(Re-)Integration of children and adolescents with cancer into physical education
Created in cooperation with, among others, Birte Eichhorn (Sports Scientist at the Pediatric Oncology Center Bremen) and the Parents Association for Children with Leukemia and Tumors Bremen e. V.
Dear Teachers,
It is crucial that teachers can inform themselves about children and adolescents with cancer, as they play an important role in their lives. Through a better understanding of the illness and its effects, teachers can create a supportive and empathetic learning environment. This not only helps those affected to continue their education but also promotes awareness and empathy among all students. In this way, you make a significant contribution to ensuring that children and adolescents with cancer experience a sense of normality and belonging despite their challenges.
Many thanks to the NAOK location in Munich, which created and provided the following videos.
Video 1: 'Sports in the Clinic at the NAOK Location Munich'
(Duration 3:08 min)
Video 2: 'School Sports after the Clinic' (Duration 2:10 min)
Mit dem Laden des Videos akzeptieren Sie die Datenschutzerklärung von YouTube.
Learn More
Mit dem Laden des Videos akzeptieren Sie die Datenschutzerklärung von YouTube.
Learn More
As part of the reintegration of the affected child into school sports, you may encounter certain technical terms. To promote a better understanding, we have compiled an explanation of these terms below.
Relevant Terminology
Fatigue
Fatigue syndrome is a persistent, excessive exhaustion that cannot be relieved by rest or sleep and severely limits daily performance. Affected individuals require an individual adjustment of their activities to avoid overexertion, with gentle forms of exercise and regular breaks being helpful. It is important to watch for signs of fatigue and to respond empathetically to the needs of those affected in order to enable their participation in activities without endangering their health.
It has already been found that exercise is significantly more effective than medication in the presence of fatigue (Mundt, 2019).
Endoprosthesis
An endoprosthesis refers to implants that replace natural body structures, such as joints. These usually remain permanently in the body.
In the case of bone cancer, an endoprosthesis often has to be inserted to regain as much mobility as possible. However, a one hundred percent load capacity is not possible. Therefore, there may be limitations, for example, regarding sprinting ability and jogging.
Physical education teachers should consider the individual needs of students with an endoprosthesis and adapt sports activities in such a way that the artificial joint is not overloaded. Loads with high impact effects or intense movements should be avoided. Close cooperation with physicians or NAOK and a gradual increase in stress help to minimize the risk of injuries or complications.
Rezidiv
We speak of Rezidiv when cancer comes back after successful cancer treatment.
A Rezidiv can be a significant emotional burden for affected children and adolescents, associated with anxiety, frustration, and health limitations. Often, physical exhaustion and the need for further treatments lead to reduced resilience, which makes everyday life and especially participation in school activities difficult. Empathetic support, flexibility in organizing the learning process, and understanding of individual needs are therefore crucial to support affected students.
Stem Cell Transplant
In a stem cell transplant (SCT), donor blood stem cells are transported into the body through an infusion into a vein and find their way from there independently to the bone marrow. There, the transplanted stem cells are intended to grow so that the formation of new, healthy cells begins. As preparation for the transplant, the immune system is suppressed. Therefore, the susceptibility to infection is high and the body is weakened, especially after an SCT.
The effects of a stem cell transplant on everyday life are diverse and can bring both physical and psychological challenges. The affected person often needs a long time to fully recover, and everyday life must be partially adjusted, especially with regard to infection prevention, physical resilience, and regular medical follow-up care.
Maintenance Therapy / Continuous Therapy
In some cases, intensive therapy is not sufficient, so children and adolescents must take chemotherapy in tablet form at home for a longer period (about 1.5 years). Once the maintenance therapy has been optimally adjusted and the catheter has been removed, those affected can resume their everyday life largely normally. As a rule, only a few side effects are to be expected, but regular outpatient visits are necessary to monitor the blood count. Faster exhaustion is also typical and can occur during maintenance therapy.
However, maintenance therapy is different for children with brain tumors. More severe side effects are to be expected here. Although the children can continue to attend school during therapy, they are more susceptible to infections and often have a poor blood count, which can lead to additional side effects and possibly longer hospital stays.
Proton Therapy
Proton therapy is a form of radiation therapy that is used when the tumor is located deep in the body or surrounded by sensitive organs. Depending on the radiation schedule, school can be attended between treatments.
In this case, communication between family and school is important.
Port Catheter
A port catheter serves as an access point for medical treatments such as chemotherapy or blood draws and is implanted under the skin. The catheter must be protected from mechanical stress, which is why sports with direct contact or impacts should be avoided. Students with a port catheter may have limitations in their physical resilience, so activities should be adjusted accordingly. It is also important to pay attention to the hygiene of the catheter area to reduce the risk of infections.
For example, swimming should be avoided during this time.
Shunt
A shunt in the head is a medical device that is used, for example, to administer medication or to drain excess fluid from the brain. The shunt consists of a catheter. Children and adolescents with a shunt should be careful to avoid activities that lead to strong head loads or impacts in order to reduce the risk of complications such as infections or malfunctions of the shunt. It is important to take signs of discomfort or health changes seriously.
