Smilow and Yale Cancer Center Town Hall | February 3, 2022

Transcript

• 00:00I wanna welcome everyone to this town hall.
• 00:03For those of you.
• 00:04Who don't know me, I'm Eric Weiner
• 00:07and I actually am the in place,
• 00:10and the new Yale Cancer Center
• 00:12director and physician in Chief
• 00:14of of Smilow Cancer Hospital,
• 00:16and I'm really thrilled to be here.
• 00:19We have a great program today.
• 00:22I just want to make a few comments.
• 00:23First and foremost,
• 00:25I I want to thank Nita,
• 00:28who served in a remarkable way
• 00:32as the interim director.
• 00:35Between Charlie Fuchs and me and we
• 00:38all owe her just in an incredible
• 00:42incredible thanks for all that
• 00:46she has done and hopefully Nita
• 00:48will continue to remain very
• 00:50involved in the Cancer Center.
• 00:52But again, thank you, Nita.
• 00:56So I've actually officially been on
• 00:59the job for this is my third day my
• 01:03my about a third of our possessions
• 01:06arrived in an apartment today,
• 01:08so a good sign means that I'm settling in.
• 01:13And it's been a great three days.
• 01:16In truth,
• 01:17I've really been working behind the scenes,
• 01:19or maybe not so behind for the past
• 01:21two months, and I've seen many,
• 01:23many of you in lots of meetings by zoom.
• 01:27I have felt over those two months
• 01:29that I've been drinking from a
• 01:31firehose and I'm now I think I feel
• 01:33like I'm drinking from 2 fire hoses,
• 01:35but I seem to be managing so far.
• 01:39I have been incredibly impressed
• 01:42by everyone I've met,
• 01:43and all that is going on here.
• 01:45It's really quite remarkable,
• 01:48but I'm well aware of the many
• 01:52challenges that exist and the fact
• 01:55that the job is going to take a lot
• 01:57of hard work and it's going to take
• 02:00a lot of hard work on my part, but.
• 02:04On all of your parts, as as as well.
• 02:08I really believe that we can take
• 02:11what is remarkable talent here in
• 02:14basic science and translational
• 02:17science and population science.
• 02:19And also in clinical care and build
• 02:23a that truly world renowned program.
• 02:25A place that's my go to place for patients,
• 02:28not just patients who live in Orange
• 02:30and Milford and all over Connecticut
• 02:33but throughout the region throughout
• 02:35the country and even around the world.
• 02:38And I actually believe that Yale
• 02:41has truly limitless potential.
• 02:44At the same time,
• 02:46I have and this isn't just the
• 02:48past three days,
• 02:49it's over the past two months I have been.
• 02:53Really impressed by the
• 02:56commitment to diversity,
• 02:58both diversity in terms of the
• 03:00makeup of our faculty and staff,
• 03:02but also in terms of the commitment
• 03:05to serve people who are somewhat
• 03:08less advantage than others.
• 03:10And Yale is way ahead of that
• 03:13compared to many institutions.
• 03:15Certainly many institutions
• 03:17that I'm familiar with.
• 03:20It's.
• 03:21Gonna take a lot of teamwork in
• 03:23the months and years ahead.
• 03:26We all have to be on the same page
• 03:28and rowing in the same direction,
• 03:30which doesn't mean that everybody
• 03:31always has to agree all the time
• 03:34and and disagreement and dissent
• 03:36are really helpful to move an
• 03:38organization forward. I actually was
• 03:41never a camp counselor as a kid,
• 03:43but I think one of the things that I
• 03:45do better than most is not most people,
• 03:47but most other things that I do is being a
• 03:50camp counselor and bringing people together.
• 03:52And so I'm gonna do my best to bring
• 03:56you all together over the course
• 03:59of the the months and years ahead.
• 04:03So we'll get to the the topic
• 04:06of the town hall in the second,
• 04:08but I just want to ask you all as I
• 04:11start to come along on this journey
• 04:14and come to build a very special Yale
• 04:17Cancer Center and Smilow Cancer Hospital.
• 04:20I think we can.
• 04:21We can really do it and I'm totally psyched.
• 04:24And so, without further ado,
• 04:26let's let's get to our presentations.
• 04:30We have 3 today.
• 04:33The 1st is a clinical update from Kevin
• 04:37Billingsley, our Chief Medical Officer,
• 04:38and I think we're in a has slides
• 04:41that she's going to share.
• 04:42And Kevin, it's all yours.
• 04:52Thank you Eric.
• 04:53It is so I I also want to join you and.
• 04:59Really, extending my gratitude
• 05:01to Doctor Ahuja, and of course.
• 05:07Extending all of our warm
• 05:09welcome and good wishes to you,
• 05:12and it's just delightful to
• 05:13have you here and have you on
• 05:15this virtual podium with us.
• 05:22You know I'm going to spend most of my
• 05:24time doing this in this clinical update.
• 05:27Just reviewing where we have been
• 05:31as partly an organization but partly
• 05:34a cancer care enterprise with our
• 05:38our steps along the COVID journey,
• 05:41and it has been quite a ride
• 05:45and if I leave you.
• 05:48And I leave our community with no
• 05:51other message today the message
• 05:54should be that I think we all
• 05:57need to be extraordinarily proud
• 06:00of the work that we have done.
• 06:04Not only caring for our cancer patients,
• 06:07but the contributions that we as a
• 06:09cancer care enterprise have made to
• 06:12the entire health care system and
• 06:14caring for cancer patients throughout
• 06:17Connecticut and the Northeast.
