Keira Chang

A Student's Journey Through Cancer Treatment

Keira Chang abruptly went from planning her 13th birthday party to battling acute leukemia. Facing extended hospital stays, she tackled both her disease and her schoolwork thanks to a unique City of Hope academic advocacy program

In May 2021, Keira Chang was busy planning her 13th birthday party. Because of COVID-19, she planned to host a virtual celebration with her friends and family, full of games and online activities to mark the milestone birthday. Sadly, the party never happened.

City of Hope patient Keira Chang
Keira Chang

Keira had been experiencing some unusual symptoms — mysterious bruises on her legs, tiny red spots on her body (known as petechiae) and a fever — but she was too preoccupied to think much of them. Her father, Jeff, however, grew concerned.

“I went straight to Mr. Google. I had a sneaking suspicion something might be very wrong, so we went to urgent care, where they drew some blood,” he said.

After days of waiting, the family finally received the results of Keira’s blood tests. They rushed straight to her pediatrician’s office to review the labs.

“Before I had time to realize what had happened, I went from my pediatrician’s office to the local ER before I was transported by an ambulance to City of Hope,” Keira recalled.

An Unexpected Acute Lymphoblastic Leukemia Diagnosis

At City of Hope®, Keira was diagnosed with acute lymphoblastic leukemia (ALL), which starts in the bone marrow and can spread to other parts of the body, like the lymph nodes, liver and sometimes the brain and spinal cord. Leukemia is the most common cancer in children, and this type is aggressive and can progress quickly if not treated as quickly as possible.

In a Facebook post about her experience, Keira described the whirlwind of emotions she felt at the start of her cancer journey.

“There was no time to process what was going on. My initial days were filled with scans, tests, procedures and meetings with my treatment and support teams. I watched as my parents signed piles upon piles of papers, pouring over medical documents, studying clinical trials, all while masking their grief to make me as comfortable as possible,” she wrote.

Keira’s parents were also in shock, as they went from helping Keira finish up the school year to admitting her to the hospital for urgent cancer treatment.

“We don't have a history of cancer in our family, so we didn't even think that it was a possibility, and if anybody got it, it wouldn't be Keira,” Jeff said. “So, it was really hard to accept, but we didn't have a lot of time to think about things because everything was moving so fast.”

Keira was placed in the care of Shilpa Shahani, M.D., a pediatric oncologist and assistant clinical professor in City of Hope's Children's Cancer Center, and she began long-term chemotherapy immediately.

“Physically, I felt like a train wreck, but I think the most exhausting part was in my head. When going through this process, even though I had support from my medical team, family, teachers and friends, it was impossible for me not to feel alone,” Keira said.

City of Hope’s Academic Advocacy Program

Cancer can be a profoundly isolating experience, especially for young people who are faced with the challenge of navigating the physical and emotional toll of the disease while also trying to maintain a sense of normalcy among their peers.

Already grappling with feelings of disconnection due to COVID-19 restrictions, Keira found herself further isolated from friends and peers following her cancer diagnosis. The dual burdens of illness and pandemic measures intensified her feelings of loneliness.

For Keira and her family, school was the last thing on their minds in the early days of her treatment. But, as her eighth-grade year approached, they became concerned about her falling behind and the impact that might have on her mental and emotional state.

The family relied on social workers in City of Hope’s Academic Advocacy Program for guidance.

Keira Chang after completing chemotherapy
Keira Change celebrating her final chemotherapy treatment.

“We have so many curative options, and our goal is to get these kids back to where they were before they were diagnosed. We don't want them to be a year or two behind their classmates; we want them to be able to integrate back into school. So, one of the goals of the Academic Advocacy Program is to keep them on track with their peers as much as possible,” explained Renee Joshi, a clinical social worker lead at City of Hope.

“We understand that patients may have bad days where treatment has been really hard, and they're experiencing side effects, but we try to figure out how to navigate those challenges with their school district, parents and care team.”

The Academic Advocacy Program offers support across all education levels, from preschool to college. A variety of services can be arranged for students, including hospital tutoring, home instruction, school reintegration, student and parent advocacy, special accommodations, neuropsychological testing and community resources and referrals.

During her eighth-grade year, Keira’s school district was still holding classes virtually, so although she was still in treatment, she was able to attend school online, with some modifications. To help secure those modifications, City of Hope social workers collaborated with Keira’s parents, school administration, teachers and care team to enact a 504 Plan, which is a legally binding document outlining specific modifications and accommodations to support students with disabilities in the educational setting.

“Some of my teachers would arrange for one-on-one tutoring after school every few days. They would catch me up on all the things that I needed to learn and the assignments I needed to do. That was really helpful because I was in and out of the hospital that year. These sessions helped me stay caught up,” Keira said.

The process was not seamless, but Keira was determined to stay on track. Complications from her treatment arose many times, which led to extended hospital stays, and some teachers adapted more easily to Keira’s needs than others. Still, despite those difficulties, she managed to complete her eighth-grade year without falling behind. Through it all, her social worker, Joey Fredlund, was by her side.

“Joey was fantastic. We were glad to have her help. She worked with the school district, helped us get the necessary paperwork signed from the doctors and just walked us through the whole process. She was really great and helped us the entire way,” Jeff said.

Returning to In-Person Learning

For Keira’s ninth-grade year, her family enrolled her in a private online school, where she remained through the first half of 10th grade. Still, she missed the traditional high school experience she always thought she would have.

“I definitely miss hanging out with people, especially my friends. I miss talking to people in class. I just miss being around people in general. Online, there are some opportunities to socialize, but it’s just not the same,” Keira explained.

The hope of one day being able to return to school and reclaim her life before cancer gave Keira the determination she needed to push through her cancer treatments, no matter how hard they got. Then, after two and a half years of chemotherapy, Keira successfully completed her treatment. Finally, she began to prepare for her return to in-person learning. 

“Between COVID and her treatment, Keira’s basically been in a bubble. Now, she's finally going to go back out into the world. We’re nervous but excited for her,” Jeff said.

Although Keira’s immune system is still compromised, she is getting stronger every day and feeling more like herself for the first time in years. She is thriving and has the unwavering support of her parents, friends, teachers and City of Hope.

“Going to school makes me feel normal again, and I am so happy that I’m finally able to be where I am now.”

For other children and young adults facing the challenge of juggling cancer treatment with their education, Keira has one very important piece of advice: Do not be afraid to ask for what you need.

“There are a lot of things that you just won't be able to do because you’re tired or you don’t feel well. When that happens, you have to say something. I used to feel a little awkward admitting things like that to my teachers, but there are going to be times when you just can’t keep up with everything. And this honestly applies to anyone, but especially to someone with cancer, right? You have to be able to express your needs. Asking for help is something I am still learning to do, but I’m getting better at it.”

The Department of Supportive Care Medicine at City of Hope was the first in the United States to fully integrate across supportive care specialties and into the patient’s clinical care and is one of the largest programs of its kind today. The program provides cancer patients with comprehensive physical, psychological, social and practical support services, including care navigation; survivorship programs; specialists in cancer and aging; child life specialists; psychological and spiritual counseling; pain management; integrative medicine, such as yoga, massage and meditation; and more — all with a focus on maximizing patient and family strengths, quality of life and the ability to best engage in their treatment journey and beyond. Thanks to a gift from The Sheri and Les Biller Family Foundation, City of Hope is working to expand this offering across its cancer care system and to advocate for establishing supportive care as a standard best practice for cancer care in the United States.