The experiences of patients with oesophageal cancer receiving chemoradiotherapy treatment: a qualitative study embedded in the SCOPE2 trial

Objectives: This qualitative study explored patients’ experiences and perceptions of the SCOPE2 trial. SCOPE2 examined radiotherapy dose escalation in patients with inoperable oesophageal cancer treated with definitive chemoradiotherapy (dCRT). Setting: Recruitment at five clinical sites in England and Wales, UK. Participants: SCOPE2 trial participants were invited to take part in interviews from across five clinical sites. Participants self-selected to take part in up to three interviews across four different time points: baseline (before treatment) and at 2–3 months, 3–6 months or 6 months+ after baseline. There were five female and five male interview participants. Interventions: Participants were randomised to standard dose dCRT prescribed carboplatin/paclitaxel or cisplatin/capecitabine, or an escalated dose dCRT prescribed carboplatin/paclitaxel or cisplatin/capecitabine. Methods: This qualitative study used semistructured longitudinal interviews to explore the impact of treatment on patient outlook and quality of life and the impact of the COVID-19 pandemic. Interview data were thematically analysed. Results: 10 patients participated in 16 longitudinal interviews. Three participants were accompanied by companions. Participants experienced side-effects from radiotherapy and chemotherapy including nausea, throat pain, difficulties eating and regaining appetite, thrombosis and fatigue, although most of these symptoms gradually improved. Participants required more ongoing information and support regarding treatment side-effects and cancer status in order to improve their overall quality of life. Best practice examples involved key contacts providing practical advice and signposting support. Conclusion: Participants of the SCOPE2 trial reported short and longer-term side-effects from chemoradiotherapy, but these usually lessened over time. Participants attempted to be positive about their survival prospects by readjusting their expectations, priorities and lifestyles. Providing patients with ongoing opportunities to discuss detailed and timely information regarding treatment side-effects, aftercare and cancer status could improve the overall health and well-being of patients during oesophageal cancer trials and pathways. Trial registration number: NCT02741856; ISRCTN: 97125464

• Oh I. C.: A Retrospective Analysis for the use of ICARs in Long-Term Care Facilities

Background: From 03/01/2020-03/01/2022, 171 COVID-19 outbreaks were reported to Cobb & Douglas Public Health for the long-term care facility setting (LTCFs). Follow up was conducted by the district epidemiologists to identity the suspected source of exposure for residents and staff. Throughout the course of the pandemic, these settings have been experiencing continued spread and numerous COVID-19 outbreaks. Over time, the evolving recommendations from the Centers of Disease Control and Prevention (CDC) influenced the state-level guidance for The Georgia Department of Public Health (DPH), to include the creation of a dedicated guidance document for LTCFs. ICARs were implemented as part of this guidance on a voluntary basis. Methods: A query was conducted in the Outbreak Log for the GA Department of Public Health (DPH) State Electronic Notifiable Disease Surveillance System (SENDSS). ICARs were reviewed for pertinent information concerning gaps identified for infection control and needed recommendations given. Results or anticipated results: The anticipated results are that the use of ICARs had a positive effect on the outcome of COVID-19 long-term care facility outbreaks, reducing the spread of illness and multiple forthcoming outbreaks. Conclusion: Infection control is a pertinent aspect of public health outbreak investigations and the day-to-day process for long-term care facilities. ICARs can be a beneficial asset for all parties involved if recommendations are implemented. Public health professionals and community partners can make use of infection control resources for the betterment of the residents and staff

Implementation of preemptive DNA sequence–based pharmacogenomics testing across a large academic medical center: The Mayo-Baylor RIGHT 10K Study

The Mayo-Baylor RIGHT 10K Study enabled preemptive, sequence-based pharmacogenomics (PGx)-driven drug prescribing practices in routine clinical care within a large cohort. We also generated the tools and resources necessary for clinical PGx implementation and identified challenges that need to be overcome. Furthermore, we measured the frequency of both common genetic variation for which clinical guidelines already exist and rare variation that could be detected by DNA sequencing, rather than genotyping.Targeted oligonucleotide-capture sequencing of 77 pharmacogenes was performed using DNA from 10,077 consented Mayo Clinic Biobank volunteers. The resulting predicted drug response–related phenotypes for 13 genes, including CYP2D6 and HLA, affecting 21 drug–gene pairs, were deposited preemptively in the Mayo electronic health record.For the 13 pharmacogenes of interest, the genomes of 79% of participants carried clinically actionable variants in 3 or more genes, and DNA sequencing identified an average of 3.3 additional conservatively predicted deleterious variants that would not have been evident using genotyping.Implementation of preemptive rather than reactive and sequence-based rather than genotype-based PGx prescribing revealed nearly universal patient applicability and required integrated institution-wide resources to fully realize individualized drug therapy and to show more efficient use of health care resources