• 06:20And it's all share at the end.
• 06:22Those contributions have been
• 06:25substantive and important.
• 06:28So to start with, these are our the
• 06:31hospitalization rates and death rates.
• 06:33That really show what we've been
• 06:36through in the past several weeks.
• 06:38You know, everyone knows that we had a
• 06:41really bad first wave in March 2020.
• 06:44We had an additional peak during
• 06:47the Delta variant.
• 06:49Things were quiet over the summer and
• 06:53then a meteoric rise in case rates,
• 06:56hospitalizations,
• 06:57and even although Omicron was less lethal,
• 07:02still a significant.
• 07:04Increase in death rates just
• 07:07during this past month.
• 07:09And fortunately,
• 07:10we seem to be on the tail end of that.
• 07:15Next slide.
• 07:21So I think most in the audience are familiar
• 07:25with the kind of trajectory of these
• 07:28variants right up until early December.
• 07:33Delta was the dominant variant in
• 07:35the state of Connecticut, you know,
• 07:38and it is breathtaking how quickly
• 07:40the Omicron variant took over in
• 07:43Connecticut in the northeast,
• 07:45and the S gene target failure is kind of
• 07:49the the marker for Omak, Ron, and and.
• 07:52These are data specific from our hospital,
• 07:56and I'll share that.
• 08:00These slides are are courtesy of Doctor
• 08:02Martin LO from infectious disease.
• 08:05So as you can see,
• 08:05as we entered into January very quickly,
• 08:09Omicron became the dominant variant
• 08:11in our hospital, really suppressing.
• 08:16Oma Cron dealt at a very low
• 08:19levels and we had test positivity
• 08:23rates around 20%. Next slide.
• 08:30So these are the hospitalization
• 08:32rates throughout the the system.
• 08:36Across the health system,
• 08:38we went up to over 700 patients
• 08:41as of today for this system,
• 08:44we're down to about 200 and
• 08:465255 patients in this hospital,
• 08:48Yale New Haven Hospital.
• 08:50We went up over 450 patients.
• 08:53We did briefly exceed the peak from
• 08:57the first wave in March of 2020.
• 09:00Now we're down to 134 patients
• 09:03and every indication based on.
• 09:05Wastewater and testing and other
• 09:08leading indicators is that that
• 09:11rate of inpatients will continue to
• 09:14fall in the coming days and weeks.
• 09:17Next slide.
• 09:20So one of the things that
• 09:23I was most impressed by,
• 09:24and I think great credit needs
• 09:26to be given to all of our teams,
• 09:28is that throughout this massive surge,
• 09:32we continued to really give cancer care and
• 09:36cancer treatment in an uninterrupted way.
• 09:39These are our visit volumes by type,
• 09:41including new patients and return patients.
• 09:44You can see we have our, you know,
• 09:47annual dip that we anticipate right around.
• 09:50The The the Christmas holidays
• 09:54and then very quickly.
• 09:56Even though we had soaring
• 09:58hospitalization rates and we were
• 10:00pivoting towards a Tele health approach,
• 10:03we maintained our visit volumes
• 10:06really throughout January.
• 10:07There's a brief dip right around the
• 10:11peak of the the surge in mid January,
• 10:14but as of the last week in January,
• 10:16we're right back up at our at
• 10:19our baseline volumes.
• 10:20Next slide, please.
• 10:24These are our volumes bimodality.
• 10:26You can see we drop down around
• 10:28Christmas quickly back up,
• 10:30but immediately within a week.
• 10:32We had implemented and pivoted
• 10:34back towards a very robust
• 10:37telemedical health presence and we
• 10:41had very strong infrastructure in
• 10:42place to the hard work of many,
• 10:44many people to get our patients
• 10:47seen using virtual technology.
• 10:51Next slide.
• 10:55These are new patient visits
• 10:57both in person and video.
• 10:59You can see that we are able to
• 11:02accommodate many of our our new
• 11:04patients through a video visit
• 11:06platform and prevent them from coming
• 11:08into the healthcare environment.
• 11:10And as things have started to wane,
• 11:12I think we are slowly transitioning
• 11:14back more towards in person.
• 11:16Next slide.
• 11:20One of the things that is incredibly
• 11:23important for our patients is that
• 11:26they continue in an uninterrupted way
• 11:29with ongoing cancer chemotherapy,
• 11:32and I'm really proud of these numbers.
• 11:35We don't have data for the month
• 11:37of January from our Smilow St.
• 11:39Francis site, but you can see that
• 11:43there was really no substantive
• 11:45interruption in our infusion operations
• 11:49throughout the January surge.
• 11:51Next slide.
• 11:55One of the things that was most
• 11:58challenging during the primary
• 12:00phase of the pandemic was delays
• 12:03and cancellations and surgery.
• 12:08We did have some delays in
• 12:10surgery and a few cancellations.
• 12:12I will say that the vast majority of these,
• 12:15particularly you can see this drop
• 12:17in surgical volume in mid January
• 12:20was related to patients or family
• 12:23members suffering from COVID
• 12:26related illness and volunteering,
• 12:28voluntarily delaying their procedures.
• 12:30We really were able to continue
• 12:34in an uninterrupted way for all
• 12:37of our major cancer and surgical
• 12:40oncology operations and hats off
• 12:43to all of our perioperative teens
• 12:46who continued to care for patients.
• 12:49And this occurred at a time when
• 12:51many of our staff were dealing with
• 12:55illness themselves in a rotating way
• 12:58so very pleased with those results.
