日本生殖心理学会誌 Vol.4, No.2, 12-19, 2018

ー原著論文ーA study of the criteria for young cancer survivors to
become foster or adoptive parents in Japan
本邦におけるがんサバイバーに対する里親制度・特別養子縁組制度の実態調査

Kouhei Sugimoto1）, Rie Anami2）, Eriko Shiraishi3）,
Yodo Sugisita4）, Nao Suzuki4）
杉本 公平１）、阿南 里恵２）、白石 絵莉子３）、杉下 陽堂４）、鈴木 直４）
1）Reproduction center, Dokkyo Medical University Saitama Medical Center１）獨協医科大学 埼玉医療センター
2）NPO Japan Society for Fertility Preservation（JSFP）
２）日本がん・生殖医療学会
3）Department of Obstetrics and Gynecology, The Jikei University School of Medicine
３）東京慈恵会医科大学 産婦人科
4）Department of Obstetrics and Gynecology, St. Marianna University School of Medicine
４）聖マリアンナ医科大学 産婦人科学

Abstract:
Purpose: To elucidate the criteria for young cancer survivors to become foster parents or adoptive
parents by activities of child guidance offices and adoption agencies in Japan.
Methods: We conducted a questionnaire survey on 69 child guidance offices and 18 adoption agencies
to determine the criteria for young cancer survivors to become foster parents or adoptive parents.
Results: Child guidance offices and adoption agencies emphasized that the foster care and adoption
systems are designed in the best interest of the children involved; however, some had positive opinions
about cancer survivors becoming foster or adoptive parents because of their life experience. They
indicated that the health status of cancer survivors receiving treatment, in the follow-up period after
treatment or in remission, should be considered on an individual basis based on their medical
certificate, and they expected to cooperate with healthcare providers.
Conclusion: This study showed child guidance offices and adoption agencies were not negative about
cancer survivors becoming foster parents or adoptive parents. However, we consider that a gap still
exists between healthcare providers and child guidance offices/adoption agencies in terms ofpossibility of cancer recurrence over the long-term. Therefore, we should immediately establish acooperation system between these groups to share recognition of cancer risks. Cooperation with The
Foster Parent Association as well as cancer survivors may also be required.
Key words: oncofertility, fertility preservation, foster parent, adoption, survivor
要 旨： 本研究の目的は本邦における児童相談所や特別養子縁組団体を介して若年がんサバイバーが里親・養親になる基準を明らかにすることである。我々は 69 の都道府県及び政令指定都市の児童相談所管轄部署と 18 の特別養子縁組団体に対して若年がんサバイバーが里親・養親になる基準についてアンケート調査を行った。両者とも里親制度・特別養子縁組制度とも児の福祉に最も配慮していることを強調していた。しかしながら、がんサバイバーが里親・養親になることに対して、その人生経験ゆえに肯定的な考えを持つ者もいた。両者は、治療中、経過観察中、あるいは完解後であってもがんサバイバーの健康状態が医師の診断書に基づいて個別的に考慮されるべきであると考えていることが示され、医療者との連携を望んでいた。本研究では児童相談所と特別養子縁組団体はがんサバイバーが里親・養親になることに対して否定的ではないことを明らかにした。しかしながら、医療者と両者の間には長期にわたるがんの再発に対する認識のギャップが存在すると考えられた。それゆえに我々は早急に医療者と児童相談所及び特別養子縁組団
体との連携を構築し、がんに対する認識を共有しなくてはならない。また、がんサバイバーそして里親団

12

受付日：2018 年 8月10日／受理日：2018 年 10月31日
著者連絡先：杉本 公平
獨協医科大学埼玉医療センター：〒343-8555 埼玉県越谷市南越谷2–１–50
電話：048-965-1111 E-mail：ksjog93@gmail.com

Kouhei Sugimoto.etc

体との連携も必要であるかもしれないと考えられた。
キーワード：がん・生殖医療、妊孕性温存、里親制度、特別養子縁組制度、がんサバイバー

Introduction

The objective of this study was to elucidate thecriteria necessary for young cancer survivors to

T he development of c a nc er t re at ment a nd

become foster parents and adoptive parents byreproductive medicine has allowed oncofertility toactivities of child guidance offices and adoption

advance rapidly; therefore, the possibility of cancer

agencies in Japan.

survivors having their own children is increasing.
Donnez et al1）. reported the first case of live birthMaterials and Methods

after cryopreservation of ovarian tissue in 2004.
Wood r u ff 2） coi ned the ter m“oncofer tility”to

