{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:27:57Z","timestamp":1784298477850,"version":"3.55.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014840","name":"Gemeinsame Bundesausschuss","doi-asserted-by":"publisher","award":["(grant number 01VSF19055)"],"award-info":[{"award-number":["(grant number 01VSF19055)"]}],"id":[{"id":"10.13039\/501100014840","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Purpose<\/jats:title>\n Childhood cancer presents lasting challenges beyond primary treatment, affecting multiple aspects of daily life. This mixed-methods study examines the impact of childhood cancer on activities and participation within the first five years after treatment. It mainly focuses on the interplay of factors influencing participation. Further, qualitative interviews provide contextual insights and experiential perspectives from affected families to complement the quantitative findings.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The study combines qualitative interviews with 30 parents and quantitative survey data from 256 parents. The survey included self-developed items based on the International Classification of Functioning, Disability and Health (ICF). A correlation-based network analysis examined relationships among factors affecting children\u2019s activities and participation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Survivors experience impairments in school activities, social interactions, and daily functioning. Network analysis highlights the interconnections among ICF-coded aspects, revealing that learning, communication, and participation in major life areas strongly influence overall activity and participation.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n While many survivors reintegrate into everyday life, hidden challenges can significantly impact their participation. This study underscores the need for a holistic, multidisciplinary approach addressing medical, educational, and psychosocial challenges, including struggles beyond visible limitations.<\/jats:p>\n <\/jats:sec>\n \n Implications<\/jats:title>\n Interventions should prioritize comprehensive support, particularly in learning, communication, and participation in school activity. Educating healthcare providers and caregivers about the interdisciplinary links between these domains is essential for a coordinated, holistic approach.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0339084","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T23:09:46Z","timestamp":1778281786000},"page":"e0339084","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Childhood cancer survivors\u2019 struggle for social integration after treatment a mixed-methods exploration of activity and participation"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4459-1773","authenticated-orcid":true,"given":"Verena","family":"Paul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Inhestern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e9sir\u00e9e","family":"Sigmund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Winzig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Sander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Rutkowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Escherich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinna","family":"Bergelt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"issue":"12","key":"pone.0339084.ref001","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/S1470-2045(22)00637-4","article-title":"Long-term survival and cure fraction estimates for childhood cancer in Europe (EUROCARE-6): results from a population-based study","volume":"23","author":"L Botta","year":"2022","journal-title":"Lancet Oncol"},{"key":"pone.0339084.ref002","doi-asserted-by":"crossref","first-page":"101733","DOI":"10.1016\/j.canep.2020.101733","article-title":"Childhood cancer: Survival, treatment modalities, late effects and improvements over time","volume":"71","author":"F Erdmann","year":"2021","journal-title":"Cancer Epidemiol"},{"issue":"1","key":"pone.0339084.ref003","first-page":"6","article-title":"Systematic Review: Associations Between Family Functioning and Child Adjustment After Pediatric Cancer Diagnosis: A Meta-Analysis","volume":"42","author":"M Van Schoors","year":"2017","journal-title":"J Pediatr Psychol"},{"issue":"6","key":"pone.0339084.ref004","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/j.pcl.2020.07.005","article-title":"Psychological Outcomes, Health-Related Quality of Life, and Neurocognitive Functioning in Survivors of Childhood Cancer and Their Parents","volume":"67","author":"G Michel","year":"2020","journal-title":"Pediatr Clin North Am"},{"issue":"6","key":"pone.0339084.ref005","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.pcl.2020.07.004","article-title":"Childhood Cancer Survivorship: Daily Challenges","volume":"67","author":"F Schulte","year":"2020","journal-title":"Pediatr Clin North Am"},{"issue":"9","key":"pone.0339084.ref006","first-page":"532","article-title":"\u201cChemobrain\u201d in childhood cancer survivors-the impact on social, academic, and daily living skills: a qualitative systematic review","volume":"31","author":"I Semendric","year":"2023","journal-title":"Support Care Cancer"},{"issue":"1","key":"pone.0339084.ref007","doi-asserted-by":"crossref","DOI":"10.1111\/cch.13207","article-title":"And what about today? 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