• 13:03Radiation oncology yet another
• 13:05key operational area where we
• 13:08continued to forge ahead without
• 13:11significant treatment interruptions.
• 13:12Lots of cute kudos and gratitude to our.
• 13:18All of our radiation oncologists,
• 13:20as well as our therapists dosimetrists
• 13:23and physicists who all managed to continue
• 13:26to keep patients coming in to their
• 13:31daily treatments without interruption.
• 13:34So before I go on to the next slide,
• 13:37I wanna share some data that is
• 13:40not really is being discussed
• 13:42at the health system level,
• 13:44but is not available in a printed,
• 13:47printed or public form yet.
• 13:50But I think it is data that speaks to the
• 13:55heroism of our of all of our clinical teams.
• 13:59And it has to do with the fact that over
• 14:02the past month our health care system.
• 14:04Has cared for the lion share of COVID
• 14:08patients across the state of Connecticut.
• 14:12Just to put some rough numbers to this.
• 14:16We've had about 17,000 COVID
• 14:19discharges in the Yale New Haven
• 14:22Health system in the month of January.
• 14:25Our closest
• 14:30colleague in this arena, another major
• 14:34health care system in the state,
• 14:36had about 11,000 discharges.
• 14:40So in terms of volume and access.
• 14:44We were far and away the leader in the state.
• 14:48But perhaps most importantly,
• 14:50through the efforts of our teams
• 14:53and through the implementation
• 14:55of care of of care pathways,
• 14:58our outcomes were the best.
• 15:01Across the system,
• 15:02the mortality rate of patients
• 15:05hospitalized with COVID related illness.
• 15:08In January of 2022 was around 8%.
• 15:14At hospitals,
• 15:15other hospital systems across
• 15:17the state of Connecticut,
• 15:19the mortality rate for COVID
• 15:21related illness and January of
• 15:232022 ranged from 13.8% to 20%.
• 15:30So lots goes into this,
• 15:32but there is enormous reason for us all
• 15:35to be proud or oncology teams may not
• 15:38have cared for all of those patients,
• 15:41but our rapid transition to
• 15:44a hybridized environment.
• 15:45It was certainly one of the things
• 15:48that helped our health system
• 15:50absorb all of those patients
• 15:52during this very critical time.
• 15:54So incredible work, folks.
• 15:58Next slide.
• 16:02Last but not least,
• 16:03an important clinical change that
• 16:05will be rolling out that people
• 16:07will be hearing more about the next
• 16:09several weeks is the health system
• 16:11is transitioning to a high sensitive
• 16:14proponent assay for diagnosis of bio,
• 16:16cardial, ischaemia and myocardial infarction.
• 16:19This is in response to updates in
• 16:22the American College of Cardiology
• 16:25and HHS pain guidelines in terms of
• 16:29accurate diagnosis, there will be
• 16:31more information to come on this.
• 16:33There is like many areas there is already
• 16:36a care pathway that in has rolled out
• 16:40that incorporates this diagnostic test.
• 16:43There will be a series of three
• 16:45town halls that I would recommend
• 16:48to any of our practicing clinicians
• 16:50and you can see those dates here.
• 16:53There's also a question concerns and
• 16:56recommendations. Email, site and link.
• 16:58So more to come on on this.
• 17:01But this is coming forward quickly.
• 17:05So again, thanks to everyone and I.
• 17:08Think that.
• 17:12Sam maybe next Sam abdelghany. Sure,
• 17:16thank you Kevin. Good afternoon.
• 17:18Everyone at Lisa and I will present some
• 17:20pharmacy in clinical practice updates.
• 17:22We decided to join our slides together
• 17:25as we've been working very closely on
• 17:27many of the topics we present today.
• 17:30Next line, so first I'll start with an
• 17:33update on drug shortage and the good news.
• 17:36Now we usually bring to you that we are out
• 17:39of a drug or managing severe drug structures,
• 17:42but this time is positive all the way around.
• 17:44We are not seeing any critical shortage
• 17:47affecting any of the cancer therapies.
• 17:49Nothing new in this area and in fact
• 17:51it's it's it's positive because ABRAXANE,
• 17:54which has minimum of you know,
• 17:56has been in shortage since
• 17:58September due to some manufacturing.
• 18:00It should be.
• 18:01Ms was an allocation remain an allocation,
• 18:04but the team has been working very hard.
• 18:07To acquire any number of vials from any
• 18:11source as much as they possibly can.
• 18:14And because of this hard work we are
• 18:18able now to lift all the restrictions
• 18:20that we had in place early in October.
• 18:23So Braxton can be used in any treatment
• 18:27indication without any restrictions.
• 18:30We do ask that patient who have a
• 18:33reaction to tax saying that preference,
• 18:36at least initially to be.
• 18:37To re challenged before switching
• 18:39to ABRAXANE.
• 18:40If that's clinically possible.
• 18:42So we within our communication
• 18:44last week we just want to share
• 18:47the same information here as well.
• 18:48Next slide.
• 18:51One quick slide on COVID-19 therapies.
• 18:56This is an area that my colleague Nancy
• 18:58Buller been working on and leading the
• 19:00the work in Smile on outside smile.
• 19:02Oh, I listed that three drugs that
• 19:05are used today to oral medications.
• 19:08When Ivy. I'm not going to
• 19:10attempt to pronounce any of them,
• 19:12I just wanted to share with everyone
• 19:15today that the criteria for you is also
• 19:17have been expanding because the declining
• 19:19rate of positive cases over time which.
