Steven is a 19-year-old male who was diagnosed with a pineal germinoma brain tumor at the age of 14 years old. Unfortunately, due to several tumor recurrences he had been on treatment for the past several years, which began when he was in the 9th grade. He was treated with resection and radiation to the ventricles and pineal region, and various chemotherapies. At the time of referral for career counseling, he was declared to have stable disease and continued to receive maintenance chemotherapy.

Most of his high school years were accomplished through homeschooling and online courses. Historically, he was reported to have high intelligence and was a successful student. As a result of excellent academic abilities and extraordinary determination, he graduated with a high school degree and began taking classes at the state university. Despite experiencing significant physical and cognitive side effects of both his brain tumor and treatment, he was attending college classes without any academic accommodations. Unfortunately, he recently became unable to keep up with his classes and began to fall behind. At the recommendation of his nurse, he agreed to a consultation with the career counselor to assist with current academic difficulties and for general academic planning.

Steven is an example of a pediatric cancer patient who continues to receive treatment while simultaneously pursuing academic goals. A career counselor would be ideal in assisting Steven in developing both proximal and distal academic goals that would lead to his future career goals. An immediate and practical need that Steven presented with was to assess his current academic standing and to provide counseling whether it was in his best interest to continue his courses or to consider a medical withdrawal. In situations like these, the decision needs to take into consideration the current time period of the semester (e.g. second week of the semester versus the week before finals), how behind the student is in terms of assignments and exams, and medical prognosis of symptoms (e.g. if side effect symptoms were expected to worsen or improve). If it is early in the semester, than a medical withdrawal might be appropriate, especially if symptoms impacting academic difficulties are not expected to improve. However, if the semester is almost over and majority of assignments and exams have been completed, then the counselor may advise Steven to negotiate “incompletes” with his professors and request additional time beyond the end of the semester to complete the course requirements.

Another priority need that Steven presents with is the need for evaluation for disability services that would provide academic accommodations including a referral for neuropsychological evaluation with a provider familiar with the possible cognitive late effects of cancer and its treatment. Once the results are presented, the career counselor could assist Steven in applying for appropriate educational accommodations and provide advocacy if there are any barriers or resistance. Even if the decision is made to withdraw from courses in the current semester, initiating an application for disability services will ensure that appropriate accommodations will be in place upon his return to school. Many college campuses may be unfamiliar with pediatric cancer survivors’ difficulties, many of which can be addressed by the career counselor providing education and advocacy on behalf of the patient.

Finally, career counseling to assess and develop educational and career goals will be beneficial so that Steven is able to concentrate his resources towards his goals. For example, if he is able to declare a major early in his college years, then he may be able to narrow down the number of classes he takes for exploratory purposes. This can also be helpful in terms of planning the courses he takes each semester by attending to factors such as not registering for too many demanding courses in the same semester or taking advantage of alternative course formats such as online courses to increase flexibility and independence of the student.

Alison is a 22-year-old female who is a long-term survivor of osteosarcoma of the right femur which was initially diagnosed at the age of 13 years. Alison received chemotherapy and a limb salvage procedure at the age of 14-years. At the time of referral, Alison was taking classes at a community college while working full time as a sales representative at a cellular phone service center and store. Fortunately, her employer provided health benefits which were not typical of most jobs for which she was eligible for. She reported that it was imperative for her to sustain her employment with this company due to the health benefits. Alison’s work duties involve assisting customers either on the sales floor or behind a counter, by constantly standing on her feet. She had not disclosed her cancer history to her manager nor requested any accommodations mostly in fear of any negative reactions or repuraussions from her manager and coworkers.

Alison reported that for the past couple of months she has had pain that worsened at the end of the day in her right hip and legs. She was recently evaluated and diagnostic imaging confirmed no evidence of disease in her right leg. Her physician recommended reducing the amount of physical activity, including time spent standing. When Alison disclosed to her nurse practitioner that she was conflicted between wanting to relieve her pain and needing to work, her nurse practitioner recommended a consultation with the career counselor.

Alison reported to the career counselor that despite her discomfort and pain, she was unable to support herself financially if she worked fewer hours. She was also fearful of losing her full time status because she would then be ineligible for health coverage benefits if she worked part time. Alison also struggled with the idea of disclosing her medical history and current pain issues to her manager.

First, the career counselor should provide education regarding the American with Disabilities Act (ADA) including ideas of reasonable accommodations that might assist Alison in being able to continue working full time. Examples of reasonable accommodations may include furnishing a stool for Alison to sit down on, allowing frequent breaks during her shift, or changing work duties to only assisting customers from behind a counter or at a desk, and so on. It will be imperative that Alison comprehends her legal rights afforded by ADA and the implications that will follow if she decides to utilize the law. In order to claim accommodations under ADA, Alison will be required to demonstrate a disability which would lead to the necessity of disclosing her medical history.

Therefore, it will be equally important to explore and problem solve a resolution regarding the disclosure of Alison’s cancer history. If Alison prioritizes not disclosing her cancer history, then she will need assistance for alternative solutions such as seeking alternative employment. If she chooses to disclose her health history and apply for accommodations at her current place of employment, then counseling to support her through the process and to cope with her manager and coworkers’ reactions would be greatly beneficial.