don’t know the answer, offer to find out. Remind students of their classmate’s right to privacy and the potential impact of sharing information on social media. If you’re caught off guard by a question, consider responding with “That’s a really good question, what makes you ask that?” This will give you some insight into why the person is asking the question.

Being prepared – When a student has cancer, it’s a good bet most classmates are thinking, “Will they die?”, and a few will probably ask. Balancing the truth and family wishes can be a challenge. A gentle way to respond might be: “Cancer is a very serious illness and we are all worried about your classmate, but we know that the treatment team at the hospital is working hard to help them. If we learn of any developments, we will let the class know.”

Providing advice – Give students guidance on how to talk to a classmate with cancer.

Encouraging emotional expression – Provide the opportunity for friends to debrief and express their feelings about cancer. For some students,  activities such as painting, writing or composing music will help them work through their emotions.

Inviting an expert – You could ask a member of the student’s medical team, such as a clinical nurse consultant, to speak to the class (with the consent of all parents, including the parents of the student with cancer). This will help students gain a better understanding of what their classmate is experiencing.

Talking to a classmate with cancer

Like some adults, students sometimes worry about saying the wrong thing, so they may start to avoid a classmate who has cancer. Teachers can help by discussing the following tips with their students.

Try to talk about day-to-day things – Their classmate is probably tired of talking about cancer all the time. But the students also need to understand that their classmate might not be interested in trivial topics such as the latest celebrity gossip.

Acknowledge the situation – Students can say: “I don’t know what to say, but I want you to know I care”, “We missed you”, “It’s good to see you”, “How are you going?” or “Is there any way I can help in class?”

Understand that their classmate might look different – Their classmate may be self-conscious about any appearance changes caused by cancer treatment. They may want to talk about these changes or they may just want to fit back in. By following the lead of their classmate, students can work out whether it’s okay to talk about the changes.

Understand that their classmate might act a little differently – Their classmate may be more tired or less social than before. Students can show their support by being patient and accepting that it may take time to adjust.

Take cues from their classmate with cancer – People who have had cancer react in different ways. By observing how their classmate behaves, students might figure out how to respond.

Exams in primary school

The National Assessment Program – Literacy and Numeracy (NAPLAN) involves annual tests for students in Years 3, 5, 7 and 9.

Students with cancer may be unwell at the time of the tests, or their cancer treatment may have temporary or permanent effects such as fatigue or learning difficulties. Parents may not be aware that their child can apply for special examination provisions, so the school should raise the issue with them. The student’s treatment centre can provide documentation to support a request for special provisions. For more information, school staff can visit the National Assessment Program website, or contact their state or territory test administration authority.

Special provisions may also be available if the student is attempting placement tests for selective classes or schools. Contact your local education authority if you know these tests are coming up.

Senior assessments

The senior assessments at the conclusion of secondary schooling are known by different names throughout Australia. In general, all students are required to meet the course requirements, but the relevant education board can adapt assessments to provide reasonable adjustments to the special needs of students with cancer.

The permitted provisions depend on the rules in your state or territory and on each student’s circumstances. For example, some students may be allowed rest breaks between exams or an extension of test time. Other students may need to have physical disabilities accommodated (e.g. by using a scribe, a reader or assistive technology). In particular cases, the student’s marks may be based on their scores throughout the school term/s, rather than the usual combination of in-school assessments and external exams.

If possible, it is preferred that students sit their exams, and then appeal for a different marking procedure. However, if you know a student might be eligible for special provisions for an upcoming exam, talk to the student and their parents about their options.

In most schools, applications for special provisions are made to the education board through the principal, school counsellor or learning support staff. There may be a cut-off date for applications and you may need to allow time to get supporting documentation from the student’s doctor or treatment team. If possible, it is best to apply well in advance, as applications may take several weeks or months to process. For students who become suddenly ill around the time of the exams or who have a family member with cancer, illness or misadventure provisions may be available.

If a student is finding the demands of the senior years too great, they can explore the options for extending the time frame. For information about options available in your state or territory, talk to the senior year coordinator, guidance officer or school principal, or contact your local education authority.

