Every year 300,000 children aged 15 and under will develop cancer worldwide, most of whom are of school-age (Sung et al., 2021; World Child Cancer, 2024). With the dramatic progress in treatment development, the survival rate of children and adolescents with cancer has been significantly improved, and the 5-year survival rate is as high as over 85% (Gatta et al., 2014； Atun et al., 2020). This increased survival rate means that cancer in children and adolescents is now considered a chronic illness rather than a death sentence (National Cancer Institute, 2020). As advances in treatment increase survival rates, the number of adolescent cancer survivors returning to school is increasing (Stephanie et al., 2017).

For school-aged cancer patients, returning to school marks their return from an abnormal health condition to normal school life (Tremolada et al., 2020). Young cancer survivors believed that returning to school provides them with a source of identity, self-worth and social contacts (Braun et al., 2023). Re-integration in school is important to facilitate the child's normal learning and attainment of academic skills (Park et al., 2018). Helms et al. (2016) found returning to school as soon as possible after the cancer diagnosis is related to better school performance and lower levels of depression. Going back to school is also of great significance to adolescent cancer patients' recovery and quality of life (Tremolada et al., 2020). As important as returning to school is, challenges often make school re-entry difficult. Disruption in schooling caused by cancer treatment, children and adolescents have to stop attending school because of the long duration of treatment (Hyeran & Lee, 2019). Children and adolescents with cancer face difficult challenges that affect their physical, psychological, and social development (Broholm-Jørgensen et al., 2022; Park et al., 2018; Semendric et al., 2023).

A study found that children with cancer may have more psychosocial problems after being discharged from the hospital due to their inability to adapt to everyday life and learning environment (Momani et al., 2015), which lead to the difficulties in the aspect of social reintegration both in the school context and in daily life (Tremolada et al., 2020). Mertens et al. (2014) described 65%–75% of childhood cancer survivors experience late physical and emotional effects. Saatci et al. (2020) found that as survivors reintegrate into peer groups and classrooms, this transition is often accompanied by psychosocial challenges that extend beyond the neurocognitive impacts on academic achievement. When returning to school after treatment, continuing side effects of chemotherapy and stigma from others can lead to a sense of inferiority in children and adolescent leukemia survivors (Wu et al., 2010). In addition, side effects of chemotherapy and drugs affect the appearance of these children and adolescents (Mertens et al., 2014), which can hurt their self-esteem and psychosocial function. Despite many distractions, returning to school remains a significant task for children and adolescents with cancer. Bessell interviewed 51 cancer survivors (8–17 years old) and found participants were keen to return to school (Bessell, 2001). Vanclooster et al. (2019) also found some diagnosed children and their families were eager to go back to school as it was a sign of ‘normality’ returning. Experts additionally reported that cancer survivors possess a “drive” that aids in return to education and work (Pedersen et al., 2018). Therefore, it is urgent to pay attention to the children's return to school experience.

In summary, diagnosis and treatment of cancer negatively impact the physical, psychological and social interactions of children and adolescents with cancer, causing them to face many problems while returning to school. Understanding the factors that promote and hinder the return to school of children and adolescents with cancer can help them return to school and improve their social adjustment. Salchow et al. (2020) mentioned that a deeper understanding of the personal situation of survivors provides an important component for high-quality comprehensive cancer care. Qualitative research provides insight into the school re-entry experience of children and adolescents with cancer. Compared to quantitative studies, qualitative research can capture individuals' nature and inner voices (Thorne, 2011). To date, qualitative reports have examined the overall experience of return to education in children and adolescents with cancer, but to the best of our knowledge, the qualitative evidence has not been synthesized. Therefore, this study was performed to aggregate and synthesize existing evidence to fully portray the school re-entry experiences of children and adolescents with cancer. The additional information provided by qualitative studies provides an evidence-based basis for the construction of targeted intervention.

This meta-synthesis aimed to describe the experiences of children and adolescent cancer patients as they return to education, and to identify facilitators and barriers to returning to school.