Lessons from COVID-19, challenges of remote learning for childhood cancer survivors.

Abstract

10054 Background: More than half of childhood cancer survivors (survivors) will have neurocognitive deficits that impact schooling, most commonly reflecting attention and executive dysfunction. Schools are legally bound (IDEA, 2004) to support eligible students with Individualized Education Program (IEP) informed instruction and related services (e.g. assistive technology, speech-language, physical, or occupational therapy) to foster academic success. However, these service provision were not designed under the constraints of remote learning. The COVID19 shift to remote learning is likely to extend beyond the pandemic especially for medically fragile students. This quality improvement project describes challenges for survivors during remote learning and recently developed related patient education materials. Methods: Interviews with families were used to identify themes around challenges during remote learning, which informed development of a 29-question survey disseminated via flyer in local oncology clinics and social media posts by local childhood cancer organizations in Fall 2020. Results: The survey was completed by 67 parents describing their affected child (mean age= 8.6 years; 60% male; 78% White, 12% Black, 95% non-Hispanic). Most children (74%) had completed therapy (43% for leukemia, 18% for brain tumor; 39% other). The majority (86%) attended public school and 37% received special education or related services: speech-language (26%), occupational (23%), and physical (14%) therapies, and vision services (3%). Fully remote learning was reported for 73%, in-person 4%, and hybrid learning for 14%. The majority (57%) reported observing greater difficulty with attention and focus during RL, indicating difficulty occurred about half of the time during related services therapies, class and/or small group video instruction. Technology-related challenges included difficulty navigating online instruction/equipment (28%), reading difficulty (16%), and difficulty seeing materials/lack of vision supports (18%). Findings did not differ based on treatment or IEP status (p>0.50). Few (14%) reported their school team discussed assistive technology options for online learning. Parents indicated the most helpful supports for addressing challenges included speech-to-text tools, screen readers, and audio books. Parents reported their oncology team was helpful in making referrals to neuropsychology and therapies and completing documentation necessary to secure supports. Conclusions: Childhood cancer survivors, irrespective of diagnosis or IEP status, report challenges with remote learning. Families find a lack of information or special accommodations as roadblocks to success. Oncology providers were identified as valued resources, so educational materials ( https://tinyurl.com/nxbhj5or ) were developed for oncology teams to share with families.