• 19:22Change the criteria based on the supply we
• 19:25have and a number of cases and now we are in.
• 19:29Very good place that allow us to open
• 19:32the criteria to essentially match what
• 19:34what's in the EU A and I highlighted.
• 19:37I mean it's oppressive disease and
• 19:38I'm using suppressive treatment,
• 19:40so essentially all our patients will
• 19:42be eligible for this treatment now,
• 19:45which was not the case with a
• 19:48more restrictive criteria.
• 19:49That the other comment I want to
• 19:53mention about the oral drugs initially
• 19:54and we we use the apothecary as the
• 19:58main source of the oral antivirals.
• 20:02They continue to be the the major source,
• 20:04but not the only one.
• 20:05We are now identifying locations closer to
• 20:07patient homes in Rhode Island in New York,
• 20:10and we are hearing that the
• 20:13state will start looking at long.
• 20:15Long term care facilities and and other
• 20:17areas to have this medication available.
• 20:20So in terms of availability of
• 20:23COVID-19 treatment therapies,
• 20:24expanding access and now available to
• 20:28everyone and hopefully all our patients
• 20:31will have access that as soon as they need.
• 20:34Next,
• 20:35slide moving from treatment to prevention or
• 20:38prophylaxis and during the last treatment,
• 20:41we talked briefly about a V
• 20:44shield and new drug that was.
• 20:47Available to us with an EUA for preexposure
• 20:50poleaxes in our patient population.
• 20:53Anybody with immuno compromised or may not
• 20:56mount adequate response to vaccination.
• 20:59And if you recall there was a two IM
• 21:01injections in the same appointment followed
• 21:04by one hour monitoring period since the
• 21:08beginning of availability of the drug.
• 21:10We we've been doing a lot of
• 21:12work on creating patient list to
• 21:15identify who is the patient or
• 21:17the patient population that will.
• 21:18Most likely benefit we created a A
• 21:20therapy plan in EPIC we we have this
• 21:23model that was designed to distance
• 21:25decentralized the workflow have the
• 21:27drug available in every clinic and
• 21:30have the clinicians follow the normal
• 21:32process to order an IM medication.
• 21:35We continue to work through many of the
• 21:39workflow issues over the last week but then.
• 21:44And your information that made us
• 21:46really look at the recommendation and
• 21:49look away to simplify and disseminate
• 21:52this information to everyone.
• 21:55This information that we learned
• 21:56last week that our patient now are
• 21:59eligible for a new dose of vaccine
• 22:03and Lisa will go over the detail.
• 22:05I'm going to call it,
• 22:06but I'll call it booster kind.
• 22:08Avoid the numbers,
• 22:09the 3rd or the 4th or the 5th.
• 22:12But because now?
• 22:14Our patients are eligible
• 22:15for this vaccination
• 22:17that has impact on when you give FS SHIELD
• 22:20and how the the the vaccine without
• 22:23the vaccine will be effective or not.
• 22:25So in the next slide we have a busy slide
• 22:31that contain all the new recommendation,
• 22:33but I'm I'm going to try to hit
• 22:35up high level points initially.
• 22:37If a patient is not eligible for a
• 22:41vaccine or is deemed not responsive.
• 22:45To vaccination based on the
• 22:46treatment they get and for example,
• 22:48a patient on on reflex map,
• 22:50they should get treatment with every shield.
• 22:53It's the best available option.
• 22:55Vaccination is not an option here and
• 22:57that the drug will be available to them
• 23:00for our patients who are eligible for
• 23:03vaccine vaccination is the priority here.
• 23:07Every shield is not a replacement
• 23:09for vaccination,
• 23:09so we want this patient to get their
• 23:12booster dose five months after.
• 23:15The primary series and Lisa will go
• 23:17over the details of definition in
• 23:20in a minute after the vaccination.
• 23:22We we are asking for the team to
• 23:27check spike anybody level 2 weeks
• 23:29after and depending on the level if
• 23:32it's less than two ten which we add
• 23:35designating as not adequate response,
• 23:38every shield would be an option.
• 23:40If we have a patient who is eligible
• 23:43to the vaccine but they are not due
• 23:45for that dose for 45 days or more,
• 23:48they are eligible for every shield
• 23:51at the tire is low.
• 23:53And they can schedule the vaccine
• 23:55at later time.
• 23:56One group of patients that we talked
• 23:58a lot about what can be available to
• 24:01them about a patient who received
• 24:03as an initial dose of J&J vaccine,
• 24:05followed by a second dose of M RNA vaccine.
• 24:09Those patients.
• 24:12Are not today there is no recommendation
• 24:14from the CDC on any additional vaccine doses,
• 24:18so for them the recommendation is
• 24:20to check the spike and everybody on
• 24:23level 2 weeks after the second dose,
• 24:25and again based on that level we.
• 24:29Maybe she can be an option,
• 24:31so really that the high level vaccine,
• 24:33eligible or not,
• 24:34and then we have specific criteria.
• 24:37This recommendation will be
• 24:39disseminated in multiple format.
• 24:41We are working on a care pathway,
• 24:43so it's going to be built in any order
• 24:45and until that finalized the drug is
• 24:48available today in all our clinics a
• 24:52couple of things before I turn over
• 24:55the slide to Lisa we we did a lot of work.
• 24:58Also on simplifying that criteria.
• 25:00So we still have tier one and Tier 2.