Access to tertiary study

In some states and territories, access schemes can help a student enter tertiary study if they have experienced long-term educational disadvantage because of a cancer diagnosis or treatment. Depending on the location, these are known as Schools Recommendation Schemes (SRS), Educational Access Schemes (EAS) or Special Entry Access Schemes (SEAS). Each university applies its own access scheme calculation to the student’s final score and determines if they will be admitted into their elected program of study.

Visit the website of the universities/tertiary admission centre in your state or territory to find out more about applying for an access scheme. You can also contact the tertiary institutions directly for information about any alternative pathways available to students. The school careers counsellor should also be able to offer guidance.

School staff could explore whether there is any extra financial assistance available for the student, for instance:

• Redkite’s educational assistance includes grants to help students pursue tertiary study after cancer
• Ronald McDonald House Charities Australia’s Charlie Bell Scholarship program provides grants to assist with the cost of vocational or tertiary studies for young people aged 15–20 years who have experienced serious illness.

Children and adolescents deal with the news that a family member has cancer in different ways. How they express their feelings will depend on their age and maturity, their coping style, their relationship with the family member, and their understanding of cancer.

When any close family member has cancer, the child may feel sadness and concern for them but also react to the change in family dynamics and grieve the loss of parental attention. This can be over seemingly simple things, such as the parent not going to watch them play sport or attending school events. Younger children may feel that they are to blame for their family member getting cancer. Older students may also worry about whether the cancer runs in their family.

A child or adolescent may not be able or willing to talk about how they feel, but might express these feelings through their behaviour. They may misbehave in the classroom, mirror their family member’s symptoms or side effects, or be distracted, sad, angry or withdrawn. Changes at home may make it difficult for the young person to keep up with their schoolwork and other commitments such as sports training or music tuition. For example, they may have to go straight to the hospital after school or they may have to take on extra household responsibilities.

Because children spend so much time at school, parents usually choose to tell select members of the school community about the diagnosis. This allows school staff to create a positive school environment for the student and keep an eye out for changes in behaviour. A liaison person such as a year adviser or student wellbeing coordinator can help establish trust and confidentiality with the parents and student.

If you are aware that a student’s family member is ill, try to maintain the school routine. Just like a young person with cancer, the student may view school as a safe, comfortable place. They may enjoy feeling normal, or even take pleasure in receiving attention from teachers or classmates.

Some young people ask their parents not to tell the school about the family member’s cancer. They might not want their classmates or teachers to perceive them differently.

Keep in mind that some children whose family member has cancer seem able to cope, but there may be times when it gets too much. Key milestones  in their family member’s testing or treatment can be especially difficult and may lead to anxiety or changes in behaviour. Even when the active treatment has finished, there may still be blood tests every three or six months and the student may continue to feel distress about the possibility of the cancer coming back.

When a family member has cancer, the child will probably be preoccupied with what is going on at home. Studying and completing homework may not always be their main priority. Away from school, a young person may be acting as a carer, visiting the hospital, looking after younger siblings and taking on household duties. They may have limited time to socialise. In single-parent and separated families, the situation can become even more demanding for the student.

It is likely that the student’s academic performance will be affected. It can be helpful for the school liaison person to talk to the family about  adjusting their expectations. While many families will hope their child can keep up with their schoolwork, it is important to identify changes in school performance and respond appropriately, such as by offering flexible due dates or tutoring.

If students whose family members have cancer are sitting NAPLAN or senior exams, they may qualify for special provisions. They may also be eligible to be considered for an access scheme for tertiary study.

There are many ways your school can assist students after a family member’s cancer diagnosis. With the family’s consent, you might:

Keep track – Appoint the student wellbeing coordinator or year adviser to provide regular contact with the student, monitor their behaviour, and help keep track of assignments and school events. Offer the student the option of seeing the school counsellor. Special consideration may be needed for examinations and assessments. The student may also need flexibility with their attendance at compulsory sports training or music rehearsals.

Notice changes – Ask the teacher to look out for changes in the child’s behaviour, social interactions and academic performance, and keep the family updated.

Connect – Put the family in touch with another family in the school community who has experienced cancer and is willing to be contacted.

Organise a parent team – A group of parent volunteers can be organised privately or by the school’s parent association, such as the P&C or P&F. This group can help the family stay on top of excursions, homework, school events and after-school activities. They may also want to help by giving the student lifts to and from school and after-school activities (such as sports training), providing child care or meals. Another way to help is to arrange video recordings of school events so that the family can share them at home.

