Smilow Cancer Hospital Town Hall | March 2, 2023

Transcript

• 00:00Me to welcome Mark. Community to the
• 00:05reduce our team and our panelists.
• 00:08This evening I'm joined by my
• 00:11esteemed partner Kim Slusser.
• 00:12Our Vice president of Patient services.
• 00:16Liz Herbert is with us this evening.
• 00:19Liz is the vice president of the Smilo
• 00:22Cancer Network and I'm really delighted
• 00:25to introduce Doctor Caron Taranga.
• 00:28I will introduce him in more formal
• 00:31length later in the program, but.
• 00:34He is our division chief
• 00:37of Surgical Oncology.
• 00:38So we will be starting with some
• 00:42clinical announcements and then doctor
• 00:44Terrago will share with us a very
• 00:47exciting new multidisciplinary clinical
• 00:49program that he and his team will be
• 00:53leading here at Smilow and throughout
• 00:55the system for the treatment of
• 00:57patients with peritoneal malignancies.
• 01:05Alright. Well, thank you everyone.
• 01:07I want to also give my thanks
• 01:10for joining us this evening.
• 01:12I know we had to reschedule.
• 01:13We were originally going to
• 01:14have our town hall last week,
• 01:16but we had a visit from the Joint Commission,
• 01:19so we had to reschedule.
• 01:20So we appreciate everybody's flexibility.
• 01:23We started last month starting
• 01:25to share patient stories and this
• 01:28is a a wonderful patient story
• 01:30from our radiation oncology team.
• 01:32This young man turned 10.
• 01:36Umm, just just a couple weeks
• 01:39ago and unfortunately he had to
• 01:41spend his 10th birthday with us
• 01:44receiving his radiation therapy.
• 01:46But you can see that our nursing
• 01:49and and clinical teams really made
• 01:52this day very special for him and
• 01:55they threw him a 10th birthday
• 01:57party to celebrate and he was so
• 02:00appreciative and there were cupcakes
• 02:02and decorations and presents and
• 02:05it was just a really special.
• 02:07Day for him making it the best
• 02:09it could be even though he is
• 02:12going through quite a lot.
• 02:14So I want to give just a special,
• 02:17you know,
• 02:18kudos to our radiation oncology
• 02:19team for taking the time to make
• 02:21his day as special as it could be.
• 02:25Another announcement that we wanted
• 02:27to share this evening is we have
• 02:31launched our new graduate Nurse
• 02:33Ambulatory Fellowship program.
• 02:35So this is a program where we will
• 02:38have new graduate nurses hired
• 02:40directly into the ambulatory area.
• 02:43This is a new space for us and smilo,
• 02:45we have historically only hired experienced
• 02:49nurses into our ambulatory area and
• 02:53really you know they have come from our.
• 02:54Inpatient units are from other
• 02:57organizations with oncology experience.
• 02:59So out because of the generosity of
• 03:01the Frederick A DeLuca foundation,
• 03:04we have been able to develop
• 03:06a fellowship program.
• 03:07This is a 9 month program that
• 03:09will really be dedicated to the
• 03:11onboarding of new graduate nurses.
• 03:13So they can really.
• 03:16Really have a strong background
• 03:18in oncology before they have to
• 03:21fully be integrated into practice.
• 03:23We will also focus on mentorship
• 03:25for this group.
• 03:26It will be a cohort of 6 nurses.
• 03:28We are already starting to take applications.
• 03:31From my understanding,
• 03:32we've had many shadow experiences
• 03:34with students and have a lot
• 03:36of interest in this program.
• 03:37So we're very excited about our
• 03:39first cohort that will begin in July
• 03:42and then following the next year,
• 03:44we will also add an advanced.
• 03:46Practice provider Ambulatory
• 03:48fellowship program to this,
• 03:51to this curriculum.
• 03:52And so we're we're really excited about it.
• 03:55We're looking forward to it.
• 03:58And and we'll share more as we
• 04:01on board our our new graduates.
• 04:04This summer.
• 04:07We also want to take the time to
• 04:10recognize our advanced practice
• 04:12providers who recently received
• 04:15clinical ladder promotions.
• 04:17So we have Kelly, Christina,
• 04:20Carrie Ann and Ann Marie.
• 04:22So congratulations to all of you for
• 04:25achieving the clinical ladder too.
• 04:27Again, you show commitment to your
• 04:29practice and to your profession
• 04:31and we are just so appreciative
• 04:34of you being on our team.
• 04:39We are also delighted to announce that
• 04:42Annette Hood has been promoted to
• 04:46manager of oncology pharmacy services.
• 04:48So we want to make sure that we
• 04:51recognize Annette for everything
• 04:52that she has contributed to smilo and
• 04:54congratulate her on her promotion.
• 04:56So congratulations on that.
• 05:02And as I mentioned last week,
• 05:03we had our Joint Commission
• 05:05accreditation survey.
• 05:06The surveyors were here
• 05:08from February 20th to 24th.
• 05:10And again this is a survey for the
• 05:13entire Yale New Haven Hospital which
• 05:15Milo is is part of and we take part in that.
• 05:19In that accreditation survey,
• 05:20I will tell you that the surveyors visited a
• 05:24lot of our smilo sites and and departments,
• 05:28so on the York Street campus
• 05:30out in our network.
• 05:32And they were very busy visiting pharmacy,
• 05:35radiation oncology, our clinics,
• 05:37our infusion centers and our inpatient units.
• 05:41Also our Smilo boutique received
• 05:43their reaccreditation for their
• 05:44durable medical equipment.
• 05:46So congratulations to this Milo boutique.
• 05:49And we just received so many compliments
• 05:51regarding all of our all disciplines,
• 05:54all clinical team members and departments.
• 05:56We they couldn't believe the quality measures
• 05:59that we had in our radiation oncology.
• 06:02Department very impressed with our
• 06:04pharmacy services and our nursing
• 06:07practice and our physicians and
• 06:09the way that they demonstrated care
• 06:12and compassion to our patients.
• 06:14And they complemented our documentation
• 06:16for all of our clinical team
• 06:18members how thorough it was.
• 06:20And they could really tell that
• 06:22we had a commitment to safety
• 06:24and to coordination of care.
• 06:26Several of our areas had 0 findings,
• 06:28and I listed them there,
• 06:30North Haven, Waterbury, Torrington.
• 06:31All of our inpatient units and orange.
• 06:35So I just want to thank everyone on
• 06:37the Smilo team for a very successful
• 06:40Joint Commission accreditation survey.
• 06:42Even the findings that we had within
• 06:44Smilo were very minimal and usually
• 06:47related to a small environment of
• 06:49care finding the hospital as a whole
• 06:52will be revisited in the next 30 to
• 06:5545 days for some findings that we
• 06:57had to do some immediate correction.
• 07:00And again,
• 07:00most of those were around our
• 07:02environment of care.
