Challenges in the care of Ewing’s sarcoma in a Jehovah’s Witness patient

Carlos Julio Vargas-Potes, Diana Marcela Mendoza-Urbano, Luis Gabriel Parra-Lara , Ángela R. Zambrano, .

Keywords: sarcoma, Ewing, drug therapy, anemia, blood component transfusion

Abstract

Ewing’s sarcoma is a bone and soft tissue neoplasm, whose management is related to hematological toxicity. This aspect represents a medical and ethical challenge in Jehovah’s Witnesses patients, who, due to their religious beliefs, reject the blood component transfusion, with the risk of discontinuing chemotherapy or using suboptimal doses.
We present the case of a 34-year-old Colombian woman, Jehovah’s Witness, diagnosed with Ewing’s sarcoma with clinical stage IIB (T1N0M0) in the left maxillary and mandibular regions, treated with chemotherapy, who presented a hemoglobin nadir of up to 4.5 g/dL, and surgical indication as part of the treatment. In these patients, the transfusion decision has ethical implications that require therapeutic alternatives and a multidisciplinary approach.

Downloads

Download data is not yet available.

References

Grünewald TG, Cidre-Aranaz F, Surdez D, Tomazou EM, de Álava E, Kovar H, et al. Ewing sarcoma. Nat Rev Dis Prim. 2018;4:5. https://doi.org/10.1038/s41572-018-0003-x

National Cancer Institute, SEER Program. Malignant bone tumors. In: Ries L, Smith M, Gurney J, Linet M, Tamra T, Young J, et al., editors. Cancer incidence and survival among children and adolescents: United States SEER Program 1975-1995. Bethesda, MD: National Institutes of Health; 1999. p. 99-110. Accessed: February 20, 2023. Available from: https://seer.cancer.gov/archive/publications/childhood/childhood-monograph.pdf

Esiashvili N, Goodman M, Marcus RBJ. Changes in incidence and survival of Ewing sarcoma patients over the past 3 decades: Surveillance epidemiology and end results data. J Pediatr Hematol Oncol. 2008;30:425-30. https://doi.org/10.1097/MPH.0b013e31816e22f3

Anderton J, Moroz V, Marec-Bérard P, Gaspar N, Laurence V, Martín-Broto J, et al. International randomised controlled trial for the treatment of newly diagnosed Ewing sarcoma family of tumours - EURO EWING 2012 Protocol. Trials. 2020;21:96. https://doi.org/10.1186/s13063-019-4026-8

Chang Lee R, Sukumaran S, Koczwara B, Woodman R, Kichenadasse G, Roy A, et al. Patterns of care in Jehovah’s Witnesses patients with solid tumours and lymphoma. Cancer reports (Hoboken). 2019;2:e1148. https://doi.org/10.1002/cnr2.1148

Jonsen AR, Siegler M, Winslade WJ. Contextual Features. Clinical ethics: A practical approach to ethical decisions in clinical medicine. 9th edition. New York, NY: McGraw-Hill Education; 2022. Accessed: February 20, 2023. Available from: http://accessmedicine.mhmedical.com/content.aspx?aid=1186991592

Boyle JM, Novak D. Religious and cultural perspectives in bioethics. In: Viens AM, Singer PA, editors. The Cambridge Textbook of Bioethics. Cambridge: Cambridge University Press; 2008. p. 377-8. Accessed: February 20, 2023. Available from: https://www.cambridge.org/core/books/cambridge-textbook-of-bioethics/religious-and-cultural-perspectives-in-bioethics/2EFEAB3A368098EC5D98436146EB8651

Fonseca M, Cuichan MV. Testigos de Jehová: un desafio transfusional médico y quirúrgico. Mediciencias UTA. 2020;4:30-9. https://doi.org/10.31243/mdc.uta.v4i2.354.2020

Besio M, Besio F. Testigos de Jehová y transfusión sanguínea: reflexión desde una ética natural. Rev Chil Obstet Ginecol. 2006;71:274-9. https://doi.org/10.4067/S0717-75262006000400010

Muramoto O. Bioethical aspects of the recent changes in the policy of refusal of blood by Jehovah’s Witnesses. Br Med J. 2001;322:37-9. https://doi.org/10.1136/bmj.322.7277.37

Rourke E. Blood relations. N Engl J Med. 2019;380:2292-3. https://doi.org/10.1056/NEJMp1901351

Petrini C. Ethical and legal aspects of refusal of blood transfusions by Jehovah’s Witnesses, with particular reference to Italy. Blood Transfus. 2014;12(Suppl.1):s395-401. https://doi.org/10.2450/2013.0017-13

Beauchamp TL, Childress JF. Principles of biomedical ethics. New York: Oxford University Press; 2001.

