This proposal seeks to increase the school attendance of children with newly diagnosed cancer and by minimize the social and academic difficulties of the long term survivor (LTS). The proposed study is a randomized trial testing the efficacy of a new intervention, a Behavioral Management Protocol for School Attendance. The trial involves 8 major midwestern medical centers and a total of 600 patients. Having survived the disease, LTS still faces the multiple physical, psychological and social sequelae of his/her illness and treatment. School is a normalizing setting for the child with cancer. It helps to counteract the anxiety and depression accompanying severe illness by providing ongoing scholastic and peer involvement and in pre-empting potential future and academic and psychosocial difficulties. Thus, attending school is critical to long term development of children with cancer. However, re-entering school and maintaining adequate attendance are problems for these children. To date, few attempts to modify behavior patterns have been successful. The current study will take a direct, and preventive approach to school attendance by intervening early and utilizing a Behavioral Management Protocol. The Protocol outlines a systematic plan implemented by the parents at the time of diagnosis. Six hundred newly diagnosed (within 2 weeks) pediatric oncology patients (ages 6-16), with any malignancy (except brain tumors or advanced/metastatic disease) will be entered. Patients will be randomly assigned to one of two groups: intervention and control/no-intervention. Demographic and disease related data will be obtained. Baseline measures of attendance (# days absent), school grades and social competence (Child Behavior Checklist) will be collected for the year prior to diagnosis. The intervention group will then follow the Behavioral Management Protocol for a 12 month period. For both groups, records of school attendance, grades and social competence ratings will be gathered yearly. Two hundred new patients will be entered in each of years 1-3. All patients will then be followed for the duration of the study period. The investigator will: 1) assess the efficacy of the Behavioral Management Protocol in increasing school attendance during treatment and maintaining increased school attendance in the LTS; 2) evaluate the effects of increased school attendance on outcome measures of social competence and academic achievement; and 3) explore the degree to which demographic and disease related variables are predictive of school attendance.