Educate – Arrange for a visit from the hospital’s clinical nurse consultant or a local community nurse to conduct an education session about the treatment.

Contact Camp Quality – Camp Quality provides innovative programs and services to develop life skills and strengthen the wellbeing of children aged 0–13 growing up with cancer, and their families. They offer a free educational puppet show for primary schools across Australia. Their Kids Guide to Cancer app answers common questions and is particularly aimed at children aged 8–13 who have a loved one diagnosed with cancer. Camp Quality also organises recreation programs, camps and family experiences to support children and families impacted by cancer. To find out more, visit the Camp Quality website or call them on 1300 662 267.

Get in touch with CanTeen – CanTeen is an organisation for young people aged 12–25 who are affected by cancer, including siblings and offspring. It offers counselling in person or by phone, email or instant messaging, and can collaborate with school wellbeing staff. CanTeen also runs camps, recreation days, seminars and workshops, produces resources for young people and provides an online community for young people impacted by cancer. It also offers support to parents, including assistance with navigating the challenges cancer brings to parenting. Visit the CanTeen website or call them on 1800 226 833.

Contact Young Carers – Help the student connect with the Young Carers Program offered by the Carers Associations in each state and territory. This program offers information and support tailored for people aged under 26 who care for someone in their family with an illness or other problem. Call 1800 242 636 or visit the Young Carers Network website to find out more. You can also check out the Carer Gateway for local support services, practical information and resources for carers. You can also call them on 1800 422 737.

Link with Kids Helpline – Put students in touch with the Kids Helpline. This is a telephone, web and email counselling service with a fun, interactive website for kids, teens and young adults aged 5–25. It offers confidential counselling for anything worrying a child or young adult. Contact them on 1800 55 1800 or visit the Kids Helpline website.

Parents may be concerned about the reactions of their child’s classmates to the situation. Awareness raising and education about cancer can help encourage a supportive environment, but it’s important to discuss this first with the student and their family.

It’s also a good idea to include the student in discussions about how to share the news about their family member’s diagnosis. Young people can be particularly self-conscious and sensitive to others’ reactions. Talking about the situation with their classmates can increase understanding and
acceptance, and may make life easier for the affected student. Be mindful, however, that some affected students will prefer to deal with their family situation privately and their wishes should be respected.

Ways to create a supportive school environment include:

• integrating information about cancer into the curriculum
• maintaining a positive school culture of respectful relationships where bullying or cruel comments (either in person or online) are less likely to occur
• planning cancer awareness activities or events to teach students more about cancer
• holding a cancer fundraising event, if the family agrees.

Cancer fundraising events

When a member of your school community is confronted by cancer, people usually ask: “How can we help?”

While the primary role of schools is to educate students, some schools allow students and staff to organise fundraising programs. These can be standalone events or may be combined with other awareness raising activities.

A family member’s cancer often leads to considerable financial strain because income is lost and treatment-related expenses mount. However, it is important to check with the family before any fundraising event is planned, as they may not be comfortable with the idea and their wishes should always be respected.

Your school community may choose to donate any funds raised directly to the family. Alternatively, you and the family might decide to support cancer charities.

Cancer fundraising events not only collect money to help people with cancer. They can also empower school community members, help educate others and spread a message of support and hope.

Children and adolescents will vary in how comfortable they feel talking about cancer. A young person may want to keep school as a place where they don’t have to constantly think about their family member’s cancer. You should never force a student to discuss the disease.

If a student whose parent or sibling has cancer would like to talk about their situation, you may want to involve members of your school’s student wellbeing team, learning and support team, or the school counsellor. If the student shows signs of prolonged distress, such as marked changes in their behaviour, refer them to professional counselling support. This can be arranged by the school counsellor.

Talking about cancer

When talking to a student about their family member’s cancer, you will naturally tailor your conversation according to their age and responses. It is also worth keeping in mind a few general pointers:

• use words they can understand
• find out what they already know
• be honest
• offer a listening ear
• don’t make promises you cannot keep
• show your own emotions.

Listen to our podcast episode ‘Explaining cancer to kids’

Although a staff member is not obligated to tell parents and students about their diagnosis, they may choose to share some information. This can be particularly helpful in smaller communities, where the staff member may be confronted with questions about their absence if they run into students and parents at the shops or other local places.