We researched the criteria for young cancer

describe the merging of the two fields of oncology

survivors to become foster parents and adoptive

and fertility, and she established a worldwide

parents at 69 child guidance offices and 18 adoption

network for fertility preservation treatment in 2006.

agencies in Japan using a questionnaire. Completed

Globally, about 100 children have been born by thequestionnaires were returned and informed consent

method of cryopreservation of ovarian tissue3）.

was provided. We compared the results of the

However, not all cancer survivors are eligible toquestionnaire between child guidance offices andreceive fertility preservation treatment, and not all

adoption agencies with the chi-square test, and wecancer survivors who receive this treatment are able

judged that there was a significant difference whento conceive. Ito et al . reported that the expected

the P value was less than 0.05.

4）

live-birth rate of cancer survivors receiving oocyte
pick-up for embryo cryopreservation was 66%,
meaning that one in every three cancer survivors

Questionnaire contents
The questionnaire consisted of the following eightcannot have a child. They concluded that decisionitems:

trees for oncofertility care might need to be adapted

Q1. Number of accepted foster parents and adoptive

simultaneously along with improvements to theparents in the last year.

social environment, such as greater support for
adoption, in order for cancer survivors to feel securein their decisions4）.
The foster care system and adoption are usefulmeans for young cancer sur vivors who desire
children but lack fertility due to cancer treatment.

Q2. What are the criteria for selecting foster parents
and adoptive parents? Choice options were as
follows:
1. Anybody with chronic diseases is not accepted
as foster parents or adoptive parents.

Cancer survivors often feel conflicted about the

2. Anybody who is not limited in activities of daily

responsibility of being a parent because theyliving with chronic diseases can be accepted as

feel inferiority complex due to their diseases.

foster parents or adoptive parents.

Child guidance offices and adoption agencies are

3. Anybody who is partially limited in activities ofmanaging the foster care and adoption systems anddaily living with chronic diseases is accepted as

taking considerable interest in the health status of

foster parents or adoptive parents.

the foster parents and adoptive parents. However,

4. Others

there are no standardized criteria for the healthstatus of foster parents and adoptive parents. The

Q3. Do you accept young cancer patients receivinglack of criteria may result in confusion over whether

cancer treatment to become foster parents orsomeone is fit to become a foster or adoptive parent.

adoptive parents? Choice options were as follows:

We should work to solve this problem in cooperation

1. Anybody who is receiving cancer treatment with

with child guidance offices and adoption agencies.

any cancer and any stage is not accepted as

13

A study of the criteria for young cancer survivors to become foster or adoptive parents in Japanfoster parents or adoptive parents.
2. Anybody who is receiving cancer treatment
is considered as foster parents or adoptive
parents, depending on the type of cancer andthe degree of stage.
3. Anybody who is receiving cancer treatment
is considered as foster parents or adoptive
parents, based on the medical certificate.

daily living with a cancer history is considered
as foster parents or adoptive parents byconsulting with him or her.
5. Anybody who is partially limited in activities ofdaily living with a cancer history is considered
as foster parents or adoptive parents, based on
the medical certificate.
6. Others

4. Others
Q6. Will you use a consultation service to determine
Q4. Do you accept young cancer survivors under

the health status of potential foster parents orfollow-up after cancer treatment to become foster

adoptive parents through the Japan Society forparents or adoptive parents? Choice options wereFertility Preservation（JSFP）when it becomes

as follows:

available in the future? Choice options were as

1. Anybody who is in the follow-up duration is notfollows:

accepted as foster parents or adoptive parents

1. No, I won’t.

due to the risk of recurrence.

2. Yes, I will in some cases.

2. Anybody who is not limited in activities of daily

3. Yes, I will in all cases.

living in the follow-up period is accepted as
foster parents or adoptive parents.

Q7. Will you attend public lectures on the foster care

3. Anybody who is in the follow-up period issystem and adoption for young cancer survivors

considered as foster parents or adoptive

organized by the JSFP? Choice options were as

parents, based on the medical certificate due tofollows:

the risk of recurrence.

1. Yes, definitely.

4. Anybody who is partially limited in activities

2. Yes, if possible.

of daily living in the follow-up duration is

3. No.

considered as foster parents or adoptive parents

4. I can’t attend, although I wish I could.

by consulting with him or her.
5. Anybody who is partially limited in activities ofdaily living in the follow-up period is considered
as foster parents or adoptive parents, based on

Multiple responses were allowed for Q3-Q5.
Q8. Do you have any other comments?（Free
Description Responses）

the medical certificate.
6. Others

Ethical Considerations
We conducted this questionnaire sur vey in

Q5. Do you accept young cancer survivors in remission

accordance with the ethical code of the ethicalafter cancer treatment to become foster parents orcommittee in Dokkyo Medical University Saitama

adoptive parents? Choice options were as follows:

Medical Center.

