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Transgender and gender diverse (TGD) people experience disparities in cancer care, including more late-stage diagnoses, worse cancer-related outcomes, and an increased number of unaddressed and more severe symptoms related to cancer and cancer-directed therapy. This article outlines plans to address the unique needs of TGD people through a TGD-focused oncology clinic. Such a clinic could be structured by upholding the following tenets: (1) champion a supportive, gender-affirming environment that seeks to continuously improve, (2) include a transdisciplinary team of specialists who are dedicated to TGD cancer care, and (3) initiate and embrace TGD-patient-centric research on health outcomes and health care delivery., Competing Interests: The authors report no competing interests., (© 2024 The Authors.)

Background: Older LGBTQIA+ patients face discrimination in healthcare and therefore are sometimes reluctant to engage and interact with healthcare providers. This report explores whether a large medically-based internet platform can be used to engage these patients and describes preferable methods for doing so., Methods: This study used Mayo Clinic Connect, a continuously monitored, internet-based social media platform of 100,000-plus users. Participants completed a brief on-line survey to ensure their study eligibility. No patient-identifying data was asked. Participants then were to call in by phone during specified day time hours for a 45-minute qualitative interview. Alternatively, as a second subsequent option, they were to complete an on-line typed response to 4 questions about their health and healthcare. No temporal overlap occurred between the availability of the phone interview option and the typed-in response option., Results: For the phone interviews, 17 of 64 individuals were deemed eligible, but no individual called in to be interviewed. In contrast, for the typed-in response option, 20 of 37 individuals were eligible and provided comments., Conclusion: A large medically-based internet platform can be used to engage older LGBTQIA+ patients, but the use of typed-in comments appears more successful, presumably because of greater anonymity and convenience., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Purpose: 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., Methods: 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., Results: 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., Conclusion: 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., Competing Interests: Conflict of Interest Liewei Wang, John Logan Black III, and Richard M. Weinshilboum are cofounders of and stockholders in OneOme, LLC, which was used only to return results to the study participants. Additionally, John Logan Black III and Mayo Clinic Ventures have applied for a patent on the CNVAR software cited in this study as well as the methodology upon which the software is based. All other authors declare no conflicts of interest., (Copyright © 2022 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)

Purpose: Sleep disturbance is a prevalent problem for cancer survivors and effective behavioral treatments are not widely used for this population. This study evaluated home-based sleep interventions based on cognitive behavioral therapy for insomnia (CBT-I)., Methods: This phase II randomized controlled trial evaluated two manualized interventions over 7 weeks. The intervention group received sleep hygiene information, stimulus control, sleep restriction, and a bedtime imagery audio recording. The control group was similar, but without sleep restriction and used audio recordings of bedtime short stories instead of imagery. Eligibility included adult cancer survivors who had trouble falling asleep or falling back to sleep on 3 of 7 days. Patients with diagnoses of sleep or mental health disorders were excluded. The primary endpoint was change in time to fall asleep or falling back to sleep after awakening, from baseline to week 7. Two-sample T tests evaluated differences between arms for this endpoint., Results: Ninety-three of 168 planned participants were enrolled from 20 institutions. The study closed early for poor accrual. Baseline time to sleep was 45 min and 52 min for the intervention and control group, respectively. At 7 weeks, both groups improved, the intervention group to 26 min and control group to 30 min, a non-significant difference between groups (p = 0.85). Secondary outcomes improved in both groups with no significant differences between arms., Conclusions: Improvement in sleep outcomes in both arms was consistent with other CBT-I interventions delivered through alternative approaches to provider-delivered therapy. More research on optimal scalable delivery of CBT-I is needed., Clinical Relevance: This study supports the effectiveness of CBT-I based behavioral interventions for sleep but also the need for better delivery methods to improve uptake and effect size., Trial Registration: ClinicalTrials.gov identifier: NCT00993928.

Providing concise, consistent, and individually relevant patient education is critical. At one institution, patients and families attended a chemotherapy education class consisting of an 11-minute DVD and an oncology nurse-facilitated group discussion. Postclass and eight-week follow-up surveys assessing understanding of treatment side effects, self-care management, and confidence in managing side effects were administered. Quantitative and qualitative data suggested the DVD and oncology nurse-facilitated group discussion provided consistent information, flexibility, and expert knowledge in empowering patients and families to self-manage chemotherapy side effects.

Purpose/objectives: To evaluate the most prevalent physical, social, emotional, and spiritual concerns of cancer survivors., Design: Descriptive, cross-sectional study., Setting: A matrix (multisite) cancer center in three urban centers in the United States., Sample: 337 cancer survivors representing nine diagnostic groups in a broad spectrum of time since diagnosis., Methods: Participants completed a survey designed to evaluate the self-reported concerns of cancer survivors. Demographic information and questions using Likert scales were used to measure concerns and quality of life. Descriptive statistics and regression analyses were used to evaluate data., Main Research Variables: Cancer diagnosis; time since diagnosis; and physical, social, emotional, and spiritual concerns., Findings: Overall, quality of life was reported as a mean of 8.44 on a scale of 0-10. The top five concerns identified were fear of recurrence, fatigue, living with uncertainty, managing stress, and sleep disturbance. Prevalence and severity of concerns differed by cancer diagnosis and time since diagnosis. Patients reporting extreme concerns related to fatigue were associated with lower quality-of-life scores., Conclusions: The research indicated that fatigue and fear of recurrence are lasting concerns across the survivorship trajectory and that age, cancer diagnosis, and time since diagnosis will have an effect on the survivor's experience., Implications for Nursing: Nurses should take a proactive role in assessing the physical, social, emotional, and spiritual needs of all cancer survivors, regardless of cancer type and time since diagnosis. Future research and support programs for cancer survivors should focus on the major concerns of fatigue and fear of recurrence., Knowledge Translation: The results of this research confirmed the importance of designing programs to support cancer survivors in an integrative manner from initial diagnosis into the period of long-term survivorship. Specific attention should be placed on the concerns related to fear of recurrence, fatigue, financial burden, and the long-term effects of cancer treatment.