Informing Cancer Education and School Reintegration After Childhood Cancer: Metacognitive, Psychosocial, and School-Participation Indicators

Children and adolescents with a history of childhood cancer may experience psychosocial, cognitive, and school-related difficulties, yet survivorship education and follow-up need to reflect heterogeneous needs rather than assume uniform impairment. This cross-sectional case-comparison study compared shared psychosocial and metacognitive outcomes in 61 participants with a history of childhood cancer and 57 age-aligned typically developing peers aged 8-17 years, and examined trauma-related symptoms and school-related burden within the cancer-history group. Shared Strengths and Difficulties Questionnaire outcomes and harmonized Metacognitions Questionnaire-derived outcomes were analyzed using Welch tests, Hedges' g, and false-discovery-rate correction. Within the cancer-history group, correlations and theory-driven regression models examined metacognitive correlates of psychosocial, trauma-related, and school-impact outcomes. The analyses provided no evidence of statistically reliable between-group differences after correction, although the modest sample means that small group differences cannot be excluded. Within the cancer-history group, low cognitive confidence in memory was strongly associated with hyperactivity/inattention and total difficulties, and negative beliefs about worry were the clearest unique statistical correlate of trauma-related symptoms. School-related burden was common, with 60.7% endorsing at least one school-impact item, but this prevalence should be interpreted cautiously because comparable school-impact data were not collected from peers. The findings inform cancer education by identifying targets for survivorship psychoeducation, family-school-health-care communication, and school reintegration support: perceived cognitive competence, worry-related beliefs, and school participation.