1. Anybody who has a cancer history is not
accepted as foster parents or adoptive parents,

Resultseven if healthy now.
2. Anybody who is not limited in activities of daily

The overall response rate of the questionnaireliving with a cancer history is accepted as foster

was 76%（66/87）and, more specifically, 77%（53/69）

parents or adoptive parents.

for child g uidance offices and 72%（13/18）for

3. Anybody who is not limited in activities ofadoption agencies, respectively. The average

daily living with a cancer history is accepted as

number of accepted foster parents or adoptive

foster parents or adoptive parents, based on theparents in the last year was 28 and 10 cases,

medical certificate.

respectively.

4. Anybody who is partially limited in activities of

14

Regarding criteria for accepting foster parents orFigure 1

Kouhei Sugimoto.etc

Child guidance office ％（n）％
Adoption agency ％（n）
0（0）

0（0）

20（3）

25（14）

27（4）

31（17）

53（8）44（24）

Figure 2

1

2

3

4

1

2

3

4

Figure 1   Responses to“Q2. What are the criteria for selecting foster parents andadoptive parents?”
None of the respondents chose option 1.

Child guidance office ％（n）

Adoption agency ％（n）
6（1）

8（5）※

25（4）※

22（14）
31（5）
46（29）
24（15）

38（6）※ P ＝ 0.08 chi square test
1

2

3

4

1

2

3

4

Figure 2   Responses to“Q3. Do you accept young cancer patients receiving cancer
treatment to become foster parents or adoptive parents.”
Fifteen% of the respondents（8% of child guidance offices, 27% of adoptive agencies）
indicated that they did not accept cancer survivors receiving cancer treatment as foster
parents or adoptive parents; the incidence of this response tended to be higher in adoption
agencies（P=0.08）.

adoptive parents（Figure1）, no respondent indicatedcancer treatment（Figure2）, respondents indicatedthat those with chronic diseases are not acceptedthat those receiving treatment for any type ofas foster parents or adoptive parents and that only

cancer at any stage are generally not accepted as

those without limitations, even partial limitations,foster parents or adoptive parents. However, thosein activities of daily living can be accepted asreceiving cancer treatment can be considered as

foster parents or adoptive parents. No one chose

foster parents or adoptive parents based on theiroption 1, and most people chose option 3 regarding

medical certificate. Fifteen% of the respondents

the criteria for accepting foster parents or adoptive（8% of child guidance offices, 27% of adoption

parents.

agencies）indicated they did not accept cancer

Regarding young cancer patients receiving

patients receiving cancer treatment as foster

15

Figure 3
A study of the criteria for young cancer survivors to become foster or adoptive parents in Japan

Child guidance office ％（n）

Adoption agency ％（n）
0（0）
5（1）
0（0）

2（1）
5（3）
12（8）※

30（6）※
25（16）
30（6）18（12）

38（25）
35（7）※ P ＝ 0.08chi square test

1

2

3

4

5

6

1

2

3

4

5

6

Figure 4

Figure 3   Responses to“Q4. Do you accept young cancer survivors in the follow-up
period after cancer treatment to become foster parents or adoptive parents?”
Only one child guidance office（2%）chose option 1, and three（5%）chose option 2.

Child guidance office ％（n）
0（0）

Adoption agency ％（n）
4（1）

4（1）

0（0）

13（9）

21（15）

25（6）

29（7）

20（14）
14（10）
38（9）31（22）

1

2

3

4

5

6

1

2

3

4

5

6

Figure 4    Responses to“Q5. Do you accept young cancer survivors in remission aftercancer treatment to become foster parents or adoptive parents?”
Eleven% （nine child guidance offices（13%）; one（4%）adoption agency（4%））chose option 2.

parents or adoptive parents, and the incidence

Those without limitations in activities of dailyof such response tended to be higher in adoption

living in the follow-up period can be accepted asagencies（P=0.08）. Most respondents consider that

foster parents or adoptive parents based on their

the individual health status of a cancer patient

medical certificate. Those with partial limitations

receiv ing treatment should be based on theirin activities of daily living during the follow-

medical certificate.

up period can be considered as foster parents

Reg a r d i ng you ng c a nc e r s u r v ivor s i n t hefollow-up period after cancer treatment（Figure3）,

16

or adoptive parents based on both their medical
certificate and individual consultation.

respondents indicated that those in such a period

Only one child guidance office（2%）chose option

are generally not accepted as foster parents or

1, and three child guidance office（5%）chose option

adoptive parents due to the risk of recurrence.