• 07:03But the Joint Commission surveyors
• 07:04could not have been more impressed
• 07:06with the care delivery that we
• 07:08provide our patients.
• 07:09So thank you to the entire team
• 07:11and so proud to be to be part of
• 07:14Smilo and you represented us well
• 07:17last week for the Joint Commission.
• 07:19I'm going to turn it back over to Kevin.
• 07:23Thanks, Kim. You know,
• 07:24I'm just going to add my voice to yours
• 07:27with saying a very heartfelt thank
• 07:30you to all of our clinicians and staff
• 07:33and teams across the organization.
• 07:35Regulatory readiness is one of
• 07:38these difficult ongoing tasks that
• 07:41in the moment seems thankless,
• 07:43but it pays huge dividends and the safety
• 07:48of our care and the recognition and.
• 07:54You know support for our organization
• 07:56when we do well in these surveys.
• 07:58So it is a real kind of testament to
• 08:02the dedication of our of our teams and
• 08:05our staff to have such a really a strong
• 08:08review that we all should be proud of.
• 08:11You know, one of the other areas that
• 08:13we are surveyed in, ranked of course,
• 08:15is the annual U.S. news.
• 08:19And World Report Best Hospital survey,
• 08:22this is a a national ranking
• 08:26that we're aware of that.
• 08:28Brings together a number of factors and
• 08:31one of them is the reputational survey.
• 08:34The reputation is based on voting of
• 08:38clinicians through the Doximity app.
• 08:42Virtually all of us are getting
• 08:45who have registered for Doximity,
• 08:47and I will encourage all of our
• 08:51clinicians to sign up for doximity.
• 08:54It's easy to do.
• 08:55You can.
• 08:56If you haven't,
• 08:57please register through the website
• 09:00on the slide.
• 09:02You will receive a link from
• 09:05Doximity or you can use this QR code.
• 09:08Please register vote.
• 09:10You obviously can vote for Yale
• 09:13and for smilo you will find that as
• 09:17a staff member or faculty member.
• 09:21That is something that we disclose
• 09:23in the voting process,
• 09:25so the the biggest thing we can
• 09:28all do is reach out to colleagues.
• 09:32Trainees.
• 09:34And peers around the country and
• 09:36remind them of the excellence of our
• 09:40clinical programs, our research,
• 09:42our training and our outcomes.
• 09:45So that we get the appropriate
• 09:47recognition for all the work we do.
• 09:49Next.
• 09:52A couple of announcements,
• 09:55umm, one of our most important
• 09:58committees within the Cancer
• 10:00Center and the Cancer Hospital is
• 10:02the the so-called P&T committee.
• 10:04This is pharmacy and therapeutics.
• 10:07We have some leadership appointments
• 10:09that I want to make sure that
• 10:12the Community is hearing about.
• 10:15Doctor Scott Huntington of the
• 10:17Lymphoma Service has graciously
• 10:19agreed and stepped up to serve as
• 10:22the new chair of this committee.
• 10:24Doctor Ann Chang will be serving
• 10:27as vice chair.
• 10:28And I need to of course mention
• 10:31and thank Sam Abdulghani,
• 10:33who's our Executive director of
• 10:35Oncology Pharmacy Services.
• 10:37The P&T committee plays a
• 10:39pivotal role in maintaining an
• 10:42up-to-date and value based oncology
• 10:45formulary across our enterprise.
• 10:48The P&T committee structure
• 10:50also does things like help us
• 10:53with the approval and review of
• 10:56inpatient chemotherapy requests.
• 10:58In review and evaluation of inpatient
• 11:02treatment of high risk patients.
• 11:04So I can't overstate the importance
• 11:08of this work and the the quality
• 11:10and safety of the care we deliver.
• 11:13So please join me at some point when
• 11:15you run into Doctor Huntington, Dr.
• 11:18Chang or Sam and please thank
• 11:20them for their service.
• 11:23So without any further commentary,
• 11:27it is a real pleasure for me to more
• 11:29formally introduce Doctor Turaga,
• 11:31who is our featured speaker today.
• 11:34You know, one of the most gratifying
• 11:37things as a clinical leader is
• 11:39to see new faculty come into the
• 11:43organization and bring exciting and
• 11:46novel multidisciplinary programs.
• 11:48Doctor Turaga is a world expert
• 11:51in the multidisciplinary.
• 11:53Treatment of peritoneal surface malignancies.
• 11:56He's a graduate of the All India
• 11:58Institute of Medical Sciences.
• 12:00He did his surgical training
• 12:01at Creighton University,
• 12:02followed by surgical oncology
• 12:04training at Moffitt Cancer Center
• 12:06and the University of Pittsburgh.
• 12:09He's held a succession of faculty
• 12:11appointments with ascending roles
• 12:13and leadership at the Medical College
• 12:16of Wisconsin and the University of
• 12:19Chicago before we had the good fortune
• 12:21to recruit him here to Yale as our
• 12:24division Chief of Surgical Oncology.
• 12:27Over the years,
• 12:29he's developed a robust clinical
• 12:32and integrated research program
• 12:34in the treatment of this group of
• 12:37patients who have a unique cancer
• 12:39problem that is primary or metastatic
• 12:42cancer involving the lining of the
• 12:44abdomen or peritoneal surfaces.
• 12:46This is a challenging area to treat,
• 12:48which requires not only systemic therapy,
• 12:51but local regional chemotherapy
• 12:53and complex surgery,
• 12:54and that will be his topic today, so.
• 12:57Welcome again Doctor Turaga.
• 12:59Thank you for sharing your
• 13:01insights with our community.
• 13:03Thank you so much, Kevin, Dr.
• 13:05Billingsley and thank you everyone.
• 13:07I think it's it's very exciting to see
• 13:10the remarkable outcome of the Jayco visit.
• 13:12I think it's it's it's a
• 13:14feather and everyone's cap.
• 13:15So congratulations and thank you
• 13:18for letting me share a little bit.
• 13:20I'm going to make a it's it's a
• 13:23very short presentation so hopefully
• 13:25we'll have time for questions.
• 13:27I hope you're seeing my presentation view.
• 13:31But I I'm hoping to speak with all of you
• 13:33a little bit about peritoneal metastasis.
• 13:36And I think it's as Doctor
• 13:39Billingsley had mentioned, it's a,
• 13:41it's a poorly understood area.
• 13:43And if you think of cancers that
• 13:45spread to the lining of the abdomen,
• 13:48they can either be any of the GI cancers,
• 13:51ovarian cancers and then certainly
• 13:53there's cancers that actually arise in
• 13:56the curriculum like mesothelioma or
• 13:58desmoplastic small round cell tumor.
• 14:00So it's a very heterogeneous group of
• 14:02cancers. There's a lot of patients.
• 14:04In fact, if you think in the United States,
• 14:05there's probably about 150,000 patients
• 14:08with biracial metastasis every year.