• 25:03We're gonna simplify that and all
• 25:05our patients will be eligible today
• 25:07without looking at the specific
• 25:10therapy they are getting.
• 25:12And the other work that we're doing
• 25:14is collecting data on vaccines
• 25:16and antibody levels,
• 25:17and hopefully that will give us information
• 25:20that guide decisions down the road.
• 25:23So we we're trying to capitalize on
• 25:25this opportunity to learn more about
• 25:28vaccine response in our patients.
• 25:30With that, I'll end. I'll turn over to Lisa.
• 25:34Thanks Sam, we wanted to just level set
• 25:37some vaccine terminology and there's
• 25:39efforts across the health system to
• 25:41standardize how we're referring to
• 25:44the primary vaccine series and any
• 25:46additional doses moving forward.
• 25:48So I wanted to just start with defining
• 25:51what we consider primary vaccine series.
• 25:54So for healthy immune competent patients,
• 25:56that would include two doses of
• 25:58an Mr AM RNA vaccine series,
• 26:01satisfies or materna for one dose.
• 26:04With the J&J vaccine for our
• 26:06immuno compromised patients,
• 26:08that primary series is defined as
• 26:10three doses of an M RNA vaccine.
• 26:13Either Pfizer or Moderna.
• 26:15So I'm really not thinking of our
• 26:18immuno compromised patients as
• 26:20getting 2 vaccines plus 1/3 dose.
• 26:23Some have referred to the third
• 26:24doses of booster.
• 26:25We really want to move away from that
• 26:28and really think about the terminology
• 26:30being primary series as three doses
• 26:32for the majority of our patient population.
• 26:35And then the terminology of booster
• 26:37will be used to to describe any shot
• 26:40that's given at least five months after
• 26:42the completion of the primary series,
• 26:45and that would be either 3 doses
• 26:47for immunocompromised patients,
• 26:49or two doses for immunocompetent
• 26:51so immunocompromised patients who
• 26:52have completed their primary series
• 26:54and received the three shots of the
• 26:57M RNA vaccine series are eligible
• 26:59for a booster of that scene vaccine
• 27:02five months after the completion
• 27:04of their third shot.
• 27:05If they haven't received
• 27:06their third shot yet,
• 27:07their recommendation is that they
• 27:09complete their primary series,
• 27:11get their third shot,
• 27:12and then five months later receive a booster.
• 27:15So we're hoping that kind of
• 27:19standardizing and socializing the
• 27:21terminology will help simplify some
• 27:24of the guidelines moving forward.
• 27:27Yeah, we'll go ahead and yeah,
• 27:28I just I'm not gonna go
• 27:29through this in detail.
• 27:30This is more to just remind people
• 27:32that we do have a resource,
• 27:34a health system resource,
• 27:36which is called the COVID-19
• 27:37vaccine decision table.
• 27:38This is retrievable from the COVID
• 27:41Intranet website and it they are
• 27:44actively updating this to align with the
• 27:47terminology that I just outlined for all
• 27:49for the group and it has age specific.
• 27:53Criteria for each vaccine type and
• 27:57will be updated with the booster
• 27:59dose information as well.
• 28:01Next slide.
• 28:04Again,
• 28:04just a reminder in that same document,
• 28:06it also has an appendix that
• 28:09outlines the definition of
• 28:10immunocompromised conditions that
• 28:12qualify for A3 dose primary series.
• 28:15I won't go through this in detail,
• 28:17but is more to just remind people that we
• 28:20have standard definitions for these groups.
• 28:23And then I think there's one last slide
• 28:26just to also share that the health
• 28:29system vaccination scheduling website
• 28:31has also been updated to standardize
• 28:34the language as I just presented it and see.
• 28:37I'm also confirmed that CVS is
• 28:39using very similar language,
• 28:41so you can see here.
• 28:42It should be very clear when
• 28:45you go to schedule that.
• 28:47You're either scheduling a third
• 28:49dose because you're immunocompromised
• 28:51and completed your second dose
• 28:52at least 28 days ago.
• 28:53Or you're scheduling a booster dose and
• 28:56have completed your second or third dose.
• 28:58If immunocompromised at least five
• 29:00months ago, so we're hoping these
• 29:03efforts will make it a little bit
• 29:05easier for patients to understand
• 29:07what they're signing up for.
• 29:09And I've also heard from some that
• 29:11my chart reminders are also going out
• 29:14to people who may now be eligible.
• 29:17For their boost booster,
• 29:18I think the timing of this is because
• 29:21the majority of our patients.
• 29:23Started to receive their third
• 29:25doses in August,
• 29:26so we're right approaching the five month
• 29:28park for a large number of these patients.
• 29:32I think that was the last slide.
• 29:34Thank you.
• 29:35So before we turn this over to Carrie,
• 29:39there are a few questions about
• 29:41vaccines that I think it probably
• 29:43makes sense to answer now.
• 29:45So first, in terms of the the concept of.
• 29:51The primary series being three shots
• 29:53for an immuno compromised patient.
• 29:55Does it matter if that third shot
• 29:58is was given five or six months
• 30:01after the first two? No, no,
• 30:03it's at least 28 days after,
• 30:06but if they haven't received it and
• 30:07I think you know in that scenario,
• 30:09I think the language is a little
• 30:11maybe a little bit arbitrary,
• 30:13but I think the importance is is that
• 30:15they complete their three doses and
• 30:17then they they can't get a booster
• 30:19after they complete that series.
• 30:21OK, and then the the booster would
• 30:23then still be five months later.
• 30:25Yes, yeah, exactly.