2. Many respondents indicated that they should

Kouhei Sugimoto.etc

consider the health status of individual cancer
patients receiving treatment based on their medical
certificate. The incidence of choice of option 3
tended to be higher in adoption agencies（P=0.08）.
Regarding young cancer survivors in remission
after cancer treatment（Figure4）, respondents
indicated that those with a cancer history are
generally not accepted as foster parents or adoptive
parents, even if they are healthy at the time of

Table 1   Will you use a consultation service to determine
the health status of potential foster parents or
adoptive parents through the Japan Society for
Fertility Preservation（JSFP）when it becomes
available in the future?
Q6

Child guidance office, %（n）Adoption agency, %（n）

1

8%（4）

0%（0）

2

92%（45）91%（10）

3

0%（0）

9%（1）

application. Those with a history of cancer without
limitations in activities of daily living can be
accepted as foster parents or adoptive parents basedon their medical certificate. Those with partial

Table 2   Will you attend public lectures on the foster
care system and adoption for young cancer
survivors organized by the JSFP?

limitations in activities of daily living with a cancer

Q7

history can be considered as foster parents or
adoptive parents based on their medical certificate
and individual consultation. Eleven %（nine（13%）

3

0%（0）

0%（0）

child guidance offices, one（4%）adoption agency）

4

85%（39）18%（2）

Child guidance office, %（n）Adoption agency, %（n）

1

0%（0）

18%（2）

2

15%（7）

64%（7）

chose option 2; however, more than half indicatedthat they should consider the health status ofindividual cancer survivors receiving treatment
based on their medical certificate.

Discussion
The child guidance offices and adoption agencies

Regarding the use of the JSFP consultation

participated in this study emphasized that the foster

services to determine the health status of foster

care and adoption systems are designed so as to serve

parents or adoptive parents（Table1）, only 8%（fourthe best benefit of the children involved. However,child guidance offices）responded that they would

some had positive opinions about cancer survivors

not use such services. Almost all respondents（92%,

becoming foster or adoptive parents because of theirchild guidance offices, all adoption agencies）

life experience. They indicated that they should

expected to use the JSFP consultation services

consider the health status of individual cancer

when they become available.

patients receiving treatment, during the follow-up

As for public lectures on the foster care system

period and after treatment based on their medical

and adoption for young cancer survivors organizedcertificate. They also expected to cooperate withby the JSFP
（Table2）, 17% of the respondents（sevenhealthcare providers in helping cancer survivors（15%）child guidance offices, nine（82%）adoption

to become foster or adoptive parents. However, we

agencies）, mainly near Tokyo, showed an interest

consider that healthcare providers do not completely

in attending the lectures. None of the respondents

agree that cancer survivors become foster or adoptive

answered that they would not attend.

parents, and also consider that a gap exists between

Comments from the free description indicatedhealthcare providers and child guidance office/that some respondents worried about children who

adoption agencies in terms of the possibility ofmight re-experience the loss of their parents if thecancer recurrence over the long-term. To bridge thisfoster or adoptive parents would die soon aftergap, first, healthcare providers should try to shareplacement. However, they did not want to refuse

the recognition of cancer risks with child guidancecancer survivors as foster parents or adoptive

offices/adoption agencies. Since the outcomes andp a rent s a nd t hey ex p e ctd to co op erate w it hrecurrence rates of cancers are expected to continually

healthcare providers. Some respondents mentioned

improve through the development of medicine, thethat they had positive opi n ions about cancer

circumstances for each individual cancer survivor willsurvivors being foster or adoptive parents due tobe different. Although both child guidance offices andtheir life experience.

adoption agencies indicated that they should consider

17

A study of the criteria for young cancer survivors to become foster or adoptive parents in Japanthe cancer survivor’s eligibility to become a foster

survivors as foster parents or adoptive parents. We

or adoptive parent on an individual basis, adoption

should examine how the results of this study would

agencies might be a little more cautious about that.

influence cancer survivors by sharing the results withAll adoption agencies expected to use the JSFP

them. In addition, we should cooperate with cancer

consultation services in the future; however, five childsurvivors and The Foster Parent Association as well

guidance offices did not. Healthcare providers mightas child guidance offices and adoption agencies. Since

have to support adoption agencies more strongly.

