Abstract
Fecal specimen collection in the clinical setting is often unfeasible for large population studies, especially because cancer patients on immunotherapy often experience constipation. A method for constructing and using an at-home stool collection kit designed for epidemiological studies in cancer patients is presented. Participation and compliance rates of the collection kit among late-stage cancer patients from an ongoing, longitudinal study are also discussed. The kit includes three different media on which samples are introduced. Using one stool sample, patients collect specimens by smearing stool onto a fecal occult blood test (FOBT) card, containing three slides for collection. Additional specimens from the same stool sample are added to one tube containing 8 mL of RNAlater preservative and one tube containing 8 mL of 95% ethanol. Stool specimens are stored at room temperature and returned to researchers within 3 days of collection. The purpose of this kit is to yield stool specimens on a variety of media that can be preserved for extended periods of time at room temperature and are compatible with multi-omics approaches for specimen analysis. According to leading microbiome researchers and published literature, each collection method is considered optimal for use in large epidemiological studies. Moreover, the kit is comprised of various components that make stool collection easy, so as not to burden the patient and hence maximize overall compliance. Use of this kit in a study of late-stage lung cancer patients had a participation rate of 83% and baseline compliance rate of 58%.
Highlights
The microbiome, the vast collection of microbes inhabiting the human body, has been associated with cancer development and progression [1–4], as well as response to chemotherapy and immunotherapy [5–7], yet the biological mechanisms underlying these associations remain unknown
Gut microbiome studies should utilize valid, reproducible, and standardized methods to enhance data comparability across studies, as differences in stool collection methods contribute to inter-study variability [8–10]
For specimens stored at room temperature, preservatives must be used to stabilize nucleic acids or other small molecules needed for downstream analyses and should be compatible with multiple omics approaches, including metagenomics, metatranscriptomics, and metabolomics
Summary
The microbiome, the vast collection of microbes inhabiting the human body, has been associated with cancer development and progression [1–4], as well as response to chemotherapy and immunotherapy [5–7], yet the biological mechanisms underlying these associations remain unknown. Since most people cannot provide a stool sample when convenient for researchers, stool must be self-collected and refrigerated or stored at room temperature until specimens can be transported to the laboratory. 15-mL Sarstedt stool collection tubes with spatulas
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