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Social Competence in Childhood Cancer Patients

FionaShulteby Fiona Schulte, Ph.D, R. Psych.

Meet Joe:

Joe is a 16 year-old boy who, today, is a survivor of Osteosarcoma*. He is a bright, outgoing, determined young man who had big dreams for his future. Throughout his cancer treatment he referred to himself as a ‘fighter’, a ‘survivor’ and felt proud to show his bald head off to his health care team and those he came in contact with in the Oncology Clinic waiting room and the Children’s Hospital cafeteria. After a grueling year of chemotherapy, surgery to remove the tumor from his leg, intensive rehabilitation, followed by more chemotherapy, Joe could not wait to return to school to get back on track with following his dreams. Sadly, Joe found his return to school, and specifically, his interactions with peers were not all that he hoped they would be. Joe found that his former peer groups at school were not what he remembered them to be and he no longer knew exactly where he fit in. Physically, Joe had a hard time keeping up with his peers. Joe attempted to interact with new peers but found he said the word ‘cancer’ and he got awkward looks and did not know how to respond. And over lunch, Joe found his peers talking about things like video games and long boarding which Joe found to be immature. Joe was left feeling socially isolated and alone.

What is Social Competence?

Social competence has been defined as “the ability to achieve personal goals in social interaction while simultaneously maintaining positive relationships with others over time and across situations” (Yeates, et al., 2007). Social competence is critical to the healthy development of children and there is a large body of research that has linked deficits in social competence in childhood to long-term psychological difficulties in adolescence and adulthood (Ladd, 2005). Peer relationships are critical for the healthy development of social competence. Having at least one high-quality friendship has been identified as an important protective factor against peer rejection.

What do we know about Social Competence in Childhood Cancer Patients?

Social deficits have been observed as a consistent ‘late effect’ for childhood cancer patients. A late effect is a side effect that occurs months or years after treatment and can be physical, or psychological. Specifically, children with cancer have been described by their peers and teachers as being more socially isolated and withdrawn (Barrera, Shaw, Speechley, Maunsell, & Pogany, 2005). These difficulties seem to persist from treatment into survivorship. Certainly, however, not all patients with cancer experience these difficulties. Research is currently being conducted that is attempting to identify risk and protective factors.

Survivors of pediatric brain tumors tend to be at greatest risk for social difficulties (Schulte & Barrera, 2010). Unfortunately, the reasons for this are not well understood.

How do you Enhance Social Competence?

  • Stay connected! Although children may not always feel up to engaging with their peers due to the physical side effects of cancer and cancer therapy, social media is a fabulous way to stay in touch.
  • Encourage your child to make friends and to engage with peers in extra-curricular activities. Extra-curricular activities help to build a sense of mastery and self-esteem. Begin by identifying activities that take advantage of your child’s strengths. As well, children may initially feel more comfortable engaging in solitary activities, in a group setting (e.g., art class). With more confidence, arrange extra-curricular activities that allow your child to share interests with other children and encourage team-work. This will help continue to develop self-esteem, social skills and cultivate other interests
  • Contact your local children’s cancer agency/foundation and see if they offer social activities. Activities may range from cancer camps, to weekend retreats, to weekend outings. Connecting with other children with cancer can help your child feel that they are not alone.
  • Explore services offered through your pediatric cancer hospital. Some centres offer groups that are tailored specifically to help enhance social skills in pediatric cancer survivors. Hospitals may also have dedicated psychosocial staff who can help provide support to you or your child or help you find support within the community.

*Details of this patient have been changed to protect confidentiality.

The Failed Arms Race of Childhood Cancer




Barrera, M., Shaw, A. K., Speechley, K. N., Maunsell, E., & Pogany, L. (2005). Educational and social late effects of childhood cancer and related clinical, personal, and familial characteristics. Cancer, 104, 1751-1760.

Ladd, G. W. (2005). Children’s Peer Relations and Social Competence: A Century of Progress. New Haven: Yale University Press.

Schulte, F., & Barrera, M. (2010). Social Competence in Childhood Brain Tumor Survivors: A Comprehensive Review. Supportive Care Cancer, 18, 1499-1513.

Yeates, K. O., Bigler, E. D., Dennis, M., Gerhardt, C., Rubin, K. H., Stancin, T., et al. (2007). Social outcomes in childhood brain disorder: A heuristic integration of social neuroscience and developmental psychology. Psychological Bulletin, 133, 535-556.


Fiona Schulte is the staff clinical psychologist for the Hematology, Oncology and Bone Marrow Transplant program at the Alberta Children’s Hospital and a Research Assistant Professor at the University of Calgary (Faculty of Medicine). She completed a Postdoctoral Research Fellowship at the University of Calgary in 2010 and received her Ph.D. at the University of Toronto in the program of Health and Behavioral Science in 2009. Her Postdoctoral and Ph.D. research centered on the psychosocial outcomes of pediatric cancer survivors, with a focus on social functioning in childhood brain tumor survivors. She currently holds two multi-site interdisciplinary team grants focused on establishing evidence-based psychosocial interventions to brain tumor survivors, as well as to siblings of oncology patients. In addition, her current research program is working to investigate how to systematically assess distress in pediatric cancer patients and allogeneic transplant patients and their families. 



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