• 30:27And two more questions.
• 30:29Are you recommending a
• 30:31second booster for anyone?
• 30:39Not at this time that I can can think about.
• 30:41I think that's our next like we're
• 30:43trying to get through this initial
• 30:45push and then I think the next step
• 30:47is figuring out what's the next.
• 30:49You know, what's the next step after
• 30:52that initial booster is is given?
• 30:54And Sam, do you look like you wanted to add?
• 30:57I just want to point out that what
• 30:59we presented today is specific
• 31:01to patients and not employees.
• 31:02I think there was one question here.
• 31:06And and in terms of the definition
• 31:10of immunocompromised patients,
• 31:11and you had a slide that that addressed that,
• 31:14and you had on that slide
• 31:17chemotherapy all chemotherapy is,
• 31:19of course not the same, and,
• 31:21for example, would you consider a
• 31:24woman getting keep side of being a
• 31:28not a very immunosuppressive therapy,
• 31:30or a man for that matter,
• 31:32as being immunocompromised and needing that?
• 31:36That third vaccine is a primary series.
• 31:39Yeah, so the CDC used a pretty
• 31:42broad definition and I think our
• 31:44guideline in that appendix was
• 31:46in some sense and attempt to stay
• 31:49consistent with what the CDC outlined,
• 31:51but agree there's a lot of variety
• 31:54within the groups listed on that
• 31:56slide around level of of some you
• 31:58know or degree of immunosuppression.
• 32:01And finally a question and
• 32:03I'm just going to read it.
• 32:05Is the Moderna Rooster a full
• 32:08dose of vaccine or a partial dose?
• 32:11And if an immunocompromised patient
• 32:13received a booster as a third dose,
• 32:16and if the booster is a partial dose,
• 32:18what are the recommendations?
• 32:24I actually do not know the
• 32:26answer to the first part.
• 32:28If it's whole or partial.
• 32:32Sam the booster from Moderna is
• 32:35half half half of the dose. So
• 32:39it so if a patient received 2 doses of
• 32:42Moderna and what was thought to be a
• 32:45Moderna booster which was half dose and
• 32:48is immunocompromised, is that adequate?
• 32:55Yeah, I don't. I don't think we
• 32:56have a lot to guide us in answering
• 32:58that other than they should get up.
• 33:00They should get a booster
• 33:01dose when they're eligible.
• 33:02I think Doctor Seropian's were phoning a
• 33:04friend and he's a concurring with that.
• 33:08Uh, yeah. There is no official
• 33:12reach in this circumstance.
• 33:14They should get a fourth dose.
• 33:17I guess if they're if they're really,
• 33:19truly immunocompromised. OK.
• 33:25So thank you very much,
• 33:27Sam and Lisa and Kevin,
• 33:30who I didn't get chance to thank.
• 33:31And now we're going to turn
• 33:33this over to Kerry Gross,
• 33:35who I believe is giving us an
• 33:38update on the Center for outcomes,
• 33:41public policy and effectiveness
• 33:42research or or copper.
• 33:43And just to point out that carry
• 33:47mentors multiple people in oncology
• 33:51and has multiple cancer researchers.
• 33:55As part of copper,
• 33:57so carry the floor is yours and
• 33:59you're gonna share your screen.
• 34:14Can you see that? My slide.
• 34:18Alright, so I'm wanted also to.
• 34:23I have to say welcome Eric.
• 34:25We're excited to have you here and
• 34:27I'm really honored to be presenting
• 34:29on the first town hall and.
• 34:32I was going to start by describing the
• 34:35copper center and a little bit of a
• 34:38description about what outcomes research is,
• 34:41because for many people it's a type of
• 34:44research that they're not familiar with,
• 34:47but actually everything we've
• 34:48been talking about on this call
• 34:50directly relates to outcomes.
• 34:52Research Sam and Lisa talking about,
• 34:55you know.
• 34:55Right now we're adopting these
• 34:57new antiviral viral therapy
• 34:59that we know very little about,
• 35:01talking about rationing.
• 35:02You know accessing these therapies when
• 35:05there when there's very low supply.
• 35:07Kevin talking about our high volume
• 35:10up for COVID our high volume
• 35:12hospital and how we seems like
• 35:14we may have been offering better
• 35:16outcomes for our patients.
• 35:18So all these things,
• 35:19adoption of new therapies looking at
• 35:22the way we're delivering healthcare
• 35:24relation between volume and outcomes.
• 35:26This is all outcomes research already.
• 35:31So our cancer outcome center.
• 35:34My name is Carrie Gross.
• 35:35I'm a general internist,
• 35:37but I've been interested in
• 35:39cancer of my whole career.
• 35:41My main focus is on looking at the adoption
• 35:44and impact of new cancer therapies.
• 35:47So today I just spend a few minutes
• 35:49telling about what is the copper center,
• 35:52what's new, and what's next.
• 35:54Why does she care about it and
• 35:55why we hope to engage engage more
• 35:57people in the work that we're doing?
• 35:59So copper is a a pretty large consortium
• 36:04of faculty of Clinician investigators
• 36:07from throughout the medical school
• 36:09and the School of Public Health.
• 36:12So again, I'm a general internist.
• 36:14So I really look to all of my.
• 36:16Oncology colleagues, in particular to
• 36:18help to identify the salient question.
• 36:20So we have colleagues from medical oncology.
• 36:23As you can see here, Sir John OBGYN,
• 36:27neurology, public health, etc.
• 36:29So it's really an interdisciplinary group.
