February 2024

Researchers investigated the practices surrounding the reintegration of pediatric patients into school following hematopoietic cell transplantation (HCT). The increasing use of allogeneic HCT as a curative option for children with hematologic conditions presents unique challenges. These challenges are especially significant during the patients’ formative years, potentially affecting their physical, emotional and socioenvironmental well-being. The study revealed significant variability in return-to-school practices among pediatric HCT centers, highlighting the need for standardized practices across transplant centers.

Download a PDF to the study highlights and citation here

Background

The study was motivated by the recognition that early return to school could benefit school age HCT survivors. However, practices across pediatric HCT centers vary significantly. To address this variability, the goal of this study was to assess the existence of standard operating procedures (SOPs) and understand the factors influencing decisions on when HCT recipients should return to school. This research aims to understand current practices and perspectives among pediatric HCT centers in the United States regarding school reentry post-transplant.

Methods

Researchers conducted a two-phase cross-sectional web-based survey through CIBMTR® (Center for International Blood and Marrow Transplant Research®)—a research collaboration between the Medical College of Wisconsin® and NMDP^SM. In phase 1 of the study, the CIBMTR Health Services Research Program approached medical directors of pediatric HCT programs listed in the NMDP Registry^SM via email between January and February 2020. They were asked a single question regarding the existence of an SOP for recommending when HCT recipients should return to school. In phase 2, HCT physicians from 60 HCT centers were surveyed between Dec. 14, 2020, and Jan. 1, 2021. These physicians answered up to 22 questions about the decision-making process for school reentry post-transplant.

Results

The study revealed significant variability in return-to-school practices among pediatric HCT centers. Out of 46 respondents (55% response rate), 28 (61%) reported having an SOP. However, the 12 SOPs shared with the researchers showed wide variations in recommendations.

For the second phase of the study, 122 HCT physicians from 60 HCT centers responded (30.6% response rate). Key findings included:

Autologous HCT: 60% of physicians recommended school return within 6 months post-HCT. Key considerations included ongoing health complications (88%), disease status (61%) and the primary oncologist’s preference (47%).
Allogeneic HCT: 65% of physicians recommended school return only after 6 months post-HCT or once off immune suppression. Key factors were graft-versus-host disease or immune suppression (93%), immune reconstitution (89%) and ongoing health complications (87%).
Additional findings: 80% of respondents addressed the need for an individualized education plan before school reentry, while 75% considered home schooling. Additionally, 75% of physicians recognized the difficulty of school reentry due to physical demands, cognitive concerns, emotional distress and lack of support from schools.

Key takeaways

The study highlights the need for standardized SOP development for post-HCT school reentry, with room for individual center and patient circumstances. The Figure below proposes a process to standardize these recommendations. Collaborative efforts among transplant centers could lead to more consistent practices, ultimately improving the quality of life for pediatric HCT survivors. By addressing the identified variability in practices, the transplant community can work towards better support systems and recommendations, easing the transition back to school for young patients.

Figure

This figure proposes a process to standardize return to school recommendations.