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Circulating cell-free DNA (ccfDNA) is used increasingly as a cancer biomarker for prognostication, as a correlate for tumor volume, or as input for downstream molecular analysis. Determining optimal blood processing and ccfDNA quantification are crucial for ccfDNA to serve as an accurate biomarker as it moves into the clinical realm. Whole blood was collected from 50 subjects, processed to plasma, and used immediately or frozen at -80°C. Plasma ccfDNA was extracted and concentration was assessed by real-time quantitative PCR (qPCR), fluorimetry, and droplet digital PCR (ddPCR). For the 24 plasma samples from metastatic pancreatic cancer patients, the variant allele fractions (VAF) of KRAS G12/13 pathogenic variants in circulating tumor DNA (ctDNA) were measured by ddPCR. Using a high-speed (16,000 × g) or slower-speed (4100 × g) second centrifugation step showed no difference in ccfDNA yield or ctDNA VAF. A two- versus three-spin centrifugation protocol also showed no difference in ccfDNA yield or ctDNA VAF. A higher yield was observed from fresh versus frozen plasma by qPCR and fluorimetry, whereas a higher yield was observed for frozen versus fresh plasma by ddPCR, however, no difference was observed in ctDNA VAF. Overall, our findings suggest factors to consider when implementing a ccfDNA extraction and quantification workflow in a research or clinical setting.

BackgroundEmergency medicine (EM) clinician well-being has been negatively impacted throughout the COVID-19 pandemic. Resident physicians are particularly vulnerable yet less is known about their perspectives.MethodsThe objective of this study was to use qualitative methods to understand EM residents’ perspectives on well-being during COVID-19. EM residents at an urban, academic institution in the USA were recruited via email and participated in virtual, semi-structured interviews between November 2020 and February 2021. Interviews were conducted by a trained qualitative researcher, recorded, transcribed and de-identified by a third party vendor. All transcripts were double coded by two trained study team members using thematic analysis to identify the themes and interviews were stopped when no new themes emerged.ResultsSeventeen semi-structured interviews were conducted until thematic saturation was reached with residents in their first 4 years of training: 6 postgraduate year (PGY)-1 (35%), 6 PGY-2 (35%), 2 PGY-3 (12%) and 3 PGY-4 (18%). Five themes were identified: (1) isolation from peers in training contrasting with a collective call to action, (2) desire for increased acknowledgement and structured leadership support, (3) concerns about personal needs and safety within the clinical environment, (4) fear of missed educational opportunities and lack of professional development and (5) need for enhanced mental and physical health resources.ConclusionsThis qualitative study elucidated factors inside and outside of the clinical environment which impacted EM resident well-being. The findings suggest that programme and health system leadership can focus on supporting peer-to-peer and faculty connections, structured guidance and mentorship on resident career development and develop programmes which bolster resident on-shift support and acknowledgement. These lessons can be used by training programmes to better support residents, but the generalisability is limited due to the single-centre design and participation.

There is a relative lack of data regarding how patients weigh various factors when choosing a treatment strategy for interstitial cystitis/bladder pain syndrome (IC/BPS). Our aim is to describe patient experience with their current and prior treatments and discuss factors they consider when choosing a treatment. Twenty-one women with IC/BPS participated in five focus groups moderated by a psychologist. Focus groups were conducted until thematic saturation was reached. Group discussions were transcribed and independently coded by two reviewers. Emergent themes and concepts were identified using grounded theory methodology. Data on symptoms and beliefs regarding medications were collected using validated questionnaires: Interstitial Cystitis Symptom and Problem Index (ICSI and ICPI) and Beliefs in Medications Questionnaire-Specific (BMQ-S). The median age of participants was 42 years, and all had some college education. Median score (range) for the ICSI was 12 (4, 20) and for the ICPI was 10 (3, 16), indicating moderate symptom burden. Most patients had tried only first- or second-line treatments. The median BMQ-S score was 2, indicating a neutral attitude toward medication. Several themes were identified. Patients expressed interest in self-management of symptoms using a structured care plan that incorporates guided self-care practices and care that can be delivered virtually. Patients desired to minimize treatment side effects by reducing prescription medications and avoiding surgical procedures. Finally, patients had considerable interest in alternative treatments; however, they wanted these treatments to be evidence-based. Women with IC/BPS have a strong interest in guided programs that teach self-care practices and deliver alternative treatments through remote platforms.