The staff member could discuss how to tell the school community with appropriate colleagues, such as the school principal, counsellor, student wellbeing team and/or staff wellbeing officer.

Most parents will appreciate a straightforward approach. Parents can be contacted by letter, email or phone; a parent group such as the P&C or P&F could be asked to relay the news; or parents can be invited to a meeting.

It’s a good idea to let the parents know if the teacher plans to be away and for how long. The principal can also explain how the school plans to manage the teacher’s work.

Telling students requires a sensitive approach. Remember, students come from all types of backgrounds, so some of them may not know much about cancer and others may have a personal experience with it. A young person’s age and maturity also affect their level of understanding.

Plan what to say to students in advance and prepare answers to any likely questions. It is wise to send a letter or email home to parents so they know that their children might want to talk about their teacher’s cancer. Any letter should include contact details for appropriate support services and resources.

Keeping in touch with the teacher

Students may like to:

• prepare get well cards
• draw pictures
• write a story
• send a letter or email describing what they’ve been doing in class
• make a video of get well messages from students
• start a blog to keep the teacher up to date with news from the classroom.

When people in your school community learn about a colleague’s cancer, there will be a variety of reactions. Many people wish to be supportive but  are unsure what to say or do. Some people will ask questions or be extremely helpful; others will pretend they don’t know or will go out of their way to avoid the person with cancer.

On rare occasions, there may be parents who will make it clear they don’t want their child in the class of a teacher who has cancer because they believe their child’s schooling will be disrupted. In this case, the principal can explain how the school plans to maintain the student’s schedules.

If any member of your school community reacts in an insensitive manner to the news of the diagnosis, or how the school plans to manage the  absence, speak to the principal or staff wellbeing officer.

The principal can assist students and parents who want to find out more about cancer or would like to access counselling services.

If parents are aware of your colleague’s cancer, they might offer to help in various ways. The school could appoint a contact person to manage these offers. The contact person can check what sort of help, if any, the colleague would like from parents and then coordinate the support.

Depending on school policy, a parent’s assistance in the classroom may be helpful at this time. The principal can clarify whether this is allowed and what clearances (e.g. Working with Children Check) are needed, and the teacher can decide if it would be welcome.

Many teachers have their own personal support network outside the school community and may prefer to keep their professional and personal lives separate. However, others gratefully accept offers such as a meal roster or help with their own children.

If a teacher with cancer does not want direct support, you can check whether they would be happy for your school to host a general cancer awareness or fundraising event.

Many employees continue to work while undergoing cancer treatment. Whether a person is able to work depends on the kind of work they do, the type and stage of cancer, the type of cancer treatment and any side effects from treatment. It also depends on personal factors such as their other commitments and whether they want people to know about the diagnosis.

If a staff member continues to work during treatment, they may need flexible working arrangements or to have their role modified. For example, some employees having chemotherapy may need to arrange a non-contact role with students to reduce their risk of catching an infection.

As more people are diagnosed in early stages – and as survival rates and treatments improve – it is increasingly likely that an employee will return to work after treatment or continue to work during treatment in some capacity. Cancer survivors are more likely to return to their job if they have a supportive work environment.

Returning to work after treatment can be difficult. School staff returning to work are often anxious about how they will manage cancer-related fatigue, employer expectations, and changes in their appearance, workload, productivity and relationships with colleagues and students.

Download our booklet ‘Cancer, Work & You’

People diagnosed with cancer or undergoing treatment often experience side effects such as nausea, vomiting, hair loss and fatigue. Long-term physical changes might be visible, such as the loss of a limb, but they can also be less obvious, such as loss of strength or diminished vision.

Cancer treatment sometimes causes temporary cognitive impairment, such as short-term memory loss or difficulty concentrating. People can usually manage these cognitive difficulties by getting extra sleep, making to-do lists and avoiding situations where quick thinking might be required.

The school community can help by being patient and understanding. A person who has had cancer treatment may not be as efficient as they once were for some time, but can usually make a successful transition back to work if the environment is supportive.

Initial support

When a staff member informs the principal that they have cancer, they need a sensitive and sympathetic response. Aside from worrying about work, the person may be making difficult personal decisions. It can be helpful to remind them of any staff counselling services, such as the Employee Assistance Program (EAP), that they and their family members can use.

