Smilow Cancer Hospital Town Hall | March 2, 2023

March 03, 2023

Hosted by Dr. Eric Winer | Presentations from: Drs. Kevin Billingsley, Kiran Turaga Kim Slusser, RN, BSN.

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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&amp;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&amp;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&amp;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&amp;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.