BACKGROUND: Healthcare‐associated burnout is linked to reduced quality of care, decreased patient experience, and higher cost. The National Academy of Medicine has emphasized the importance of supporting clinician well‐being across healthcare; however, well‐being is poorly defined, especially early in emergency medicine training. OBJECTIVES: The primary objective of this study was to explore and understand the attitudes, beliefs, and perspectives of emergency medicine (EM) resident physicians surrounding well‐being. A secondary objective was to identify priority areas of focus to promote a culture of well‐being for EM trainees. APPROACH: We conducted semi‐structured focus groups of EM resident physicians at an urban, academic institution with a 4‐year training curriculum. Focus group interviews were transcribed and constructivist aggregated themes were identified using content analysis with a constant comparative coding approach. RESULTS: Seventeen EM residents participated in semi‐structured qualitative focus groups (PGY1 = 6, PGY2 = 6, PGY3 = 2, PGY4 = 3). Six key themes related to well‐being emerged spanning clinical and nonclinical areas: (1) a focus on basic needs being met, (2) on‐shift operational structure, (3) individual feedback, (4) feeling valued for clinical contributions, (5) a sense of community within the clinical environment, and (6) a sense of personal ownership over time. CONCLUSIONS: Shifting the focus for medical trainees away from mitigating burnout and toward proactively promoting well‐being is important. Understanding the perspectives and key themes in how EM residents define well‐being can help support trainees early in their careers. Using qualitative methods, this study identified six key themes that can guide trainees, educational leaders, and academic hospital systems as they work toward building a culture of well‐being early in graduate medical education.

Background We aimed to determine whether plasma cell-free DNA (cfDNA) concentration is associated with survival in patients with isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM). Methods Pre-operative and post-chemoradiotherapy blood samples were prospectively collected from patients with newly diagnosed IDH wild-type GBM. Patients underwent surgical resection or biopsy and received adjuvant radiotherapy with concomitant temozolomide. Cell-free DNA (cfDNA) was isolated from plasma and quantified using SYBR Green-based q polymerase chain reaction (qPCR). Results Sixty-two patients were enrolled and categorized into high vs. low cfDNA groups relative to the pre-operative median value (25.2 ng/mL, range 5.7–153.0 ng/mL). High pre-operative cfDNA concentration was associated with inferior PFS (median progression-free survival (PFS), 3.4 vs. 7.7 months; log-rank P = .004; hazard ratio [HR], 2.19; 95% CI, 1.26–3.81) and overall survival (OS) (median OS, 8.0 vs. 13.9 months; log-rank P = .01; HR, 2.43; 95% CI, 1.19–4.95). After adjusting for risk factors, including O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status, pre-operative cfDNA remained independently associated with PFS (HR, 2.70; 95% CI, 1.50–4.83; P = .001) and OS (HR, 2.65; 95% CI, 1.25–5.59; P = .01). Post-hoc analysis of change in cfDNA post-chemoradiotherapy compared to pre-surgery (n = 24) showed increasing cfDNA concentration was associated with worse PFS (median, 2.7 vs. 6.0 months; log-rank P = .003; HR, 4.92; 95% CI, 1.53–15.84) and OS (median, 3.9 vs. 19.4 months; log-rank P < .001; HR, 7.77; 95% CI, 2.17–27.76). Conclusions cfDNA concentration is a promising prognostic biomarker for patients with IDH wild-type GBM. Plasma cfDNA can be obtained noninvasively and may enable more accurate estimates of survival and effective clinical trial stratification.

12125 Background: This pilot study describes the cancer-specific social risk factors (SRFs) of oncology patients on active treatment and the acceptability of using SRF screening to inform care and bolster support during cancer treatment. Methods: This is an ongoing cross-sectional survey of adult cancer patients on active treatment at two outpatient cancer centers in the University of Pennsylvania Health System. Since October 2019, 176 patients have completed our two-part, 19-item social risk screening tool (44% response rate; 49% age > 65yo; 45% female; 35% non-white). Survey questions were adapted from other social screening measures (e.g., AHC-HRSN tool, PRAPARE), then pre-tested and modified for our cancer-specific population. Part 1 of our tool covers 12 SRFs in four core domains: technology (e.g., internet accessibility challenges), environmental (e.g., housing instability), emotional (e.g., social isolation), and financial (e.g., ongoing financial toxicity). In part 2, seven acceptability questions cover patients’ perceived appropriateness of and comfort with screening, expectations of clinical staff to act on identified SRFs, prior SRF assistance received, interest in receiving SRF assistance (i.e., a proxy for patients’ most pressing unmet social needs), willingness to add SRF data to electronic health records (EHR), and comfort sharing findings with other clinicians (e.g., oncologists, primary care physicians, nurses). Results: We identified an average of 2.48 SRFs per patient. The five most commonly reported SRFs were ongoing financial toxicity (57%), internet accessibility challenges (46%), social isolation (40%), housing instability (34%), and insufficient internet for telemedicine (29%). The majority of patients thought that SRF screening was appropriate (56%) and many felt comfortable being screened (63%). Half of patients expected cancer center staff to connect them to social resources (50%), fewer wanted staff to just be aware of their SRFs (43%), and a minority did not want staff to know about their SRFs (7%). Many patients had received prior SRF assistance (49%) or were interested in receiving future help (51%). Most patients felt discomfort toward listing SRF results in their EHR (63%) and some felt uncomfortable giving other clinicians access to this data (38%). Conclusions: Our study shows that oncology patients contend with SRFs while undergoing treatment and find SRF screening acceptable. These findings support clinical implementation of a cancer-specific social screening tool into routine cancer care, but also bring attention to privacy preferences and limited acceptability of EHR documentation of SRFs. Cancer centers adopting this approach may gain insights into where interventions or resources could be targeted to meaningfully address SRFs, potentially improving clinical outcomes for vulnerable populations.