Positivatest
A Positivatest bypasses the premature decision for a sports exemption. It is issued by the medical staff and contains a concrete description of the problem from a biological-medical perspective. The responsible person fills out a checklist that includes, for example, the assessment of general sports suitability, information on physical performance, and specific health risks associated with the illness. (Marckhoff, 2021)
FAQ
What exactly do I need to pay attention to?
During therapy, the student has spent a significant amount of time in inactive lying phases. This shakes the trust in one's own body and often leads to a comparison with the former 'high-performing' sports self.
Please talk to the child and his/her parents to find out what is relevant to observe at what time and what course of action is then helpful.
It is important to always keep an eye on the signs of strain (e.g., dizziness, very high pulse, headaches) and reduce them if necessary. A fatigue issue may also be present and should not be underestimated. Overall, it is of great importance to ask about and consider the child's needs and to show understanding for the respective situation.
What is my role in the (re-)integration process?
The physical education teacher plays a crucial role in the (re-)integration process of children and adolescents with cancer. We understand that teachers are faced with many tasks and challenges. Nevertheless, it is important that exercise and sports are not neglected, even though therapy is often very demanding and stressful. Keeping children away from physical education out of fear or excessive caution can have negative consequences. In contrast, physical activity promotes rehabilitation after cancer and strengthens children's self-esteem. Therefore, no exemption from physical education should be granted without valid reasons. The task of the physical education teacher should be to provide supportive guidance, with the support being individually tailored.
Can I adjust my assessment in class?
If there is a restriction regarding physical, psychological, or conditional parameters, it is very useful to adjust the assessment. It is important that each child is considered individually and that no blanket adjustment should take place.
The family must present a certificate from the clinic recommending grade adjustment or non-grading. (Possibly link document.)
How can I make the adjustments?
Accommodation or exemption from grading is a good option, as with other chronic illnesses. The evaluation of performance should be individual. Open communication between the student and the teacher forms the basis. Further consultation with the parents and/or medical staff can also be advantageous. The option of self-determined breaks can give the child security.
Isn't sport too risky with cancer?
There is no negative correlation between sport and cancer. On the contrary, it is recommended in every phase of therapy. Furthermore, the social aspect of sport is important. The development of one's own personality is positively influenced by play, sport, and exercise. It provides the opportunity to find role models, resolve conflicts, overcome fears, and/or discover strengths. School sports are especially important for children and adolescents who are not active in a club. A common reason for children or adolescents with cancer is the fear of not being good enough and being able to keep up. Therefore, school sports can be the only access to the positive connections between exercise and sport.
To be as well prepared as possible, a positive medical certificate issued by the medical staff can be helpful.
Additional Literature
Oberwetter, K., et al., Sportunterricht mit Schüler*innen nach einer Krebserkrankung. Sichtweisen und Erfahrungen von Sportlehrer*innen [Physical Education with Students After Cancer. Perspectives and Experiences of Physical Education Teachers], 2024. 40(05): p. 194-199.
Beerbom, C., Schönberg, C., & Kubandt, M. (2010). Unterrichtsentwicklung: Schülerinnen und Schüler mit chronischen Erkrankungen [Instructional Development: Students with Chronic Illnesses]. Ludwigsfelde-Struveshof: Landesinstitut für Schule und Medien Berlin-Brandenburg (LISUM).
Durlach, F-J., Kauth T., Lang H., & Steinki, J. (2007). Das chronisch kranke Kind im Sport in Schule und Verein [The Chronically Ill Child in Sport at School and Club]. (Niedersächsisches Kultusministerium, Hrsg.). Stuttgart: Bräuer GmbH.
Lawrenz, W. (2020). Chronisch kranke Kinder und Jugendliche im Schulsport [Chronically Ill Children and Adolescents in School Sports. Society for Pediatric Sports Medicine]. Gesellschaft für Pädiatrische Sportmedizin.
Marckhoff, M. (2021). Das „Positivattest“-die Lizenz zum Sporttreiben [The 'Positive Medical Certificate' - The License to Play Sports]. Bauchredner. 100-105.
Mundt, M. (2019). Krebs und körperliche Aktivität: Durch Bewegungstherapie die Kontrolle zurückgewinnen [Cancer and Physical Activity: Regaining Control through Exercise Therapy]. best practice onkologie, 4, 136-140.
Rank, M., Freiberger, V., Halle, M., & Tiska, O. (2012). Sporttherapie bei Krebserkrankungen: Grundlagen – Diagnostik – Praxis; mit 19 Tabellen [Sports Therapy for Cancer: Fundamentals – Diagnostics – Practice; with 19 Tables]. Stuttgart: Schattauer.
Contact Us
E-Mail: Gabriele.Gauss@uk-essen.de
Tel: (+49) 0201 723 6563
Fax: (+49) 0201 723 6247