• 14:10So it's a very,
• 14:11not an uncommon problem at all,
• 14:13but it's unfortunately very poorly
• 14:16understood and requires sort of
• 14:18expertise in terms of taking care of.
• 14:22So I think you know this is this
• 14:24is something that was not uncommon
• 14:26for us to see.
• 14:27And so you can sort of see this
• 14:29patient here has been carrying about
• 14:3025 liters of mucinous tumor in his
• 14:34abdomen that we operated on 12 years ago.
• 14:37He had been told by three different
• 14:39doctors at three academic institutions
• 14:41where I was prior that he was
• 14:43going to die in three months.
• 14:45And this gentleman came to
• 14:46us had a big surgery,
• 14:47it was a 14 hour surgery where we
• 14:49cleaned out all the cancer that he had,
• 14:51did hot chemotherapy in his abdomen and
• 14:54and he just sent me a note recently
• 14:56saying that he was doing well.
• 14:57So it's it's just remarkable to think
• 14:59about how bad we are and sort of
• 15:02understanding some of these tumors.
• 15:03And in fact at one time we did a
• 15:05survey in our clinic and 90% of our
• 15:07patients that had lived five years
• 15:09or longer had been told either by
• 15:11a physician or health care provider
• 15:12that they would only live three
• 15:14months and so.
• 15:15It it comes down to the fact that you
• 15:17have to identify those patients that do well,
• 15:19those patients that don't do well
• 15:21and how can we advance the field
• 15:23being here at Yale.
• 15:24So I think that's sort of my my
• 15:26interest in terms of thinking about
• 15:28how do we actually advance the
• 15:30care for these patients.
• 15:32Some of you that have heard me speak before,
• 15:35will would have certainly heard
• 15:37about this this patient that that
• 15:40I had the the honor of taking care
• 15:43of and this was a high school,
• 15:45he was a middle school teacher.
• 15:47And what you're seeing for those
• 15:48of you that are
• 15:49not surgeons is the head of the patient
• 15:51that towards the left of the screen,
• 15:53the feet of the patient are down here.
• 15:55And he had colon cancer
• 15:57and he got chemotherapy.
• 15:58He did everything right.
• 16:00He got his scans every three months.
• 16:02He did everything that we had prescribed
• 16:04them as doctors to take care of his cancer.
• 16:06And he presented 2 years later with
• 16:09an obstruction in the emergency room.
• 16:11And I was, I said let me go try to fix it.
• 16:14And this is what I saw.
• 16:15He had CT scans, were completely clean.
• 16:17So all the doctors treating
• 16:18him thought he had no cancer.
• 16:20And you can see this is actually
• 16:22his liver right here.
• 16:22This Elmer's glue is all cancer
• 16:25that's basically fused his colon,
• 16:27which is this structure right here.
• 16:28You could sort of see these deposits and
• 16:30those of you that are on your monitors
• 16:32are probably even appreciate these.
• 16:33Small tumors that were on
• 16:34his entire small intestine.
• 16:36But here was a young person
• 16:38whose life was lost.
• 16:39Because we did everything right and
• 16:42we still couldn't fix this, right.
• 16:44And so I think you know cancer is
• 16:45a tough disease and that's why you
• 16:47know we all come to work to see if
• 16:49we can help our patients and reduce
• 16:51suffering and hopefully cure cancer.
• 16:53But these are sorts of the types of
• 16:55patients where there was sort of a
• 16:57mismatch between what we knew as
• 16:58as physicians and the care that was
• 17:00being provided for these patients.
• 17:03And so the techniques that we developed
• 17:05along with several others were
• 17:07something called cytoreductive surgery.
• 17:09You know,
• 17:09this is a term that many of you here,
• 17:12sometimes people call it debulking surgery.
• 17:14You know,
• 17:15debulking means I'm not doing a complete job.
• 17:17You know, I'm not taking out all the tumor.
• 17:19I'm doing it only to help someone
• 17:21with sort of symptoms.
• 17:22Signal reduction means I'm trying
• 17:24to get all the tumor out with
• 17:26an intention of curing someone.
• 17:27So that's the goal is the goal
• 17:29is can we attempt to cure them.
• 17:31Now we don't cure everyone.
• 17:32But we are able to help patients
• 17:34live a lot longer.
• 17:36Can we convert these cancers
• 17:38into what we call,
• 17:40you know,
• 17:41the hitchhiker model where we keep
• 17:42them alive long enough until the
• 17:44next best therapy comes for them.
• 17:45And we do cure a percentage of patients even
• 17:48with aggressive cancers like gastric cancer,
• 17:51colon cancer that spreads through the lining.
• 17:53And so the, the appreciation of the
• 17:55peritoneum is sort of the key factor here.
• 17:57So this is one of my patients that you know,
• 18:00a general surgeon,
• 18:00actually very respected general
• 18:01surgeon in the community saw and said,
• 18:03oh, you know, I can't do surgery,
• 18:05there's lots of cancer, you know,
• 18:07and you should go home and die.
• 18:08And when we actually looked at it,
• 18:09what we noticed is this was
• 18:11all along the peritoneum.
• 18:12So you can actually trip or
• 18:13clean out the peritoneum
• 18:14myself patients.
• 18:15It's like taking off paint on the wall.
• 18:18And so it's basically you're
• 18:20not damaging the walls,
• 18:21you're just taking the paint off the
• 18:22walls and this is what we're doing.
• 18:24Over here you can see this is being done
• 18:26open in this scenario where we have
• 18:27our hand here and this is that lining,
• 18:29it's like, it's actually like Saran wrap.
• 18:31It's it's exactly as thin as Saran wrap.
• 18:34But this the same patient,
• 18:35you know over here we've cleaned
• 18:36all the muscle out.
• 18:37You can actually see the muscle
• 18:39fibers that are completely
• 18:40cleaned out and the entire bird,
• 18:42Neal tack has come off over here.
• 18:44So just using techniques and you know,
• 18:46developing techniques where
• 18:47we don't have to cut organs,
• 18:49where we don't have to take colons
• 18:51out and uteruses out and ovaries out,
• 18:53you know, help us kind of develop an
• 18:56expertise in getting patients better.
• 18:58And and sort of many times this
• 19:00program is called the HIPEC program.
• 19:01And so that's sort of like the,
• 19:03you know,
• 19:04the common way that we described this.
• 19:06But you know it's,
• 19:07it's again it's a broad multidisciplinary
• 19:09program where we all think about
• 19:11patients with peritoneal metastasis.
• 19:13So that's really sort of
• 19:14what our interest is.
• 19:14But one of the treatments that's
• 19:16very appealing is when there's
• 19:17so much cancer everywhere,
• 19:19once you've cleaned it all out,
• 19:20can you actually put hot
• 19:22chemotherapy in the abdomen.
• 19:24So this is what we've done
• 19:25in that same patient,
• 19:26you know you basically you put catheter 1.