If the person is newly diagnosed, they may feel like they are being bombarded with  information. Rather than adding to this “information overload” in the initial conversation, the principal might want to set up a meeting at a later time and come prepared with relevant material, such as detailed information about working arrangements and leave entitlements.

Download our fact sheet ‘Talking to your employee about cancer’

It is important for the principal to respect a staff member’s preferences about how much they would like to disclose about their cancer, and who they would like to tell.

Many people with cancer find it helpful to talk to someone in a similar situation. If there is another staff member with cancer, the principal could put the employees in touch with one another (with their permission). Another option is for the staff member to contact someone with a similar experience through Cancer Council. For more information, call 13 11 20.

The principal can provide advice and guidance regarding changes to a staff member’s work schedule. The staff member may consider taking a break, adjusting their workload or arranging a flexible work schedule. The principal can help the staff member make these decisions in line with leave and relief staffing procedures.

Return to work

By law, employers must make reasonable adjustments for an employee affected by cancer or its treatment. These may involve physical adjustments, such as access to disabled bathroom facilities, or adjustments to workload.

When a staff member returns to work after a long absence, organising a return to work meeting can make the situation clear for all involved and help prevent misunderstanding among colleagues. It is helpful to develop a written return to work plan with input from the staff member’s health care team. Tailored to the staff member’s specific situation, the plan outlines any agreed adjustments and establishes a timeline.

There are several ways to reduce an employee’s anxiety and help them during their transition back to work. These can include:

• specifying regular meetings in the return to work plan to help the person manage their workload and talk about any concerns they may have (such as job security)
• adjusting their work schedule and load as agreed in the return to work plan
• making any necessary physical adjustments
• liaising with other staff (being a contact person or coordinating offers of help)
• proactively liaising with parents and students, if appropriate
• offering counselling/EAP support for the person and their family
• supporting the employee’s decisions and offering reassurance.

When a family member has cancer

The information in this section may also be helpful if a colleague’s partner, child or parent is diagnosed with cancer. The colleague is likely to need time off work to care for their family member. If the treatment hospital is a long way from home, they may require particular flexibility. Working carers must juggle many demands alongside their workplace responsibilities. A supportive work environment can help them manage.

Download our fact sheet ‘Supporting working carers’

Supporting other colleagues

When an employee is diagnosed with cancer, the principal can help to address any concerns that other staff may have. The staff member with cancer may ask the principal to liaise with colleagues on their behalf. Support should be offered to employees who are upset. If your school offers an EAP, staff can be referred to this service.

If an employee has to take a leave of absence, the principal can work with colleagues to organise substitutes for the absent employee. Most colleagues are likely to be flexible and accommodating, but a temporary substitute or permanent replacement may need to be arranged.

Supporting students and families

A staff member may wish to inform parents or students about their cancer diagnosis, but may be uncomfortable standing up in front of the class or calling parents to relay the news. The principal can offer support by coordinating how the information is shared. They can also liaise with any parents who are concerned and explain how the school will maintain the students’ continuity of education during the staff member’s absence.

It is important for the principal to talk to students regularly to assure them that the school is supporting their teacher and to let them know if their teacher will be taking time off. Principals can also remind students that school staff are available to support them.

When someone in your school community dies – particularly a student or colleague – your school’s guidelines for managing critical (serious) incidents may apply.

The school must decide, with the family’s permission, how to inform people. It is usually better to tell students in their normal class groups or in small groups, rather than holding an all-school assembly. It is important that students are told in an honest and sensitive way, without overloading them with too much emotion from the person giving them the information. Often the principal will work with other executive staff and/or the school counsellor to draft a short script or guideline for teachers to tell their classes what happened. Teachers are often very grateful for this as it relieves them of the pressure of deciding what to say while they are still processing their own initial grief. The school counsellor may be able to offer further guidance and support.

Staff can be briefed with the following information:

• an outline of key points that clearly explains the circumstances of the death
• some positive words of reminiscence
• details of how the school will honour the person who has died, if appropriate
• details of the funeral service and arrangements for attendance, if known and if the family wishes the school community to participate
• the best way to send condolences from the school and individuals
• details of support and counselling services.

