College and Cancer Treatment

This page is for college students going through cancer treatment while enrolled, and for the families helping them. It covers who to contact first, your rights at school, medical leave and financial aid, health coverage, dorm life, and what to do about a fever or other signs of infection.

The National Cancer Institute counts people aged 15 to 39 as adolescents and young adults. The American Cancer Society estimates, as published on NCI's SEER site, that about 85,480 people in that age group will be diagnosed with cancer in the United States in 2025. That is about 4.2 percent of all cases. Breast, thyroid, and testicular cancer and melanoma are the four most common types. Many of those people were enrolled in school the week they found out.

Treatment during a semester creates two jobs at once. One is medical. The other is paperwork, and it runs on deadlines that do not move for illness.

Start with the campus disability services office, not with a professor. A sympathetic professor can bend one course. Only the disability office can create a record that binds the whole school.

Two laws apply. Section 504 of the Rehabilitation Act covers any school that takes federal money. Title II of the Americans with Disabilities Act covers public colleges. Both require a school to make what the Department of Education calls "appropriate academic adjustments."

The rules changed the day you left high school. A public high school must provide a free appropriate public education. It often does this through an Individualized Education Program, or IEP. An IEP is a written plan the school writes and reviews. A college owes you no IEP and no such plan. The Department of Education says plainly that a college does not have to invite your parents into the process.

Two more shifts matter more than students expect.

First, you must identify yourself. The Department of Education states that if you want an academic adjustment, "you must identify yourself as having a disability." Nobody in the registrar's office will spot your infusion schedule and act on it.

Second, old paperwork may not carry over. A school may ask for current documentation, including a diagnosis of your current disability and information on how it limits major life activities. Your high school IEP is often not enough, because college demands are different.

The Department of Education lists these as examples of academic adjustments:

• extended time on tests
• priority registration
• a reduced course load
• note takers, and permission to record lectures
• accessible housing
• adaptive hardware and software
• sign language interpreters

For cancer care, priority registration and a reduced course load do the heaviest lifting. Chemotherapy cycles are set in advance. If you know that day 1 of each cycle is a Tuesday, build the schedule around it before registration opens rather than dropping a course later.

The limits are just as concrete. A school does not have to lower or substantially change the essential requirements of a course or a degree. It does not have to make a change that would fundamentally alter the nature of a service. It does not have to supply personal attendants, individually prescribed devices, readers for personal use, or tutoring. It does not have to take on an undue financial or administrative burden.

If a school refuses and you believe the refusal is discrimination, the Department of Education's Office for Civil Rights takes complaints at 1-800-421-3481 or ocr@ed.gov.

Federal student aid rules treat a leave of absence very specifically. Under 34 CFR 668.22, an approved leave does not have to be treated as a withdrawal only if it meets a list of conditions. Three of them are:

• The school has a written leave policy.
• You follow that policy.
• The school decides there is a reasonable expectation you will come back.

The rule has other conditions too, such as the school approving the request and not adding charges. Ask the school for its written policy.

The ceiling is 180 days of approved leave in any 12-month period. That period starts on the first day of your first leave. Days spent on an approved leave are not counted in the payment period used for aid.

If you do not return when the leave ends, the school must treat you as withdrawn. That is where the money changes. When a student withdraws before finishing 60 percent of the payment period, only a proportional share of federal aid counts as earned. After the 60 percent point, all disbursed aid is earned.

So the 60 percent point is a real date on a real calendar. Ask the financial aid office to put that date in writing before you decide when to step away. The start date of a leave can change how much aid you keep.

Many students are on a parent's plan. That coverage generally runs until age 26. For Marketplace plans, it runs through December 31 of the year you turn 26.

Several things that feel like they should end that coverage do not. All of these leave the parent's plan intact:

• Getting married.
• Having a child.
• Leaving school.
• Living away from home.
• Not being claimed as a tax dependent.
• Turning down an offer of job-based coverage.

Marketplace open enrollment runs November 1 through January 15. Before you switch to a student health plan, check whether the cancer center treating you is in that plan's network. Mid-treatment is the worst time to change oncologists.

CDC states that people treated with chemotherapy are more likely to get infections. Neutropenia, a low number of the white blood cells that fight bacteria, is the reason. Ask your care team when your count is likely to be lowest.

Shared bathrooms, communal kitchens, and a roommate with a cough are all real exposures during the days your count is lowest. The Department of Education says a school that offers housing must give students with disabilities comparable, accessible housing. Ask disability services whether a single room or private bathroom can be arranged. Ask early, with your documentation, not in August.

CDC calls a fever during chemotherapy a medical emergency. CDC says to call your doctor right away if your temperature is 100.4 degrees F (38 degrees C) or higher. Call your oncology team, day or night, even in the middle of the night. Do not wait for the clinic to open, and do not wait to see whether the number goes up or lasts. If you cannot reach them quickly, go to an emergency department and tell them you are having chemotherapy. The campus health center is not the right destination.

A normal temperature is not permission to wait. If you are having chemotherapy, call your care team right away, day or night, for chills, a sore throat, mouth sores, burning when you urinate, redness or swelling around a catheter or port, or any other sign of infection. NCI says infections during cancer treatment can be life threatening.

Do not take a fever medicine such as acetaminophen or ibuprofen before you call. NCI says to talk with your doctor or nurse first, because these can hide serious problems.

Tell the triage desk this sentence: "I am on chemotherapy and I may be neutropenic." Carry a card with your regimen name, your oncology clinic's after-hours number, and the date of your last dose. Ask your oncology team in advance which emergency department they want you to use.

• https://www.ed.gov/higher-education/students-disabilities-preparing-postsecondary-education
• https://www.ecfr.gov/current/title-34/subtitle-B/chapter-VI/part-668/subpart-B/section-668.22
• https://www.healthcare.gov/young-adults/children-under-26/
• https://www.cdc.gov/cancer-preventing-infections/index.html
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• https://www.cancer.gov/types/aya