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Children afflicted with cancer may struggle to lead normal social lives even two years after being diagnosed, a study suggests, with many experiencing reduced functioning in the social realm. To combat these findings, researchers said treatment plans should include measures to reduce psychological symptoms and build up social support.

“A cancer diagnosis can disrupt social maturation, the process by which young people develop self-views, social cognition, awareness, and emotional regulation that guides them throughout the remainder of their lives,” lead author Olgan Husson, of Radbout University Medical Center in the Netherlands, told Reuters.

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Researchers wrote that feelings of isolation could keep young patients away from family and friends, or symptoms may make it difficult for them to interact with their peers. They came to this conclusion after following 215 cancer patients between the ages of 14 and 39 shortly after they had been diagnosed at one of five major U.S. hospitals, Reuters reported.

The participants answered survey questions within four months after diagnosis, a year after diagnosis and two years after diagnosis. Researchers analyzed data about the patient’s disease and severity of symptoms and gauged each participant’s level of psychological distress and need for support. Patients were also asked about their social functioning, including whether emotional or physical issues were disrupting social activities.

Using a scale of zero to 100 to measure social functioning, the researchers found that young patients had significantly worse social functioning at all time points. The scale also showed around one in 10 participants had consistently high social functioning, but nearly a third had consistently low scores.

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“A lot of kids who undergo cancer treatment isolate themselves from their peers,” Elana Evan, associate professor in pediatrics at the University of California, Los Angeles, who was not involved in the study, told Reuters. “Their body looks different, there’s a lot of physical symptoms and psychological symptoms from the treatment.”

Husson said the study, which was published in the journal Cancer, shows the need for supportive care interventions in the form of online social network and peer support groups.

Reuters contributed to this report.