Human carboxylesterase 1 (CES1) and carboxylesterase 2 (CES2) are serine esterases responsible for the hydrolysis of ester and amide bonds present in a number of pharmaceutical products. Several common genetic variants of the CES1 and CES2 genes have been shown to influence drug metabolism and clinical outcomes. Polymorphisms of the CES1 gene have been reported to affect the metabolism of dabigatran etexilate, methylphenidate, oseltamivir, imidapril, and clopidogrel, whereas variants of the CES2 gene have been found to affect aspirin and irinotecan. Although the findings of these studies may be preliminary, they demonstrate the potential clinical utility of CES polymorphisms; however, more research is required, especially with respect to CES2. In this review, we outline the functional, molecular, and genetic properties of CES1 and CES2, and highlight recent studies that have shown relations between CES1 and CES2 variants and contemporary pharmacotherapy.

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Introduction: Systematic documentation of chemotoxicities in outpatient clinics is challenging. Incorporating patient-reported outcome (PRO) measures in clinical workflows can be an efficient strategy to strengthen the assessment of symptomatic treatment toxicities in oncology clinical practice. We compared the adequateness, feasibility, and acceptability of toxicity documentation using systematic, prospective, application of the PRO Common Toxicity Criteria for Adverse Events (PRO-CTCAE) tool. Methods: At a comprehensive cancer center, data abstraction of electronic health record reviews elucidated current methods and degree of chemotoxicity documentation. Web-based 32-item PRO-CTCAE questionnaires, administered in ambulatory clinics of patients receiving chemotherapy, captured chemotoxicities and respective severities. Patient telephone surveys assessed whether healthcare providers had addressed chemotoxicities to the patients' satisfaction. Results: Over a broad demographic of 497 patients receiving chemotherapy, 90% (95% CI 84-96%) with significant chemotoxicities (n = 107) reported that their providers had discussed toxicities with them; of these, 70% received a therapy management change, while among the rest, 17% desired a change in management. Of patients surveyed, 91% (95% CI 82-99%) were satisfied with their current chemotoxicity management. Clinician chart documentation varied greatly; descriptors rather than numerical grading scales were typically used. Although 93% of patients were willing to complete the PRO survey, only 50% thought that it would be acceptable to complete this survey at routine clinic visits. Conclusion: Use of PRO-CTCAE in routine clinical practice promotes systematic evaluation of symptomatic toxicities and improves the clarity, consistency, and efficiency of clinician documentation; however, methods to improve patient willingness to complete this tool routinely are needed.

If situational judgment tests define who enters the health professions, we must be cautious and transparent in their use to avoid unintentional creation of a detrimental hidden curriculum.

165 Background: In a busy chemo DC, any efficient means of tracking important chemotoxicities can improve quality of care. The study goal was to evaluate whether tablet technology available in a DC waiting room is able to capture prevalent and severe toxicities associated with chemotherapy using the patient reported outcome (PRO) - common toxicity criteria for adverse events (CTCAE). Methods: This cross-sectional PRO-CTCAE study of 160 adult solid/hematologic cancer outpatients of all stages, who were undergoing chemotherapy (CT), focused on common chemotoxicities captured using touchscreen tablets in the DC waiting room of Princess Margaret Cancer Centre (Toronto, CA). Individual health scores from the EQ-5D VAS tool and the prevalence of AEs experienced by cancer patients within the past seven days were captured. Symptoms that were listed as moderate to very severe were considered significant. Results: Across a wide range of tumours and patients on intravenous CT, the median age (range) was 56 (19-88) years; 38% were males.Patients reported a median (range) health score (100 = best health possible, 0 = worst) of 70 (4-100). The severity offiveprevalent, key side-effects of CT were tabulated (Table). 59% of patients felt their fatigue interfered significantly with their daily activities, and 30% felt decreased appetite interfered significantly. 32% experienced nausea occasionally to almost constantly. Conclusions: The common symptoms of CT were captured FEASIBLY, and found to be highly prevalent in this CT-treated population. Capturing additional symptom prevalence outside of the 7-day time frame may be important from a clinical standpoint. Administration of PRO-CTCAE instrument through tablet technology may be an excellent method to help collect such data systematically and reliably. Updated data on 300 patients will be presented at the meeting. [Table: see text]