• 36:33So what do we try to do?
• 36:34So four things.
• 36:35So we first of all with this
• 36:38interdisciplinary focus,
• 36:40we engage in catalyze,
• 36:42really try to promote the sharing
• 36:44of ideas across disciplines.
• 36:46We aim to develop new research methods,
• 36:49which I'll talk about a little
• 36:52bit more briefly,
• 36:53we train Eric as you were mentioning, Inc.
• 36:57We engage and inspire new clinicians
• 36:59and cancer outcomes, research,
• 37:02and finally.
• 37:04Maybe one of the more important
• 37:06ones we're hoping to discover new
• 37:08information that will improve real-world
• 37:11that care and ensure equitable
• 37:13outcomes for patients with cancer.
• 37:16So I want to highlight that what
• 37:18we do is translational research.
• 37:20Often we think about translational research
• 37:23in the early phases from like 2021,
• 37:27when we're first translating new
• 37:29compounds or ideas into into the
• 37:32Cuban setting like these phase one
• 37:34trials or T2 translational research,
• 37:36which includes you know the clinical
• 37:39trials where we were really determining.
• 37:42Can a new agent or a new compound work.
• 37:46What we do in copper.
• 37:47We focus on this aspect of
• 37:50translational research.
• 37:51Both T3 and T4.
• 37:53So T3 research is what most people would
• 37:56think about effectiveness research.
• 37:58Does a practice or does a new treatment
• 38:02working in in clinical practice in T4 is
• 38:05is a population level outcomes research,
• 38:09so I want to highlight just a couple of
• 38:12exemplar projects and initiatives that
• 38:14we're working on in the copper center.
• 38:17One is a castle,
• 38:19which is the we're very big on acronyms,
• 38:22which is the cancer care and innovations lab.
• 38:25Really excited to be working on this with
• 38:28Karen Adelson over the past few years.
• 38:30So what do we do in Castle?
• 38:32It's kind of very closely
• 38:34aligned with the concepts that
• 38:36I talked about at the beginning,
• 38:38so we're really looking
• 38:40at real-world practice.
• 38:42Specifically here at Smilow,
• 38:43so we want we want to design and
• 38:46evaluate the novel payment and
• 38:49cancer care delivery interventions
• 38:51that we're seeing every day in
• 38:53dealing with as part of our clinical
• 38:55and administrative practice.
• 38:56In order to inform a practice
• 38:59here at Smilow and
• 39:00also to create generalizable knowledge
• 39:02for the US health care system.
• 39:05So just a couple really brief example,
• 39:08our projects here.
• 39:08So we looked at the new urgent
• 39:11care center to assess the.
• 39:12Impact of opening that
• 39:15center on urgent care use.
• 39:18We we're evaluating the oncology care model,
• 39:21which Yale it does participate in.
• 39:23It's a payment.
• 39:25An episode based Payment Reform initiative.
• 39:30Here you can see we looked at
• 39:32the relation between patients
• 39:34being involved in clinical trials
• 39:36and whether they their costs.
• 39:39Their overall cost of Medicare
• 39:41came in below target and we found
• 39:44that patients enrolled in clinical
• 39:46trials actually were more likely
• 39:48to have lower cost in this regard.
• 39:51This new hospitalist service,
• 39:53which is really an exciting
• 39:56development because the oncologists
• 39:58are up until very recently,
• 40:01had to be both inpatient attending and
• 40:04also covering the outpatient clinic.
• 40:06So here we looked at the impact of this
• 40:09new hospitalist service on several outcomes,
• 40:12including length of stay.
• 40:14And you can see that there's been a
• 40:17dramatic decrease in the length of stay.
• 40:19I was told to clarify this does
• 40:21not mean that the old system,
• 40:23the oncologist were not.
• 40:26That were not working hard actually is
• 40:28reflective of the fact that they were just.
• 40:29They were just.
• 40:30Expectations were too high and this new
• 40:33system is just much more patient centered,
• 40:35much more efficient or
• 40:36getting people out quicker.
• 40:38So Castle really is excited to work
• 40:41at this intersection of copper
• 40:43and smile allowed to develop
• 40:45rigorous evaluation approaches.
• 40:50That last 30 go end of life dashboard.
• 40:54So here we work with some
• 40:56of our external partners.
• 40:58In this case flat iron is
• 41:00a data science company.
• 41:01We used user data for research but also
• 41:04they work with us to help do some analytics.
• 41:07So here they've helped us to develop
• 41:10individualized end of life care
• 41:13provider reports with an idea to
• 41:15where the objective is trying to
• 41:17decrease aggressive and the life care.
• 41:20Same here, national benchmarks and just
• 41:23really briefly what's new couple things.
• 41:26Most importantly, we have a lot of
• 41:28new faculty joining Yale overall,
• 41:31and copper in particular, so I don't.
• 41:34I won't read all these allowed you,
• 41:36but many new faculty and trainees.
• 41:39Coppers never been bigger, happier than this.
• 41:42Now we now have three career development
• 41:47award, 3K award ease. In copper.
• 41:51We have a new FDA partnership.
• 41:55This other spent a couple of minutes on.
• 41:57The idea here is we're working with
• 41:59the oncology Center of Excellence
• 42:01to identify what what they're
• 42:03hoping we're hoping will be a new
• 42:06approach for drug evaluation.
• 42:08Specifically,
• 42:08looking at a new ways to investigate
• 42:11physical function in patients with cancer.
• 42:14So we're comparing love.
• 42:16Skip over here.