Staff should be asked to speak to classes only if they feel able to manage students’ reactions and questions. Some staff may like a member of the school executive team or the school counsellor to be with them when the class is told. In some schools, or for some individuals, faith or religious tradition plays a central role in dealing with loss. If your school has a chaplain or spiritual adviser, they may be able to help tell people about the death and provide support.

The purpose of telling students is to draw the school community together and facilitate the grieving process. Students who are experiencing or have previously experienced other forms of loss (e.g. sick parent, family separation or divorce) may need extra support. The cultural diversity of your school community may also influence what you say and how you say it. Some cultures have particular customs around death and bereavement.

Be aware that older students may have already found out about the death through social media such as Facebook. Social media can help members of the school community share their sorrow, record memories and send condolences. However, remind students about the family’s right to privacy and the importance of not spreading rumours or adding to the family’s grief.

Not everyone in the school community will hear the news through class meetings, so you may need to use other means. For example, you can send a letter or email to parents, put a note in the school’s newsletter or meet separately with colleagues. Remember to tell all the people who need to know, such as canteen staff, Outside School Hours Care staff, and relief teachers.

Indigenous families

If an Indigenous member of your school community dies, any information should be handled in a culturally sensitive manner. In some cases, it may be offensive for the school to mention the person’s name or to use the image, voice or video recording of the person. School staff should be aware of this possibility and check with the person’s family or community.

Funerals in Indigenous communities often take up to five days, so affected students and staff may need to be away from school for a week or more.

When death is sudden

While members of your school community will usually be aware if someone is near death, in some cases, a person’s death will be sudden or unexpected. As with other deaths, you should follow your school’s critical incident procedures.

It can be hard for some people to grieve – and react to a crisis – if they feel unprepared. Students might be angry that they weren’t told the person’s prognosis in advance. Others might feel hurt that they could not say goodbye.

You and your colleagues will have to be particularly sensitive if the death was sudden. You should be prepared for strong emotional reactions, and be ready to offer support (such as counselling) to those who need it.

Additionally, the school needs to inform others who may be affected or who might need to support the students (for example, by sending a letter or email to parents). 

If someone in your school community dies, each person’s reaction and grieving process will be unique. Responses to grief depend on the individual’s personality, how close they were to the person who has died, their own experiences with death and their access to support services. Bear in mind that it is normal for someone to feel out of control, overwhelmed or even disbelieving.

Be mindful that the staff who are trying to support grieving students may also be dealing with their own grief and loss. Staff should not feel that they need to hide their grief. It is important for students to see the adults around them modelling a range of healthy grieving processes. For people who are bereaved, you can:

Listen – Encourage the bereaved person to talk about the person who has died. If you have a conversation, be attentive and non-judgemental. Allow the person to silently reflect on their loss. Don’t try to talk about other things if they aren’t interested. Let the person cry, act angrily or talk about something else.

Find outlets – Explore different ways that the students can express their emotions. Primary students may want to make cards to send to the family, while adolescents may want to be with close friends in a supported setting. With the family’s permission, an online tribute or remembrance page may be a good way for the school community to share memories and send condolences. If it seems appropriate and the family agrees, a school memorial service can also help grieving students, staff and parents. Other options include creating an area of remembrance or raising money for a cancer charity.

Show support – If you can, offer support to the family or closest friends. Sending a note of sympathy is a simple but caring gesture.

Be patient – Accept that it may take some time for the intense feelings of grief to abate. As time goes on, it can become easier to recognise birthdays and anniversaries, although life has changed forever.

Stick to school routines – Some consistency can be helpful for students as long as teachers are flexible about how much schoolwork they can cope with.

Teach about cancer – Include discussion of cancer research and treatment in the curriculum where appropriate, particularly if students raise the topic.

Seek further support – Bereavement support services may help you or someone you know who is going through a difficult time.

Understanding grief

Grief is a natural response to losing someone. Depending on their relationship with the person who died, members of the school community may experience a range of emotions, including sadness, numbness, disbelief, loneliness, guilt, anger, relief and acceptance.

People express grief differently. Some people openly display their emotions, while others may show no visible signs of grief. There’s no right or wrong way to grieve or set amount of time it lasts. It is important that people respect each other’s way of grieving.

