School-Related Challenges Among Adolescent Cancer Survivors: Associations Between Physical Activity, Emotional Wellbeing, Post-Traumatic Growth, and Quality of Life

Abstract

Background and Aim. Childhood cancer is increasingly recognised as a chronic condition, with more adolescents returning to school after treatment while facing physical, emotional, and social challenges. Survivorship is associated with reduced physical activity, emotional difficulties, and long-term psychological effects, but may also promote post-traumatic growth. However, the interplay between physical activity, emotional wellbeing, post-traumatic growth, and quality of life remains insufficiently explored. This study aimed to examine school-related challenges, including physical education experiences, among adolescents who survived cancer before the age of 19, and to explore how these factors interact.

Methods. A qualitative phenomenological design was used. Semi-structured interviews were conducted with 17 participants from Lithuania (16 minors, 1 adult; 6 females, 11 males). Data were transcribed verbatim and analysed using thematic analysis with MAXQDA and Microsoft Excel. Identified themes included physical activity, school adaptation, emotional wellbeing, peer relationships, psychological support, and post-traumatic growth.

Results. Physical activity decreased during treatment and increased post-treatment, although some limitations persisted. Participants reported challenges in physical education due to fatigue and reduced physical capacity, often requiring adapted activities. Emotional experiences varied, with peer and school support playing a key role in adaptation. Narratives revealed post-traumatic growth, including increased resilience, maturity, and appreciation of life. Physical activity, emotional wellbeing, and social support were closely interrelated and influenced perceived quality of life.

Conclusions. School reintegration after cancer is a complex process requiring supportive environments, individualised physical activity, and peer acceptance. Survivorship may also foster post-traumatic growth and improved quality of life. These findings highlight the need for targeted educational and psychosocial interventions.

Keywords: Adolescent cancer survivors; physical activity; quality of life; post-traumatic growth; school reintegration