key: cord-0688898-n49eagf9
authors: Adduci, Annarita; Ferrari, Andrea; Grampa, Paolo; Giovanetti, Monica; Massimino, Maura
title: How the COVID-19 pandemic has prevented children with cancer from pursuing their schooling in hospital or at home
date: 2021-01-12
journal: Childs Nerv Syst
DOI: 10.1007/s00381-020-05027-1
sha: 2c438a783f224909d8de7cc8f7e3c0437cd49416
doc_id: 688898
cord_uid: n49eagf9

nan

need to protect their health. Like all other students, those with cancer have been offered access to remote classrooms. But distance learning cannot meet the specific needs of such particular students as children and adolescents with cancer. For them, the guidance that teachers attending in person can offer-as emotionally separate, neutral figures outside a patient's family-plays a crucial part in motivating patients to invest in their studies and their future. It helps them to combat a tendency (often prompted by their disease) for them to become detached and lose interest [4] .

Italy's Ministry for Education decided that operators who could be defined more specifically as providing "healthcare" (such as psychologists and social workers) could continue to do so during the pandemic, but teachers could not. The educational activities normally organized by the Local Authorities in Milan (with educators normally present on the ward) were suspended as well. This situation in Italy has not changed since March 2020. Both before and during the second wave of the pandemic in late 2020, pediatric cancer patients continued to go without the fundamental support of the schooling services normally provided in hospital and at home.

Denying these patients the chance to continue their schooling can have very severe psychological consequences. For a start, it compounds the effect of their parents' tendency to be overprotective because of their child's disease. Parents experience a heavy sense of vulnerability, and their fears concerning their child's cancer are exacerbated by their worries about the viral disease. This leads to a risk of parents tending to isolate their nuclear family, staying away from their wider network of family and friends. This dysfunctional mechanism is amplified by the restrictions necessitated by COVID-19 and also applies to their child's schooling [4] .

There is also the risk of parents tending to disinvest in their child's education and future. Uncertainty about their prognosis and the need to concentrate on the treatment of their disease can lead to any plans for the child's future being abandoned. Continuing their education, in the classroom or in hospital, can help to combat this harmful tendency. To this picture of hyper-protectionism and disinvestment, the situation deriving from the COVID-19 pandemic has added the further damage caused by the loss of any inhospital schooling resources [4, 5] .

It is hard to strike the right balance between institutions struggling to establish a set of rules to ensure the safety of school service operators, the need for clinical precautions, and the need to find some way to resume activities that are fundamentally important to our patients. After much debate proved of little use, we embarked on a campaign to raise awareness of the issue in the mass media and social media, with the support of our parents' associations ( Fig. 1) . This action mobilized a remarkable collective interest in the problem and led to the end of the stalemate in the decision-making process. The various organizations involved took action and schooling activities resumed for pediatric patients in hospital and at home. At the time of this report, schools were still closed in many parts of Italy for all except primary-school students, and secondary-school students were only attending classes online.

While the authors remain fully aware of the enormous social difficulties posed by the COVID-19 pandemic, this story aims to emphasize the importance of finding special solutions for particular categories, such as children and adolescents with cancer. It also underscores the importance of schooling, not only for a child's education and development but also and especially as a space for care and a time for living.

Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 

Implications of cancer for school attendance and behavior

On the clinical psychologist's role in the time of COVID-19, with particular reference to experience gained in pediatric oncology

How young patients with cancer perceive the Covid-19 epidemic in Milan, Italy: is there room for other fears?

COVID-19 and children with cancer: parents' experiences, anxieties and support needs

Returning to school in the era of COVID-19

Conflict of interest The authors declare that there is no conflict of interest.