The Adoption Option

CURE, Summer 2014, Volume 13, Issue 2

Building a family after cancer treatment can be a productive challenge.

If Emily Beck hadn’t consulted a fertility specialist, many more months might have passed before she learned about the 10-centimeter tumor in one of her ovaries.

At the time, the 35-year-old Philadelphia attorney and her husband had been trying to get pregnant for more than a year when they sought help from a physician and underwent the related tests. A vaginal ultrasound in November 2007 identified a malignancy, leading to removal of her cancerous ovary and fallopian tube, followed by six cycles of paclitaxel and cisplatin over the course of 18 weeks.

Initially, Beck held on to hope that she could still one day bear her own child, and her doctor left her uterus and other ovary intact pending the outcome of further tests. When the pathologist confirmed stage 3 ovarian cancer, as well as stage 1 endometrial cancer, Beck underwent a second surgery to remove her remaining ovary and uterus. Given the severity of her diagnosis, time was scarce and steps such as freezing embryos were simply off the table, she says.

“There was no longer any pretense that I might be able to become pregnant and have my own biological child,” she says. “That’s when the first wave of that mourning process began.”

Beck, now 41, describes those bleak days during a rare window of quiet. Her 2-year-old son, Earl, naps nearby, likely dreaming of trains and the melodies of “Yellow Submarine,” his Beatles fixation of the moment. “He’s insanely gorgeous,” she says, her laughter bubbling up. “We have serious problems.”

For some patients, a cancer diagnosis might close off the option of one day conceiving a child, because of the surgery, drugs and other treatments involved. Choosing adoption is another path to parenthood, one that can be relatively easy—or filled with hurdles—depending on the agency and its policies and how the survivor’s future is described by the oncologist.

Beck’s journey to motherhood was fairly straightforward, due in large part to a supportive adoption agency. But her story is by no means universal. Some survivors encounter additional layers of resistance and complexity as they strive to convince agencies or other adoption facilitators that they’re well-suited—and healthy enough—to provide a good, long-term home for a child.

Northwestern University’s Oncofertility Consortium conducted a survey of adoption agencies and created an online list of roughly a dozen “cancerfriendly” agencies, after survivors reported “a lot of hurdles” in the adoption process, says Teresa Woodruff, a researcher and the consortium’s director. In some cases, women would be rejected outright based on their cancer histories. “I was quite shocked by that,” she says.

As with any adoption, there are no guarantees, and the agency might have requirements, such as a doctor’s letter, Woodruff says. “But at least there would be no barrier to walking in the door.”

Regardless of medical circumstances, adoption can be a costly and time-consuming process. Nearly twothirds of domestic adoptions involving a newborn take at least six months and cost an average of about $35,000 to $40,000, according to a 2012-2013 survey of more than 1,100 families conducted by Adoptive Families magazine.

International adoptions cost at least as much, and the process can take a few years, depending on the country. Moreover, they can be particularly difficult for cancer survivors because some countries have health-related restrictions, says Kris Faasse, director of adoption services at Bethany Christian Services, one of the agencies identified by the consortium as being receptive to cancer survivors.

Beck and her husband, Mike, first approached the Open Arms Adoption Network, which took her cancer history in stride. The agency’s director, Meredith Rose, estimates that the agency has worked with about 10 cancer survivors in recent years, typically requesting a letter from the individual’s doctor, as they would in any circumstances involving a medical or mental health condition, she says.

In their biographies, which are included in the adoption portfolio, cancer survivors are encouraged to reflect on how the diagnosis and treatment made them more resilient, as individuals and as a couple, Rose says. “I would say that many birth parents are drawn to [cancer survivors’ resilience]. It makes them feel even more comfortable that this family is strong, and they’ve weathered something so enormous, and they are so ready to be parents.”

But not all adoptive parents are so warmly embraced. At least one adoption agency states on its website that individuals must be cancer-free for five years before being considered for a domestic adoption. In addition, those pursuing adoption will sometimes complain that the requirements or restrictions aren’t explained, including within the same agency, says Kairol Rosenthal, author of Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s. “So, is it then just up to the person who is interviewing you? How are these decisions being made? There is so much uncertainty.”

Attitudes within adoption agencies do appear to be improving, as it’s better understood that many survivors can experience a full life span, says Kristin Smith, a patient navigator with the Oncofertility Consortium. But she also describes how an agency was dropped from the consortium’s list after it balked at working with a woman who previously had ovarian cancer.

Despite the fact that her oncologist had given the OK, “they felt like her life expectancy wasn’t what they had wanted,” Smith says. “This patient was devastated.”

Ensuring that a cancer survivor is prepared to become a parent is part of the screening process, just as it is with any applicant, Faasse says. Once an applicant’s doctor confirms that the cancer history doesn’t pose a parenting issue, the agency delves into other logistics, such as the couple’s plans for child care, access to health insurance, a broader support network and a contingency plan if the cancer should recur.

Also, given that the adoption agency is responsible for the child, all prospective parents are asked, regardless of their prior medical history: What would happen if you got sick?

Applicants who have recently finished cancer treatment need to be honest with themselves and the agency about their emotional and physical capacity, Faasse says. “I probably would ask them, ‘What will happen if you are picked tomorrow? Are you ready to raise a newborn? Do you have enough emotional reserves to really meet the needs of a child?’ ”

When Beck returned to work less than a month after finishing treatment, she threw herself into researching agencies and the adoption process. But, she now says, she gave herself “a colossal panic attack” and backed off, realizing that she was pushing herself too hard in her drive to resume her pre-cancer life plans. The couple put adoption on hold for two years.

Writing in her biography for the adoption, Beck didn’t mince words about that daunting stretch in 2008, briefly detailing her diagnosis, two surgeries and chemotherapy. “I lost my fertility, my hair, a good bit of weight and all sense of security,” she wrote. She also highlighted how the experience forged stronger connections with friends, within her, and led to new interests, such as rock climbing.

Fourteen months after the couple started working with Open Arms, the couple met at a local diner with the agency director, a social worker and a 19-year-old woman who was nine months pregnant. “She had not had an easy life by any stretch and was very wise and sensitive in a lot of ways,” Beck says. “She was a pretty keen young lady.”

The teen credited Beck’s cancer history, among other factors, for having brought them together that day, which was just nine days before Earl was born.

“She said, ‘I just feel like after everything you’ve been through, you really deserve this. You deserve to be happy,’ ” Beck recalls. “That’s when we all started crying. It’s really a moment I’ll never forget.”

Northwestern University’s Oncofertility Consortium wants to expand its list of adoption agencies that are receptive to working with cancer survivors. Contact them with suggestions at oncofertility@northwestern.edu.