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Abstract Introduction In April 2019, French authorities mandated dihydropyrimidine dehydrogenase (DPD) screening, specifically testing uracilemia, to mitigate the risk of toxicity associated with fluoropyrimidine‐based chemotherapy. However, this subject is still of debate as there is no consensus on a standardized DPD deficiency screening test. We conducted a real‐life retrospective study with the aim of assessing the impact of DPD screening on the occurrence of severe toxicity and exploring the potential benefits of complete genotyping using next‐generation sequencing. Methods All adult patients consecutively treated with 5‐fluorouracil (5‐FU) or its oral prodrug at six cancer centers between March 2018 and February 2019 were considered for inclusion. Dihydropyrimidine dehydrogenase deficiency screening included gene encoding DPD (DPYD) genotyping using complete genome sequencing and DPD phenotyping (uracilemia or dihydrouracilemia/uracilemia ratio) or both tests. Associations between each DPD screening method and (i) severe (grade ≥3) early toxicity and (ii) fluoropyrimidine dose reduction in the second chemotherapy cycle were evaluated using multivariable logistic regression analysis. Furthermore, we assessed the concordance between DPD genotype and phenotype using Cohen's kappa. Results A total of 551 patients were included. Most patients were tested for DPD deficiency (86%) including DPYD genotyping only (6%), DPD phenotyping only (8%), or both (72%). Complete DPD deficiency was not detected in the study population. Severe early toxicity events were observed in 73 patients (13%), with two patients (0.30%) presenting grade 5 toxicity. Despite the numerically higher toxicity rate in untested patients, the occurrence of severe toxicity was not significantly associated with the DPD screening method (p = 0.69). Concordance between the DPD genotype and phenotype was weak (Cohen's kappa of 0.14). Conclusion Due to insufficient numbers, our study was not able to demonstrate any added value of DPYD genotyping using complete genome sequencing to prevent 5‐FU toxicity. The optimal strategy for DPD screening before fluoropyrimidine‐based chemotherapy requires further clinical evaluation.

IntroductionThe COVID-19 related quarantine had negative psychological effects among University students. Evidence from previous epidemics suggests that negative psychological effects of quarantine measures can last or even worsen after the quarantine lift. The objective of this study was to assess the evolution of students' mental health and to identify factors associated with mental health outcomes 1 month after the lift of the lockdown.Materials and MethodsThis repeated cross-sectional study collected data during the first quarantine in France (T1, N = 68,891) and 1 month after its lift (T2, N = 22,540), through an online questionnaire sent to all French University students. Using cross-sectional data, we estimated prevalence rates of suicidal thoughts, severe anxiety (State-Trait Anxiety Inventory, State subscale), depression (Beck Depression Inventory), and stress (Perceived Stress Scale) at T1 and T2. Using longitudinal data (N = 6,346), we identified risk factors of poor mental health outcomes among sociodemographic characteristics, precariousness indicators, health-related data, information on the social environment, and media consumption, adjusting for baseline mental health status.ResultsWe found lower prevalence rates of severe stress (21.7%), anxiety (22.1%), and depression (13·9%) one month after the quarantine compared to the quarantine period (24.8%, 27.5%, and 16.1%, respectively). The prevalence rate of suicidal thoughts increased from 11.4 to 13.2%. Regardless of the existence of symptoms during quarantine, four factors were systematically associated with poor mental health outcomes 1 month after the quarantine was lifted: female gender, a low feeling of integration before the quarantine period, a low quality of social ties during the quarantine, and a history of psychiatric follow-up.ConclusionsThe prevalence rates of severe stress, anxiety, and depression, although being lower than during the first lockdown, remained high after its lift. The prevalence rate of suicidal ideation increased. This stresses the need to consider the enduring psychological impact of the pandemic on students as a critical public health issue.

Background The COVID-19 pandemic has raised concerns regarding its psychological effect on university students, especially healthcare students. We aimed at assessing the risk of mental health problems according to the type of university studies, by adjusting for potential confounders. Methods We used data from the COSAMe study, a national cross-sectional survey including 69,054 French university students during the first quarantine. The mental health outcomes evaluated were suicidal thoughts, severe self-reported distress (as assessed by the Impact of Events Scale–Revised), stress (Perceived Stress Scale), anxiety (State-Trait Anxiety Inventory, State subscale), and depression (Beck Depression Inventory). Multivariable logistic regression analyzes were performed to test the association between the type of university studies (healthcare studies: medical and non-medical, and non-healthcare studies) and poor mental health outcomes, adjusted for sociodemographic characteristics, precariousness indicators, health-related data, quality of social relationships, and data about media consumption. Results Compared to non-healthcare students (N = 59,404), non-medical healthcare (N = 5,431) and medical students (N = 4,193) showed a lower risk of presenting at least one poor mental health outcome (adjusted OR [95%CI] = 0.86[0.81–0.92] and 0.87[0.81–0.93], respectively). Compared to non-healthcare students, medical students were at lower risk of suicidal thoughts (0.83[0.74–0.93]), severe self-reported distress (0.75[0.69–0.82]) and depression (0.83[0.75–0.92]). Non-medical healthcare students were at lower risk of severe selfreported distress (0.79[0.73–0.85]), stress (0.92[0.85–0.98]), depression (0.83[0.76–0.91]), and anxiety (0.86[0.80–0.92]). Limitations This is a large but not representative cross-sectional study, limited to the first confinement. Conclusions Being a healthcare student is a protective factor for mental health problems among confined students. Mediating factors still need to be explored.