• 42:17So we're comparing 4 different modalities so
• 42:19there's everybody is going to get a Fitbit.
• 42:22There's about 200 patients with breast
• 42:24cancer or lymphoma that are getting
• 42:27at multi agent site cytotoxic therapy,
• 42:29so we're getting Fitbits the stopwatches.
• 42:32It's a 6 minute walk test,
• 42:34so we're going to watch them walk.
• 42:35They're going to do self
• 42:37assessments in their computer,
• 42:38and then there's going to
• 42:39be a clinician assessment.
• 42:40So working hand in hand with the FDA will
• 42:43be evaluating different approaches to
• 42:46assessing assessing physical function.
• 42:49And finally,
• 42:51some equity focused projects.
• 42:54Eric, you mentioned that the focus
• 42:56on equity here at Yale,
• 42:58and that's something that yeah,
• 43:00it is.
• 43:00If you look at this awful thing
• 43:02that happened at Brigham and Women's
• 43:04yesterday with his new Nazis out
• 43:06there protesting against people
• 43:08who are engaging in HealthEquity
• 43:10research now more than ever,
• 43:11it's important to support these efforts
• 43:14and we're really excited to be working.
• 43:18Closely with my seller and her team in
• 43:22the Center for HealthEquity and Cancer,
• 43:25so we're looking at macalik.
• 43:27Dyneins has an oral one looking at
• 43:30disparities and use of oral anti
• 43:32cancer agents and kidney cancer.
• 43:34We have a couple of small pilots
• 43:36looking at social determinants
• 43:38of health and some other pilots.
• 43:40Proposals finally,
• 43:41so I can go into a thank you to our
• 43:47external funders and enter the Cancer Center,
• 43:51NYC or internal funders.
• 43:55Carrying whirlwind tour
• 43:57that that would that was that was great,
• 43:59and in fact I have to say that the number of.
• 44:03Surgical, medical and radiation
• 44:05oncologists who are working in
• 44:07copper even astounded me and I knew
• 44:10there were a bunch there and I know
• 44:13that there are several coming of
• 44:15people that we've been recruiting.
• 44:17Pat La Russo has a question and
• 44:20it's it's an interesting one.
• 44:23So do you think that the cost for patients
• 44:26on clinical trials is lower because they
• 44:29have to meet performance status and
• 44:31organ metrics that are more stringent
• 44:34than patients in standard of care?
• 44:36And or two.
• 44:37They're typically followed much more
• 44:39closely than patients on standard
• 44:41of care due to safety imports.
• 44:44That's a great question.
• 44:46It's artificially lower, they can't.
• 44:49The in the OCM model the people
• 44:51enrolled in trials came in below
• 44:54target and the reason why is
• 44:56could not be a more simple one.
• 44:58You're more thoughtful answers
• 45:00and this is the real reason why
• 45:03is frankly the because the drug
• 45:04company gives the drug for free.
• 45:06So you're you're in this,
• 45:08so if you're in a checkpoint trial,
• 45:10you're getting the checkpoint inhibitor
• 45:11as part of being enrolled in a trial,
• 45:13so this cost saving to Medicare
• 45:15and then says policy relevant.
• 45:17It's called saving to the pair to have
• 45:20patients enrolled in clinical trials,
• 45:22but it's it's really because of that.
• 45:27Yeah, and Karen's adding that
• 45:29yeah and also and because of that.
• 45:31I don't know if you cannot say that
• 45:34other lower novel therapy drug costs,
• 45:36be it because the costs were being cast for
• 45:39being, I mean, the other thing that
• 45:41you can't account for is the fact that
• 45:43patients who enroll in clinical trials
• 45:45are fundamentally different and not
• 45:46even not even because of organ function,
• 45:49but because of their own choices,
• 45:51and then patients getting stated or care,
• 45:54and the doctors enrolling patients
• 45:56in clinical trials are are
• 45:58also somewhat different.
• 45:59So you know they're the wild card.
• 46:03Wild cards in this whole equation, and
• 46:05they often have more social support
• 46:07outside of the health care setting.
• 46:08And maybe they even have more support.
• 46:10They do have more, probably shouldn't.
• 46:12They probably have more support from the
• 46:14medical team than non trial participants?
• 46:16It's they're more plugged in,
• 46:17you know. Maybe that's
• 46:19the bottom line is we should keep
• 46:20enrolling patients in trials once.
• 46:22Once we get everything fixed here.
• 46:23With this with the CTO.
• 46:27Any other questions that people have?
• 46:32And Pat answered absolutely to me,
• 46:34we should continue to enroll in trials.
• 46:39Alright, well Carrie,
• 46:40I thought that was really wonderful.
• 46:43It's it's. It's great to see all the
• 46:46good work that's done and and and.
• 46:48Even more so, all the work that's being
• 46:51done related to health care disparities,
• 46:54which is is hugely important.
• 46:57I didn't realize that there had
• 46:58been a a demonstration in front
• 47:00of Brigham and women yesterday.
• 47:02I somehow missed that pretty even
• 47:05in the state of Massachusetts.
• 47:08So what can I say?
• 47:11Well, thank you all very much.
• 47:12We'll end a little bit early.
• 47:14Look forward to seeing everybody
• 47:17at the next town hall.
• 47:19And again, I'm.
• 47:20I'm really thrilled to be here,
• 47:23and I think that the staff unions
• 47:26presentations demonstrated why I'm
• 47:27thrilled to be here, so thanks.
• 47:30Thank you goodnight.