• 19:28Something one comes out,
• 19:29it's almost like a car wash,
• 19:30which is putting this hot chemotherapy
• 19:32solution inside the abdomen
• 19:34circulates it for about 90 minutes.
• 19:36The premise is that it actually allows
• 19:38very high concentration of chemotherapy,
• 19:40right where the tumors were.
• 19:42I tell patients it's sort of like
• 19:43the Lysol that you spray after you've
• 19:45cleaned the grease off the floor.
• 19:46So it's sort of it's it's killing
• 19:48those microscopic cancer cells
• 19:50that increases penetration of
• 19:51the chemotherapy to these areas.
• 19:53And it has very low systemic absorption,
• 19:55so very little toxicity.
• 19:57So in fact,
• 19:58when we do these cases laparoscopically
• 20:00or things like that,
• 20:01patients can go home the next
• 20:03day after a surgery like this or
• 20:05even the same day sometimes.
• 20:06So it's,
• 20:06it's really dependent on the
• 20:08amount of work we have to do.
• 20:09And so a lot of our research is
• 20:11focused on how do we find these
• 20:13cancers super early so that we can do
• 20:15very little surgery on patients and
• 20:16actually help them take care of it.
• 20:18And this is an innovation actually
• 20:19that one of our operating room
• 20:21nurses helped us figure out.
• 20:22But this is called laparoscopic typic
• 20:24where we may basically have little
• 20:26vocals and we just put catheters
• 20:28through these little ports and we can
• 20:30run hot chemotherapy in the abdomen
• 20:31and and these patients end up going
• 20:33home the same day or the next day.
• 20:35So this is.
• 20:36This is just a remarkable way that
• 20:39we're able to affect treatments for
• 20:42patients with partial metastases.
• 20:44And I wanted to share some data.
• 20:45I've been here about six months and
• 20:46I'm still exciting to meet all of you.
• 20:48And I think the resources we have
• 20:49at Yale are just unbelievable.
• 20:51So I'm very excited for us to
• 20:52to stand up something like this.
• 20:54I've had great partners in Doctor Koons, Dr.
• 20:57Courtemanche and our entire GI Medical
• 20:59oncology team and and then of course
• 21:01everyone in the ambulatory side,
• 21:02our inpatient side and our orders.
• 21:05And I think we have just the
• 21:06right environment to do this.
• 21:07And we were in a very competitive
• 21:09environment that was in Chicago,
• 21:10one of five academic medical institutions,
• 21:13but very quickly.
• 21:14In a matter of a couple of years,
• 21:15we became one of the largest
• 21:17programs in the country and we saw,
• 21:19you know, we did you know and this
• 21:21is benchmark against MD Anderson,
• 21:23Benchmark against UCSD,
• 21:25Pittsburgh and a Wake Forest.
• 21:28So big centers that do this work.
• 21:30You know we did,
• 21:31we did almost double of what they did
• 21:33and we started getting our patients
• 21:34out of the hospital really fast.
• 21:36We didn't readmit these patients.
• 21:38We were able to actually do this
• 21:39very safely without patients
• 21:41dying from these operations.
• 21:42So we were able to quickly build
• 21:44up a program and I'm hoping that.
• 21:45We can build something even bigger
• 21:47and better while we're here at Yale.
• 21:50But as as I think Doctor Billingsly
• 21:51mentioned and as is true for
• 21:53all of cancer care, you know,
• 21:54it's it's a team effort.
• 21:55It's not ever something where oh,
• 21:58you know the surgeon is doing
• 21:59this and that's how it works.
• 22:00It doesn't work that way.
• 22:01So we had you know,
• 22:02obviously all of us surgical oncology,
• 22:04medical oncology, dynomax,
• 22:05we actually used to do these
• 22:07in pediatric patients as well.
• 22:09My 8 year old that I did 10 years ago
• 22:11just sent me a note as she got into college.
• 22:13So it's just remarkable how the types
• 22:15of stories you had, we had psycom,
• 22:17we had embedded palliative care.
• 22:18So my clinic was with.
• 22:20Relative care,
• 22:20we would see patients together
• 22:22every time of course lots of AP's
• 22:24Nurse Associates who are specialized
• 22:26to the program, therapists,
• 22:27dieticians and then of course
• 22:29research which is so important.
• 22:30You know we we're at the Yale to
• 22:32advance the field not just to you
• 22:34know do routine garden writing care.
• 22:36We're here to make things better
• 22:38for our patients and cure cancer.
• 22:39And so it really took a team for us
• 22:41to get these these things through
• 22:43and I'll talk just about a few
• 22:45initiatives that we had done that
• 22:46I think really helped.
• 22:47You know the first thing was access
• 22:48you know we had to see patients.
• 22:50Within 5 business days,
• 22:51we had all different means and
• 22:53modalities to see our patients,
• 22:55whether it was in person,
• 22:56whether it was a remote visit,
• 22:57whether it was a telehealth visit,
• 22:59whether it was a second opinion remotely
• 23:00and a program for international patients,
• 23:03so patients could access
• 23:03us in any different way.
• 23:05We had something called the Eco
• 23:06visit where we would have a non
• 23:08billable visit for a patient just
• 23:10even talk to us for us to say, hey,
• 23:12you know, we're going to look at
• 23:13your stuff and come talk to us.
• 23:15You know, very soft touch.
• 23:16You know, when someone came,
• 23:17they had, you know,
• 23:19video education patients went to extensive
• 23:21education connection with body systems,
• 23:23you know, working on getting
• 23:25them hotel stays in Chicago,
• 23:26figuring out financial aid for those that
• 23:29were from meager means support groups.
• 23:31And then of course when we had
• 23:33communications from our referring providers,
• 23:35we saw people from all
• 23:37different health systems.
• 23:37So we weren't a big health system at
• 23:39the University of Chicago and like here
• 23:41and how would we keep them engaged so
• 23:43that we would maintain referrals and.
• 23:45And sort of lower volume we would
• 23:46invite them or through our tumor
• 23:48boards participate together and
• 23:49it was very exciting to kind of
• 23:50see how we were able to do that.
• 23:52And you know about 1/3 to 4th,
• 23:551/3 to half of our patients came from out
• 23:57of state and so getting same day scanned,
• 23:59same day labs,
• 24:01infusion services,
• 24:02you know doing paracentesis
• 24:03service synthesis in clinic,
• 24:05you know obviously seeing palliative care.
• 24:06I mean these are the types of
• 24:08things that really got us to the
• 24:10place where we were able to see
• 24:11patients efficiently and kind of make
• 24:13this sort of care of our patient.
• 24:16I think you know beyond just sort
• 24:17of the research aspect of things,
• 24:19the clinical operations got you know
• 24:21amazingly better across our entire
• 24:24Cancer Center as we and bone marrow
• 24:27and stem cell therapy as we all
• 24:29three pushed very hard as programs.
