ABSTRACT
Extramedullary hematopoiesis (EMH) is hematopoiesis occurring outside of the bone marrow. It has been reported to develop in abdominal organs or lymph nodes after chemotherapy. Here, the authors describe a patient with a localized central nervous system embryonal tumor who, during intensive chemotherapy, developed dural nodules. Biopsy revealed these nodules to be EMH. Without a pathologic diagnosis, this may have been considered disease progression, altering the patient's treatment plan. This report intends to serve as a reminder that EMH should be included in the differential diagnosis of suspicious lesions and highlights the importance of their biopsy because of potential management implications.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Central Nervous System Neoplasms/drug therapy , Dura Mater/pathology , Hematopoiesis, Extramedullary , Neoplasms, Germ Cell and Embryonal/drug therapy , Central Nervous System Neoplasms/pathology , Child, Preschool , Disease Progression , Dura Mater/drug effects , Humans , Male , Neoplasms, Germ Cell and Embryonal/pathology , PrognosisABSTRACT
OBJECTIVES: Head and neck cancers (HNC) are associated with significant morbidity. Quality-of-life (QoL) analyses can assist with understanding subjective factors shaping the patient experience. Here, we assess for patient and/or tumor factors associated with increased pain reporting at the time of initial radiation oncology consultation at a single institution in 2015. STUDY DESIGN: Prospective cross-sectional questionnaire research. METHODS: All new patient consultations in 2015 were offered the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core-30 (EORTC QLQ-C30) survey. HNC patients were also offered the EORTC QLQ-HN35 module. Retrospective chart review was performed on patients who completed the surveys. Patient demographics, tumor characteristics, and QoL responses were analyzed for potential associations. Statistical analyses were conducted using SAS v9.4 (SAS Institute, Cary, NC), with P < .05 considered significant. RESULTS: Of 771 new patient consultations, 137 consultations were for HNC patients. Of those, 62 patients completed both surveys. HNC patients reported greater pain relative to all other disease sites (odds ratio [OR]: 2.05; P < .01). On univariate analysis of the EORTC QLQ-C30 data, increased pain was found to be associated with tumor size > 4 cm (OR: 3.05; P ≤ .05). The EORTC QLQ-HN35 data revealed lymph node involvement to be independently associated with pain (OR: 3.12; P ≤ .05). On multivariate analysis, increased pain was associated with lack of pain medication prescription at the time of consultation (P ≤ .05) and age ≥ 65 years (P ≤ .05). CONCLUSION: Patients with HNC reported significantly more pain at consultation than patients with other primary malignancies. Understanding factors contributing to subjective pain may allow providers to potentially address these symptoms proactively to improve patients' QoL. LEVEL OF EVIDENCE: 2c - Outcomes research. Laryngoscope, 131:326-332, 2021.
Subject(s)
Cancer Pain/epidemiology , Head and Neck Neoplasms/psychology , Quality of Life , Radiation Oncology/statistics & numerical data , Referral and Consultation/statistics & numerical data , Adult , Aged , Aged, 80 and over , Cancer Pain/psychology , Cross-Sectional Studies , Female , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/radiotherapy , Humans , Male , Middle Aged , Multivariate Analysis , Pain Measurement , Prospective Studies , Retrospective Studies , Surveys and QuestionnairesABSTRACT
The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical and Translational Science Award Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: (1) managing multiple institutional roles and responsibilities, (2) managing sensitive information, and (3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services.
Subject(s)
Biomedical Research/ethics , Confidentiality/ethics , Ethics Consultation/ethics , Ethics, Research , Professional Practice/ethics , Research Personnel/ethics , Translational Research, Biomedical , Academic Medical Centers/ethics , Humans , MoralsABSTRACT
Research ethics consultation services are designed to help scientists address ethical and societal issues that may not be considered in the context of existing regulatory frameworks, such as institutional review boards. Here, we identify some types of biomedical research for which the research process can benefit from consultation with ethicists.