foster care and adoption are not popular yet in Japan,

Gorman 5） observed a two-fold higher interestin adoption among cancer sur vivors than the

support from The Foster Parent Association might beneeded.

general population, and found that adoption was

In conclusion, this study showed that childa consideration for many young women who haveguidance offices and adoption agencies in Japan are

survived cancer. In their report of findings fromnot negative about that cancer survivors become fostera learning activity for oncology nurses, Quinn etparents or adoptive parents. However, we consideral 6）. found that adoption agencies had reported

a gap still exists between healthcare providers andthat mothers after delivery might feel confident inchild guidance offices/adoption agencies in terms

choosing a parent who had overcome hardships andof the possibility of cancer recurrence over the long-

had an appreciation for life to adopt ---their child.

term. Therefore, we should immediately establish a

However, Rosen concluded that cancer patients

cooperation system between healthcare providers

lack access to information about adoption and may

and child guidance offices/adoption agencies toface discrimination in domestic and international

share the recognition of cancer risks. Establishing

adoption. Gardino et al8）. discussed the implications

cooperation with The Foster Parent Association asof discrimination in the adoption system carrying

well as cancer survivors may also be necessary. The

over into cancer patient clinical care. They concluded

JSFP should have an important and leadership rolethat fertility preservation technologies might provide

in the enlightenment of the cooperation with healthcancer patients with a back-up option in the face ofcare providers and child guidance offices/adoption

uncertain adoption outcomes . The Oncofertility

agencies, and so they should set up the consultation

Consortium has helped tackle adoption issues forservice system evaluating the health status of thecancer survivors and there are now 11 cancer-friendly

foster parents or the adoptive parents.

7）8）adoption agencies in the United States9）.
Our study showed that child guidance offices
and adoption agencies in Japan are cancer patient

Acknowledgment

friendly, although it is yet common for cancer

We would like to thank Yasunori Yoshimura M.D.,

survivors to become foster and adoptive parents.

Ph.D., Professor Emeritus at Keio University, for being

Cooperation between health care providers anda great mentor. This study was supported by Healthchild guidance offices/adoption agencies would help

Science Research Grant from The Ministry of Healthincrease the spread of cancer survivors as foster

Labour and Welfare Award Number H29-31-008.

and adoptive parents. On the other hand, healthcare
providers including reproductive endocrinology andinfertility doctors have not taken interest in the foster
care system and adoption for infertility patients as

Author Disclosure Statement
No competing financial interests exist.

well as for cancer survivors. The JSFP should have an
important and leadership role in the enlightenment of
the cooperation with health care providers and childguidance offices/adoption agencies.
It was difficult to accurately determine the actual
opinions of the study participants. This is because
many respondents chose multiple answers indicatingthat they were very careful in accepting cancer

18

References
1） Donnez J, Dolmans MM, Demylle D, et al. Livebirth after
orthotopic transplantation of cryopreserved ovariantissue. Lancet. 2004; 364: 1405-10.
2） Woodruff TK. The emergence of a new interdiscipline:
oncofertility. Cancer Treat Res. 2007; 138: 3-11.

Kouhei Sugimoto.etc

3） Jensen AK, Macklon KT, Fedder J, et al. 86 successful
births and 9 ongoing pregnancies worldwide in womentransplanted with frozen-thawed ovarian tissue: focus
on birth and perinatal outcome in 40 of these children. J
Assist Reprod Genet. 2017; 34: 337.
4） Ito Y, Shiraishi E, Kato A, et al. The Utility of Decision
Trees in Oncofertility Care in Japan. J Adolesc Young
Adult Oncol. 2017; 6: 186-189.
5） Gorman JR, Whitcomb BW, Standridge D, et al. Adoption
consideration and concerns among young adult female
cancer survivors. J Cancer Surviv. 2017; 11: 149-157.
6） Quinn GP, Zebrack BJ, Sehovic I, et al. Adoption andcancer survivors: Findings from a learning activity foroncology nurses. Cancer. 2015; 121: 2993-3000.

7） Rosen A. Third-party reproduction and adoption in cancer
patients. J Natl Cancer Inst Monogr. 2005; 34: 91-93.
8） Gardino SL, Russell AE, Woodruff TK. Adoption aftercancer: Adoption agency attitudes and perspectives on thepotential to parent post-cancer. Cancer Treat Res. 2010;
156: 153-170.
9） Women’s Health Research Institute. Cancer Survivors andAdoption; 2010. Accessed January 19, 2018 from: https://w w w.womenshealth.nor thwester n.edu / blog/cancersurvivors-and-adoption

19