• 24:31We were able to really kind of build a
• 24:33culture of everyone kind of getting in,
• 24:35getting patients seen,
• 24:36getting things done quickly and and
• 24:38kind of really just moving things.
• 24:40You know more patient centric
• 24:42focus on patients getting home,
• 24:43patients having the right care,
• 24:45you know fewer phone calls.
• 24:46Your sort of issues that they had,
• 24:48we did enhance recovery pathways,
• 24:50you know, lots of philanthropy,
• 24:51community engagement and we
• 24:53did all of that stuff.
• 24:56Like I mentioned,
• 24:57you know palliative care was
• 24:58integrally engaged with us.
• 24:59I love the palliative care
• 25:01setup we have here,
• 25:02the integrative medicine setup.
• 25:03So I think it's remarkable.
• 25:05I see so many opportunities for
• 25:07us to work together on taking
• 25:09this to the next level.
• 25:10We made a course so that all the nursing,
• 25:12nursing students I heard about,
• 25:14the administrative fellows and students,
• 25:16you know,
• 25:16that people can actually join and learn
• 25:18more about this disease shared with others.
• 25:20We did it for surgeons and surgical trainees.
• 25:23And so there was just a course
• 25:24module that people would go through.
• 25:25So they knew sort of what the care of these
• 25:28folks was. But I think you know the,
• 25:29the bottom line for any of these is,
• 25:31is just sort of good teamwork.
• 25:33And I think you know as we as
• 25:35we're standing up this program in a
• 25:37multidisciplinary way, you know, it's,
• 25:39it's really just about us collaborating,
• 25:41working with each other,
• 25:42understanding this patient population
• 25:43which is I think very poorly understood
• 25:46but deserves to be taken care of.
• 25:47You know that's why we're Yale,
• 25:49that's why we're here because we are not
• 25:51only going to take care of these patients
• 25:53but we're also hopefully going to help
• 25:55cure these cancers with our research,
• 25:57with our innovative thinking.
• 25:59With our better technology,
• 26:00with our teamwork and so you know,
• 26:03I am very excited to be a
• 26:04part of this community.
• 26:05I'm thankful for for all of you
• 26:07for inviting me to this town hall.
• 26:09And you know I can.
• 26:10I'm glad to answer questions or share
• 26:13more information as as as you wish,
• 26:15but but please feel free to reach out
• 26:17if you want to talk more about this.
• 26:19And thank you again.
• 26:25Thanks, doctor taruga.
• 26:27That was a terrific overview,
• 26:30and I think the audience can
• 26:33probably see why I'm excited.
• 26:35Um, you know.
• 26:38I'm going to just kind of.
• 26:41Take CMO privilege and ask actually
• 26:43ask you the first question,
• 26:45Doctor Turaga.
• 26:48What do you as this program develops
• 26:51for peritoneal malignancies,
• 26:52what do you anticipate is,
• 26:54what do you think the breakdown will be
• 26:58of disease distribution and and maybe
• 27:01just kind of educate people again?
• 27:05Because it's a spectrum of diseases
• 27:08that metastasize and involve
• 27:10the peritoneum ranging from
• 27:12appendix to colon and some others.
• 27:15What do you anticipate us treating
• 27:17here most and and what what
• 27:19will we be reaching out for?
• 27:23Yeah. No, thank you for that question.
• 27:24So you know I so in in our previous program
• 27:29we had you know two of us that did it in
• 27:32the GI on space and we had three of our
• 27:35dynomax that did it and we all did it
• 27:37collaboratively and we did it together.
• 27:39So I will say that very clearly right
• 27:41off the bat, ovarian cancers especially
• 27:43in the interval debulking stage
• 27:46became a very orbital reduction were
• 27:48a very sort of a very high population
• 27:52of our gynecological oncologist.
• 27:54And we used to do on an average about four
• 27:57a month of patients with ovarian primaries.
• 28:00But talking of GI primaries,
• 28:02there is a very distinct set of patients
• 28:05that come and travel and see us.
• 28:07So patients half of our patients would.
• 28:09Travel and come and see us from like
• 28:11websites or find out about information
• 28:13through support groups and things like that.
• 28:15And those were patients with
• 28:17appendix tumors and mesothelioma.
• 28:19And the patients that came to us
• 28:20generally through the program were
• 28:22folks with colorectal cancers,
• 28:23gastric cancers and then a
• 28:25smattering of other histologies.
• 28:26And so 100 patients that we saw on
• 28:30an average we would see about 20 to
• 28:3330% of them with appendiceal tumors,
• 28:3520% with mesothelioma.
• 28:36We used to see about 30% of those.
• 28:40That colorectal cancers and then
• 28:42you know about 20% ovarian and 10%
• 28:44you know smattering of other stuff.
• 28:46So it was sort of a very you know
• 28:50comprehensive this logical growth.
• 28:51We had a clinical trial on pancreatic
• 28:54adenocarcinomas with Bert Neil meds
• 28:55and you know again I think it's
• 28:57it's a great opportunity to write
• 28:59trial to participate in things.
• 29:01You know we had a fast track program
• 29:03for malignant bowel obstructions,
• 29:04you know patients,
• 29:05you know in the past we found they would
• 29:07stay in the hospital for two weeks,
• 29:08three weeks you know with the malignant.
• 29:10Illustration and it was just
• 29:11clogging up our beds.
• 29:13And so we created this fast way system
• 29:15where patients could get in and out of the
• 29:17hospital really fast regardless of Histology,
• 29:19whether it was lung cancer,
• 29:21breast cancer, you know,
• 29:21it didn't matter if you had a malignant
• 29:23bowel obstruction from personal disease,
• 29:25you know,
• 29:25how do you kind of get your folks through.
• 29:27So I think it varies.
• 29:30You know, here I'm anticipating,
• 29:31you know,
• 29:32there's not those many folks that do
• 29:34this in a dedicated way in Boston.
• 29:36There's a few folks that do it.
• 29:37There's a few folks that do it in
• 29:39in New York.
• 29:40And so I do think that,
• 29:42you know,
• 29:42we have a nice sort of a catchment
• 29:44area of folks that will seek out
• 29:46this gear if we're able to you know,
• 29:49provide the services as well.
• 29:56I have no doubt that this is going to
• 29:58be one of our primary areas in GI cancer
• 30:01growth in coming months and years.
• 30:04Um, Doctor Weiner, welcome to the town hall.
• 30:07Thank you. Thank you Sir.
• 30:08I couldn't be here initially
• 30:10any would you like to chime
• 30:12in in any regard,
• 30:13just great, great talk I heard the
• 30:17last 10 minutes of it I think and you
• 30:20know I I really I think Karen we're
• 30:23all excited that you have joined us
• 30:25and both excited for this program and
• 30:28excited for surgical oncology in general.
• 30:31Thank you. Thank you.
• 30:32It's really hard. It's that, yeah,
• 30:36I've been here a short enough time,
• 30:38meaning a year. It's hard.
