Depending on the treatment received, female and male survivors who want to start or add to a family may not be able to conceive. Do cancer survivors face barriers when they want to adopt children? This is often a topic of discussion among patients and their nurses and other health care providers, but are oncology nurses actually prepared to discuss such matters?
The H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, instituted an 8-week training program, Educating Nurses about Reproductive Issues in Healthcare (ENRICH), to ensure that oncology nurses are better prepared to counsel patients about fertility options and adoption.1 The course aims to teach them about the options available that may reduce a patient’s risk of infertility, and to be able to offer guidance about adoption as an alternative.
Of course, the relationships that oncology nurses have with their patients are unique; nurses are often the earliest and closest clinical contacts for patients and their families throughout the long course of treatment and into survivorship. A logical assumption is that they would be part of family discussions about reproductive health and family building. Gwendolyn P. Quinn, PhD, senior member, Department of Health Outcomes and Behavior, Division of Population Science at the Moffitt Cancer Center, and colleagues describe the institute’s program using the experience of 77 nurses from 15 states who completed the online program.2
As part of the program, participants located a local, state, or international adoption agency and, using a guideline, interviewed an intake counselor or administrator. An advisory panel of communication and reproductive health experts developed the interview guide according to the program’s curriculum objectives and the purpose of the assignment. Participants then summarized the answers they received for data analysis.
Question categories were cost of adoption, challenges faced by cancer survivors wishing to adopt, reservations of birth parents, and changes that the institution planned in order to increase adoption awareness.
Most of the nurses were surprised at the high cost of adoption fees, which ranged from $3,000 to $75,000. The most commonly quoted fees were between $20,000 and $30,000, but could be lower if the child to be adopted was older or special needs. Grants or federal assistance might also lead to a fee reduction in some cases.
CANCER SURVIVORS AS PARENTS-TO-BE
The nurses found that an average of 10 cancer survivors per agency sought to adopt each year. However, some agency administrators did not know how many survivors sought to adopt; they did not track whether prospective parents were cancer survivors because this was not information they had to report.
Physician’s letter Most agencies require a medical history from prospective parents as well as a statement of health that may be given to the birth mother. Although the nurse interviewers did not find many additional requirements for cancer survivors who wanted to adopt, one requirement was that applicants who had had cancer often had to obtain a physician’s letter describing the health of each prospective parent. This requirement could place difficult restrictions on the survivor, as some agencies require survivors to be free of cancer for 5 years when they apply to adopt. Some of the participants identified agencies that went further, requiring the oncologist to submit a letter detailing the patient’s history and overall prognosis, with the option of contacting the oncologist for more information. One nurse interviewer reported, “The [medical history] could be difficult for an adoption agency to interpret… No physician could ever guarantee that a patient is cured, even after the 5-year remission gold standard.”2
Life expectancy Long-term survivorship was often an important consideration for allowing a cancer survivor to adopt; some agencies wanted assurances of a normal life expectancy.