Download our booklet ‘Understanding Grief’

Children and adolescents understand loss in different ways, depending on their age and maturity level. To find out more, consult your school counsellor or the hospital social worker.

Early primary students (4-7 years)

• may think death is temporary
• might realise that death means someone isn’t around anymore, but may not understand the cause of death
• sometimes believe their behaviour caused the death
• might wonder who will look after them or teach them
• might worry that cancer is contagious or that they will die too
• may be very open and ask confronting questions

Late primary students (7-12 years)

• understand death is permanent
• know some reasons why death happens (e.g. illness, old age)
• are less likely to blame themselves for the loss, but might blame someone else
• want to know the facts about death, including what happens after death
• are better able to articulate their feelings and act sympathetically

Secondary students (12-18 years)

• usually understand the facts of death
• might respond in a self-centred way to the loss
• may struggle with their own mortality
• may express feelings in positive ways (e.g. listening to music, playing sports, writing in a journal)
• usually want to spend more time with friends after a loss
• may express their distress through risk-taking behaviours (e.g. skipping classes, experimenting with drugs or alcohol, acting recklessly)
• need to know that support and counselling are available
• might find it especially helpful to participate in a private or public memorial service

The survival rates for children and young adults with cancer have improved substantially over the past 20 years. Today, the five-year survival rate for young people with cancer is over 80%, and this rate is expected to increase because of improvements in treatments. However, some children and young adults do die from cancer.

The death of a young person is an enormous tragedy, and it can be difficult to accept. It is important that your school community responds in a compassionate manner. The principal or the student wellbeing coordinator should ask the family of the deceased student what the school can do to help, how the parents would like to inform staff and students (if they don’t already know), and if a memorial can be organised.

If you and your colleagues worked closely with the student, you are likely to feel saddened and will need to take time to deal with your own feelings before talking to students. It may be helpful to attend the funeral service.

The student’s classmates will react in different ways, depending on how old they are. Their reactions will depend on their relationship with the student and their own coping mechanisms. Classmates should be able to turn to school staff for guidance and support.

Remember that a child who dies may have siblings at the school, so parents will still be part of the school community, and this may be difficult at first for other parents who are not sure what to say.

When a parent in the school community dies, the reactions of community members can vary. If the parent was a well-known community member, people may outwardly grieve the loss. If the parent was not particularly well known in the school community, many people may be unaware of their death.

Students who know a classmate’s parent has died will probably worry about their own family. They might want to express sympathetic sentiments,  and wonder how to support their friend and what to say. With the family’s permission, some students may attend the funeral service to support their classmate, as may staff and other parents.

Other parents may also reach out to help the family in the weeks and months afterwards. Parents can help make meals, keep track of the child’s homework, or provide transport to school and after-school activities.

You and other school staff members will probably be aware of the death, and you should explain the situation to students, if necessary. You will need to grieve the death in your own way and provide in-class support (such as a more flexible homework deadlines) to a student who has lost a parent.

The loss of a student’s sibling is extremely traumatic. No matter how close the young person was to their sibling, they will need time to mourn the loss. The student may have to take time away from school, and their parents will likely be occupied with making funeral and other arrangements.

Schools can be supportive when the student is away from school, and try to help them manage their schoolwork on their return. It is understandable that a student may be more focused on their family than on schoolwork for a time. Sometimes it is helpful to refer a grieving child or young adult to school or other counselling services, in consultation with their family.

The sibling’s treatment team can also support the bereaved student, especially by answering any questions about the illness and explaining the medical aspects leading up to the death. A hospital or school chaplain may be another source of support. You can check that the family is aware of the bereavement services offered by CanTeen and Redkite.

When a teacher or other prominent member of the school community dies, there is a far-reaching impact. You and your colleagues will need to deal with your own grief, as well as comfort students who may also be grieving.

If you are grieving, find out about all available employee support services and take time to deal with your own feelings. If you worked closely with the person, you may wish to attend the funeral. The school may organise a memorial service to honour your colleague and to allow staff, parents and students to pay their respects.

Students can take the death of a teacher particularly hard. They will mourn in individual ways. It is okay for students to know that you are sad, too – they rely on adults to model healthy grief. Reassure students that grief is a natural reaction, and that counselling is available. The principal or a counsellor can talk to students about grief and ways to remember their teacher.