• 30:39It's hard for me to believe
• 30:41that since I've been here,
• 30:42Someone Like You has actually been
• 30:44recruited and has been, you know,
• 30:46feet on the ground for now,
• 30:48probably 3-4 months.
• 30:51Yeah, it's exciting. It's,
• 30:52but it's it's been wonderful
• 30:54to get to know everyone here.
• 30:55So I think I'm excited for our future.
• 31:03So one of the things that we were
• 31:05really trying to do in this town
• 31:07hall is make sure that we had
• 31:09time for questions and answers.
• 31:10We know that there's a lot of times
• 31:12in the town hall where we don't,
• 31:14so we're hoping that we will.
• 31:17Get some questions from the crowd.
• 31:19It does look like.
• 31:20Let let me see if we have any right now.
• 31:26Can I just make a comment, which
• 31:28is something that I said
• 31:30yesterday in a different venue,
• 31:33which is that I think occasionally
• 31:36we get into situations where
• 31:39whether it's a new patient requiring
• 31:42multidisciplinary care or someone
• 31:44who's been here where where there's
• 31:47a real need for people from various
• 31:50disciplines to put their heads together,
• 31:53where we start making recommendations
• 31:55to patients without.
• 31:56Conferring with our colleagues and I
• 31:58just want to put in a really strong
• 32:02push for medical oncologists and
• 32:04radiation oncologists and surgical
• 32:06oncologists and whoever else might
• 32:09be involved because there are other
• 32:11disciplines in some areas that are
• 32:13involved that people really put
• 32:15their heads together and make sure
• 32:17they communicate before we come
• 32:19up with plans for patients and
• 32:21and and start promising one thing
• 32:23or another that's that may, may.
• 32:26May need to be done by someone
• 32:28in a different discipline.
• 32:31So I I think that we really
• 32:33have to view one another as,
• 32:35as you know, very close team members.
• 32:39And the only way we're really going
• 32:41to be as successful as we want to
• 32:43be is if across disciplines we
• 32:46function as as really a seamless team.
• 32:48And I happen to know with certainty that
• 32:51Karen would would agree with what I said.
• 32:56Absolutely. You know I think Eric
• 32:57you know these are complex decision
• 32:59making and I think as is every cancer,
• 33:01you know I think as the world is evolving,
• 33:04you know everything is going to require all,
• 33:07everyone thinking together about how
• 33:09best to take care of our patient.
• 33:11And I think you know I feel very lucky.
• 33:13You know our partners in GI Medical Oncology,
• 33:16Ganong Radon, I mean everyone is just,
• 33:19I think everyone pushes in the same
• 33:22direction and I I'm very excited.
• 33:24I think, I think we'll be able to really.
• 33:26Provide patients with stellar care.
• 33:30Agreed.
• 33:34Actor target.
• 33:34There's been a couple questions,
• 33:36so you're in the hot seat for Q&A right now.
• 33:40There's a question from Doctor Mayor
• 33:43that asked can this be applied to
• 33:45other disease sites for recurrent
• 33:47cancer at high risk of recurrence?
• 33:49For example, risk of microscopic
• 33:52disease after resection?
• 33:55You know it's a it's a good
• 33:56question and I think you know
• 33:59I'll I'll answer it in two ways.
• 34:00So one is probably not exactly what
• 34:03Doctor Mara is asking but what we did
• 34:06find especially in urological cancers
• 34:09as robotic technology was being
• 34:10used a lot more for cystectomies,
• 34:13we started seeing a lot more peritoneal
• 34:16recurrences of urological cancers.
• 34:18And and for most of you that
• 34:20remember from Embryology most of
• 34:21the urinary and urological organs
• 34:23are actually retroperitoneal,
• 34:24so they rarely have.
• 34:26Certainly.
• 34:27And So what was happening is as these
• 34:29specimens were being manipulated
• 34:30or cut or you know working on they
• 34:32started getting personal meds.
• 34:33So we actually did have a small
• 34:35trial where we ran where we did
• 34:38intraperitoneal chemotherapy for
• 34:39peroneal metastases from urological
• 34:41malignancies and we had sort of
• 34:44this variable success with that.
• 34:45But I think the question I think
• 34:47Doctor Mara might be asking is more
• 34:49related to if in a local regional
• 34:52space can you actually add chemotherapy
• 34:54perhaps like in head and neck
• 34:56cancers where you know would that.
• 34:57Prevent recurrence and the answer
• 34:59is I don't know you know it's been
• 35:01tried in different organ systems.
• 35:02We've used it in the chest for pleural
• 35:05effusions for pleural mesothelioma.
• 35:08You know it's been used in sort of
• 35:10other cavities certainly chemos put
• 35:12in the eye for for sort of hyper
• 35:14you know vendor sort of increased
• 35:16that Jeff in the eye and you have
• 35:18more sort of blood vessels.
• 35:19So there's certainly opportunities
• 35:20it's placed in the bladder so and
• 35:23there's also very interesting space
• 35:25where people are looking at intra.
• 35:27Cavitary immunotherapy,
• 35:28so there's clinical trials for sting
• 35:32agonists which are in different
• 35:35interferon agonists as well as
• 35:37you know looking at checkpoint
• 35:39and ambition in the abdomen.
• 35:40So very exciting space for
• 35:42for local regional delivery of
• 35:45of immunotherapy as well.
• 35:48Great. And we have a couple more for you.
• 35:52So there was a kind of a follow-up
• 35:55question beyond abdominal cancers,
• 35:57do you treat any hematologic
• 35:58malignancies or other types of malice?
• 36:01I think you already answered
• 36:02some of the other malignancies,
• 36:03but specifically hematologic malignancies.
• 36:07Yeah, I mean, I think the one
• 36:09of the things that I think,
• 36:10you know, Doctor Portman,
• 36:12see myself and several others,
• 36:14you know, we've chatted about and
• 36:16we're very interested in developing.
• 36:18It's a program called Oligo Metastasis.
• 36:21And so, you know,
• 36:22if you think about metastatic cancer
• 36:24and so everything metastasis is 1
• 36:26version of oligo metastases and.
• 36:28Metastatic cancer is stage
• 36:30four is spread everywhere.
• 36:32And you know in the past when you
• 36:34look at the Fisher theory of cancer,
• 36:36you say, well, it's spread everywhere.
• 36:38There's no role for surgery or
• 36:40radiation or ablation because
• 36:41these are local treatments.
• 36:43So how are you actually going
• 36:44to affect the cancer that has
• 36:46spread to the rest of the body?
• 36:47But what we're finding in a lot of
• 36:49science has found is that the concept of
• 36:52cancer spread is actually dichotomous.
• 36:54So you actually have cancers that can
• 36:56develop sort of these local regional
• 36:59deposits like liver metastases,
• 37:00personnel metastases,
• 37:02lung metastases, brain metastases,
• 37:04bone metastases that can sort of just
• 37:06be in that one area that you can
• 37:08actually treat with local regional therapy.