Rodríguez-Osorio CA, Domínguez-Cherit G. Medical decision making: Paternalism versus patient-centered (autonomous) care. Curr Opin Crit Care. 2008;14:708-13. https://doi.org/10.1097/MCC.0b013e328315a611

Whaley JT, Indelicato DJ, Morris CG, Hinerman RW, Amdur RJ, Mendenhall WM, et al. Ewing tumors of the head and neck. Am J Clin Oncol. 2010;33:321-6. https://doi.org/10.1097/COC.0b013e3181aaca71

Oh SY, Kim S-H, Kwon H-C, Lee S, Kim KH, Kwon KA, et al. Bloodless cancer treatment results of patients who do not want blood transfusion: Single center experience of 77 cases. Support Care Cancer. 2010;18:1341-6. https://doi.org/10.1007/s00520-009-0759-3

Womer RB, West DC, Krailo MD, Dickman PS, Pawel BR, Grier HE, et al. Randomized controlled trial of interval-compressed chemotherapy for the treatment of localized Ewing sarcoma: A report from the Children’s Oncology Group. J Clin Oncol. 2012;30:4148-54. https://doi.org/10.1200/JCO.2011.41.5703

Whelan J, Khan A, Sharma A, Rothermundt C, Dileo P, Michelagnoli M, et al. Interval compressed vincristine, doxorubicin, cyclophosphamide alternating with ifosfamide, etoposide in patients with advanced Ewing’s and other small round cell sarcomas. Clin Sarcoma Res. 2012;2:12. https://doi.org/10.1186/2045-3329-2-12

van Mater D, Wagner L. Management of recurrent Ewing sarcoma: Challenges and approaches. Onco Targets Ther. 2019;12:2279-88. https://doi.org/10.2147/OTT.S170585

Shah MD, Goldstein DP, McCluskey SA, Miles BA, Hofer SO, Brown DH, et al. Blood transfusion prediction in patients undergoing major head and neck surgery with free-flap reconstruction. Arch Otolaryngol Head Neck Surg. 2010;136:1199-204. https://doi.org/10.1001/archoto.2010.202

Wirtz NE, Khariwala SS. Should more conservative blood transfusion thresholds be adopted in head and neck surgery? Laryngoscope. 2017;127:1733-4. https://doi.org/10.1002/lary.26560

Nguyen A, Shin H, Saint-Cyr M, Verheyden C. Blood loss and transfusion rates in microsurgical head and neck reconstruction. Plast Reconstr Surgery Glob Open. 2018;6:e1988. https://doi.org/10.1097/GOX.0000000000001988

Shander A, Goodnough LT. Management of anemia in patients who decline blood transfusion. Am J Hematol. 2018;93:1183-91. https://doi.org/10.1002/ajh.25167

Lawson T, Ralph C. Perioperative Jehovah’s Witnesses: A review. Br J Anaesth. 2015;115:676-87. https://doi.org/10.1093/bja/aev161

Panico ML, Jenq GY, Brewster UC. When a patient refuses life-saving care: issues raised when treating a Jehovah’s Witness. Am J Kidney Dis. 2011;58:647-53. https://doi.org/10.1053/j.ajkd.2011.05.030

How to Cite
1.
Vargas-Potes CJ, Mendoza-Urbano DM, Parra-Lara LG, Zambrano Ángela R. Challenges in the care of Ewing’s sarcoma in a Jehovah’s Witness patient. biomedica [Internet]. 2023 Mar. 30 [cited 2024 Jul. 22];43(1):44-50. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/6720

Some similar items:

Published
2023-03-30
Section
Case presentation

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
Crossref Cited-by logo
QR Code