In addition to any funeral or other formal service organised by the family, your school might hold a memorial service to honour the life of a student, parent or colleague. Participation in a memorial service allows the community to share their grief and honour the loss of the school member.  Community members can collaborate with the family to organise the event.

When planning a service, you might consider:

The setting – Will the service be held at the school? How formal will it be? Is there any special music that could be played or performed?

Who will attend – Will you make a public or school-wide announcement to let people know about the service? Would the family like you to ask everyone to wear a particular colour as a gesture of support?

Who will lead the service – Are there school staff, friends, students or family who would like to be involved?

Sharing memories – How can people share favourite memories or thoughts? Will there be a program or a slide show?

Flowers, donations and cards – Should people bring flowers, or would the family prefer donations to a charity? Where can people leave sympathy cards?

Appoint a staff member (school counsellor, chaplain or teacher) for children to talk to if they become upset before, during or after the memorial service.

Lasting tributes

If the person who has died was well known in the school community, your school might want to establish an ongoing way to honour them. Options include:

• planting a tree or garden
• placing a memorial plaque somewhere in the school grounds
• establishing an annual award named after the person
• acknowledging anniversaries

It is important to understand that bereavement is a process, not a single event, and can take many months or even years. A student or staff member should be referred to professional help if they simply need someone to talk to, but especially if they demonstrate significant changes in behaviour, such as:

• saying they want to die too or becoming extremely preoccupied with dying
• suffering academically or at work for an extended period after the death
• acting sad and withdrawn for an extended period
• increased risk-taking or self-harm
• having trouble socialising.

Talk with your school principal and colleagues about ways to support bereaved members of your school community. If you think that a student needs professional support, consult your school counsellor. Staff who need counselling for themselves may be able to access it through an Employee Assistance Program (EAP) if this is available at your school. Some people may need ongoing support for many months.

You could also contact one of the organisations listed below. These can be good starting points for general advice or for referrals to bereavement counselling.

Bereavement support services

Australian Centre for Grief and Bereavement – offers online information for people experiencing grief and bereavement.

Cancer Council 13 11 20 – can refer callers to local services or recommend a telephone support group.

CanTeen – offers online information and bereavement support tailored for young people aged 12–25 years.

GriefLine – provides community and family services to support all Australians who have encountered a loss.

Redkite – offers bereavement support for families and friends of children and young people aged 0–24 years.

The Compassionate Friends – has member organisations across Australia that offer support to any family that has lost a child.

The National Centre for Childhood Grief – offers counselling for bereaved children aged 3–18.

Claire Tobin, Principal Medical Advisor, Department of Education and Training, VIC; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s Hospital and Prince of Wales Hospital, Director of The Sydney Youth Cancer Service, and Conjoint Senior Researcher, University of New South Wales, NSW; Lisa Barrow, Clinical Nurse Educator, Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, VIC; Margo Bulic, Psychosocial Support Worker, CanTeen, ACT; Amber Copeland, 13 11 20 Consultant, Cancer Council Queensland; Donna Drew, Clinical Nurse Consultant, Paediatric Oncology/ Palliative Care, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW; Allesha Fecondo, Education Consultant, Victorian Paediatric Rehabilitation Service, and Education Liaison, Ronald McDonald Learning Program, Ronald McDonald House Charities Australia, VIC; John Friedsam, General Manager of Divisions, CanTeen Australia, NSW; Pina Hutcheson, President, Catholic Primary Principals’ Association of WA; Cara Irvine, Year 8 Coordinator, Alfred Deakin High School, ACT; Andrew Long, Assistant Director, Policy and Research, Independent Schools Council of Australia, ACT; Dr Alistair Lum, Post-doctoral Research Fellow – Behavioural Sciences Unit, Sydney Children’s Hospital, University of New South Wales, NSW; Kristine Luszczynski, Learning Program Manager, Quality and Standards, Ronald McDonald House Charities Australia, NSW; Anita Neville, National Manager, Ronald McDonald Learning Program, Ronald McDonald House Charities Australia, VIC; NSW Department of Education, NSW; Mandy Roney, Consumer; Shannon Rush, Primary School Program Manager, Camp Quality, SA; Luke Wade, Education and Career Support Consultant, Redkite, QLD.