• 37:10And obviously as a surgeon and bias,
• 37:12you know that's very exciting.
• 37:13But you know,
• 37:14a lot of science and lots of research
• 37:16in these areas have helped us.
• 37:17Identify at least in some diseases
• 37:19patients that could be good candidates
• 37:22for local regional therapies
• 37:23where you actually do surgery.
• 37:25And so you know we envision the
• 37:27program and I think obviously this
• 37:29would be something that would be
• 37:30exciting for us to all work together
• 37:32to work is thinking of an oligo
• 37:34metastatic program as a pillar of
• 37:36a Cancer Center where patients
• 37:38actually you know who have stage
• 37:40four cancer are approached not
• 37:42just with a palliative perhaps and
• 37:44then but potentially a palliative
• 37:46plus curative intent if they fit.
• 37:47The oligo metastatic paradigm.
• 37:49So again it's a very complicated space
• 37:51that requires lots of definition.
• 37:53But you know in the answer to
• 37:55hematological malignancies,
• 37:55we don't usually do this,
• 37:57but certainly for lymphoid
• 37:59malignancies things like that,
• 38:00you know there have been you
• 38:02know reports of folks using
• 38:04intraperitoneal chemotherapy.
• 38:05So it is,
• 38:07it has been used again I would say
• 38:08should be used in the context of
• 38:10either a clinical trial or study or
• 38:12protocol so that we're doing the
• 38:13right thing and learning from it.
• 38:14So we're actually making life
• 38:16better for our patient.
• 38:19Thank you. I'm going to.
• 38:21We'll give you a break for a minute.
• 38:23We did. Eric, Doctor Weiner,
• 38:25this one's for you.
• 38:26It came in through our.
• 38:29Our e-mail prior to the town hall,
• 38:31but wondering if you could give
• 38:33an update about our CCSG process
• 38:36and how that's going. Sure.
• 38:39It it feels like it's half
• 38:40of my life at the moment.
• 38:42Um or maybe 3/4. So our CSG,
• 38:47CSG stands for the Cancer Center
• 38:50support grant and this as many of you
• 38:53know is essentially the infrastructure
• 38:56or matrix that binds the research
• 38:59and our Cancer Center together.
• 39:01It used to be all about trying to bring
• 39:06together basic science researchers and.
• 39:08A little bit of clinical research
• 39:10and it has really morphed over the
• 39:12years into being much more focused
• 39:14on clinical and translational
• 39:16research and then more recently much
• 39:18more focused on community outreach
• 39:21and engagement on the program to
• 39:24enhance diversity within the Cancer
• 39:27Center and training and education.
• 39:29So very much trying to serve the
• 39:33needs of our community and our
• 39:35catchment area and our catchment area
• 39:38is the entire state of Connecticut.
• 39:41It's due, I believe, on September 23rd.
• 39:46I the the actual date is of somewhat
• 39:50lesser importance to me than the
• 39:52fact that it's a few months away
• 39:55or six months away.
• 39:57And hopefully we will be
• 39:59done long before then.
• 40:01But people are busily writing,
• 40:04we have drafts of virtually
• 40:06all of the programs.
• 40:07We have our external Scientific
• 40:10Advisory Board coming in in two weeks,
• 40:142 weeks from tomorrow.
• 40:16And I think we're in reasonable shape,
• 40:19the one plea that I have for
• 40:22everyone who's in the clinic.
• 40:25Is that as people know our clinical
• 40:28Trials Office was really hurting
• 40:30for a while and is now much,
• 40:33much better.
• 40:34And our clinical trials accrual
• 40:36fell during COVID and hasn't
• 40:38really fully recovered.
• 40:39And we really,
• 40:41really need to push on a crawl over
• 40:43the course of the next four months
• 40:45so that we can show an upward trend.
• 40:47And I would just ask everyone when
• 40:50they see patients to think about our
• 40:52clinical trials iron crop and ELISA.
• 40:55The eight men who are running that
• 40:57effort have tried very hard to make
• 41:00sure that we've approved new clinical
• 41:02trials and the and and particularly
• 41:05the trials that people have told
• 41:08us are important to them and so
• 41:10please do your best to to help out.
• 41:18Things and thank you Doctor Weiner,
• 41:22doctor Taraca, we have another question
• 41:24because not only were you here today
• 41:27to talk about the HIPEC program,
• 41:29but you are also our leader
• 41:31for surgical oncology.
• 41:32And wondering if you could
• 41:33just share briefly any of your
• 41:36plans or thoughts about leading
• 41:38surgical oncology here at yeah.
• 41:42Oh, that's very, very kind of you to ask,
• 41:44uh, Kim. You know, I think we,
• 41:46I'm very fortunate that the group
• 41:48that we have here is, is incredible.
• 41:51We're about 20 surgical oncologists in
• 41:54our division and our hope is of course,
• 41:57you know, to provide seamless
• 41:59surgical cancer care to all, you know,
• 42:02patients actually in Connecticut and
• 42:03hopefully in neighboring states as well.
• 42:05And say I think to that end,
• 42:07you know our goals are #1 to,
• 42:10you know, recruit and retain our best.
• 42:12Balance, so we can make sure we
• 42:15create sort of a culture of you know
• 42:17inclusivity of making sure that we're
• 42:19supporting and fostering and mentoring
• 42:20our our faculty that are here already,
• 42:22but also bringing in new folks
• 42:24with new ideas,
• 42:25new energy so we can kind of roll.
• 42:27So I think that's something that
• 42:28is one of our prime focus right
• 42:30now is how do we actually recruit
• 42:31and retain the folks that we have.
• 42:33So that's that's the most important
• 42:35investment of time that we have
• 42:37right now in terms of thinking
• 42:38about the care you know we think
• 42:40of it in in two different ways.
• 42:42So one is the.
• 42:42Have a sort of signature programs
• 42:45which are multidisciplinary
• 42:47potentially destination programs,
• 42:49but could also be sort of programs
• 42:51that are in the community.
• 42:53So say for instance you know in breast
• 42:55cancer like a Hispanic breast cancer program,
• 42:58community based,
• 42:58but on the other hand a high
• 43:00risk breast program which is
• 43:01more sort of destination based.
• 43:03You know an endocrine cancer is like
• 43:05a thyroid RFA ablation program which
• 43:07is sort of more destination where
• 43:09people travel and come but on the other
• 43:11hand a multidisciplinary endocrine.
• 43:12Cancer Clinic which is more community based.
• 43:14So having sort of this approach where we're
• 43:17actually reaching patients where they are,
• 43:19but at the same time we're providing
• 43:21these services that not only are we
• 43:23catering to the Community of Connecticut
• 43:25but then all over the country.
• 43:26So I think in terms of our clinical you know.
• 43:30Goals,
• 43:31I mean that's what we want to achieve
• 43:33and I think with that we need access,
• 43:35you know issues that we have to work on,
• 43:36operations that we have to work on,
• 43:38staffing that we have to work on
• 43:39so that we can actually make it a
• 43:41seamless process for everyone who's
• 43:43involved as a multidisciplinary team.
• 43:44You know, it's not increased burden of work,
• 43:47but actually a joy to see these patients
• 43:49get things done and and take care of folks,
• 43:50which is why I think all of us come to work.
• 43:53So I think that's sort of the
• 43:54clinical piece of our of our mission.
• 43:56I think from you know a research standpoint,
• 43:58I think that Doctor Weiner's point, you know.
• 44:01Clinical trials are the bread
• 44:02and butter of of cancer care.
• 44:04I mean that's the only way I personally
• 44:06think we're going to advance the field.
• 44:07I mean as surgeons we do small
• 44:10mini clinical trials
• 44:10every day. You know,
• 44:11we put a stitch one way and we're like,
• 44:13oh, this kind of worked well or you know,
• 44:14I put a stitch a different way,
• 44:15well, I didn't work.
• 44:16So we do our end of 1 clinical
• 44:19trials every day and and I think
• 44:21we're very excited to partner with
• 44:23Ian and with Alyssa, you know,
• 44:25to create a whole cadre of surgical
• 44:26clinical trials that are answering critical
• 44:29questions that patients actually will.
• 44:31Travel and comfort,
• 44:31but yet these are quite simple to run,
• 44:34they're not like these you know multi
• 44:36$1,000,000 industry trials that you
• 44:38know you can actually do innovative
• 44:39new things in the surgical space.
• 44:41So we're very excited to be working
• 44:43on that and hopefully enhance
• 44:45the accruals that we have for
• 44:47for trials for our CSG grant.
• 44:49And then of course education,
• 44:51I think.
• 44:53You know Ronnie Salem who I don't
• 44:54think is on the town hall is,
• 44:56is sort of has been the leader and
• 44:58epidemy of education for cancer
• 45:00education among surgical residents.
• 45:02But but how do we kind of actually
• 45:04create a the Yale education
• 45:06way of surgical oncology.
• 45:08Can we actually make courses that are
• 45:10are national and increase our reputation
• 45:12nationally in order to do that.
• 45:14So I think those are sort of the three
• 45:16big things that we're kind of working on.
• 45:18You know it sounds I know very
• 45:20glorious and I'm sure it will take some
• 45:21time but you know I think we have.
• 45:23Ingredients and and I am an
• 45:25optimist as you know,
• 45:26I take care of patients with
• 45:28metastatic cancer but but at the
• 45:29same time I truly believe that we can
• 45:31we can achieve some of these goals.
• 45:36Doctor Turaga, I wonder if I could
• 45:38just ask you a question less on
• 45:40the clinical side and more as I
• 45:43think about this extraordinary
• 45:45program that you just described.
• 45:47We really need to get out there and tell
• 45:50the world that it's here and available.
• 45:52It's really just the kind of,
• 45:53it's a marvelous addition to what we do here.
• 45:56And I, well, I want to put you
• 45:58on a billboard all over 95.
• 45:59It actually really feels like this
• 46:01requires some deep education of the
• 46:03referring community and of patience.
• 46:05And I'm just wondering.
• 46:06What kind of plan there is to to
• 46:08engage in that kind of communication?
• 46:11I mean I think it's it's work in progress.
• 46:13I'm working with you know the
• 46:15the team from Smilo as well as
• 46:17Yale Medicine as well as our
• 46:18department and the Cancer Center.
• 46:20So creating sort of this multi
• 46:23pronged marketing approach.
• 46:24I think you're spot on this,
• 46:25you know the, the, the,
• 46:27the communication has to be both
• 46:29ways and I think actually the
• 46:31organic communication of connecting
• 46:32with physician practices groups,
• 46:34going and meeting them,
• 46:35inviting them to tumor board,
• 46:37making them part of the program
• 46:38is probably the most sustainable
• 46:40way of growing practices.
• 46:41The programs and I think that's
• 46:43something that is very high on
• 46:45our agenda of things to do.
• 46:46I think, you know,
• 46:47similarly using you know media
• 46:48like social media.
• 46:49Renee does a great job,
• 46:51you know,
• 46:51in in social media of course having websites.
• 46:54But I think all of these things you
• 46:57know need sort of a very concerted
• 47:00but very programmatic based approach.
• 47:02And so,
• 47:03you know it's funny we made
• 47:05this little playbook.
• 47:06That we had for our program in Chicago,
• 47:08we were always doing something,
• 47:09we were always either you know
• 47:11doing the Billboard ads or we
• 47:13were doing the meet new media
• 47:14ads or being at the Cubs game
• 47:16or doing at the Bears game.
• 47:17But at the same time we also had just
• 47:19numerous position outreach events
• 47:21and then we just replicated the
• 47:23same page playbook for each of our
• 47:25programs and neuroendocrine tumors
• 47:26in gastric tumors in in lung cancers.
• 47:29And so it's it's a very sort of
• 47:31a translational playbook that you
• 47:32can just create one thing and then
• 47:34you know just you know then you.
• 47:36Kind of learn from each other
• 47:38and you don't have to.
• 47:39You know, being mean to be open, so to speak.
• 47:56Well, do we have other questions?
• 47:59I can't, I I can't see. I'm not
• 48:01seeing anything else in the chat.
• 48:03Yeah, not seeing anything else
• 48:05in the chat right now either,
• 48:07so if anybody has any last questions,
• 48:10we do have a few minutes,
• 48:12so please don't be shy.
• 48:17Anything anybody on the panel wants
• 48:19to say before we start to close them.
• 48:27I think maybe as a closing note
• 48:29I will just share that I had the
• 48:31privilege of rounding with our teams
• 48:33at Trumbull and Fairfield yesterday.
• 48:35It was a delightful experience.
• 48:37I want to thank Elizabeth.
• 48:40Rosenberg and her staff and team down there,
• 48:45really great to connect with doctors,
• 48:47Fishbach, Kohram, Way con,
• 48:49our entire organization down there
• 48:52who are really doing incredible work.
• 48:55The amount of growth at that
• 48:58site is is really impressive
• 49:01and the multidisciplinarity,
• 49:03the the integration of supportive
• 49:05services at that center is something
• 49:08that really makes me proud and it's.
• 49:10What we all aspire to,
• 49:12so hats off to them and I know they're
• 49:14just reflective of the great work
• 49:16being done throughout the organization.
• 49:18So thank you everyone.
• 49:26Have a good evening everyone.
• 49:29No, no other questions. So yes,
• 49:31thank you everyone for joining.
• 49:33Thanks, Kevin and Kim,
• 49:34have a wonderful evening.
• 49:36Thank you, Doctor Turaga.
• 49:37Excellent presentation.