March 11, 2021: The Latest on COVID-19 Vaccinations: A Smilow Patient and Family Forum

March 12, 2021

Information

Hosted by Kevin Billingsley, MD, MPH

Presentations by: Drs. Tara Sanft, Kerin Adelson, Stuart Seropian, and Kim Slusser, RN

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00:00My name is Kevin
00:02Billingsley. I have the pleasure
00:04of serving as the Chief Medical
00:06Officer of the Smilow Cancer
00:08Hospital in the El Cancer Center,
00:11an on behalf of my partner Kim Slusser,
00:14and all of us here at
00:16spoiling the Cancer Center.
00:18I'd like to welcome you to this
00:20patient and family forum that is
00:23focusing on COVID-19 vaccinations.
00:28I want to take a minute to just update people
00:31on the program and introduce our panelists.
00:34Kim and I will be going through some
00:37brief clinical updates and then we're
00:40really going to jump right into the main
00:43body of our program and our aim this
00:46evening is is to update our audience.
00:49You are community on key developments
00:51in the rollout of the COVID-19
00:53vaccination both within our healthcare
00:55system in across Connecticut.
00:58And answer any questions and concerns
01:00related to the unique challenges that
01:03our patients face as we navigate
01:06through this ongoing pandemic.
01:09And we all move towards the safety backside.
01:15So I'm really delighted to have an
01:18outstanding panel of people who
01:20are contributing this evening.
01:22I first want to introduce Doctor
01:25Karen Adelson.
01:25Karen is Deputy Chief medical officer.
01:28She's a breast medical oncologist,
01:30and she also serves our system
01:33as our Chief Quality Officer.
01:36Doctor Tara Sanft is also a breast
01:39medical oncologist by clinical practice,
01:42but she importantly serves all of
01:45our patients and families as our
01:48chief patient Experience Officer.
01:50I think I briefly introduce my partner,
01:53Kim Slusser.
01:54Kim is our really our Chief
01:56Nursing Officer and she's our Vice
01:58president of Patient Services.
02:02It's a pleasure for me also to
02:05introduce Doctor Stuart Seropian.
02:07Doctor Seropian is a professor of
02:09medicine and he's director of Our
02:12Stem Cell Transplant Program and Co.
02:14Director of our Car T program and
02:17has many other titles and accolades
02:19related to his service to he
02:22malignancy's patients and BMT patients.
02:25At some point during our presentation,
02:28we are likely also going to be
02:30joined by Doctor Tomball Susac,
02:33who is the Yale New Haven health
02:36system Chief Clinical Officer.
02:40So with those introductions out of the way.
02:44Let me just kind of go ahead and and
02:47inform our audience of of a number of.
02:50Kind of key developments in our program.
02:53I think it is really important
02:55to take a minute to acknowledge.
02:58What we have all been
03:00through over the past year.
03:02It's almost a year to the date
03:05when our world changed in a very
03:08profound and traumatic way.
03:10It was about this time that the
03:13very first patients were being
03:15diagnosed with COVID-19 here in
03:17Connecticut and we started to see
03:20patients coming into the hospital.
03:22This led to some very rapid changes
03:25in the way we provided cancer care
03:28to our patients and our families.
03:31We shifted very quickly.
03:33Too many of our visits as virtual
03:35and we have adopted telemedicine.
03:38Tele Health is one of our central
03:41pillars of clinical care.
03:43And we had to in a very short period of time,
03:47relocate a number of our inpatients
03:49out of the Smilow hospital building
03:51to other sites of cancer care
03:54delivery here in New Haven,
03:55and it also required us to shift many of
03:58our ambulatory operations out of New Haven.
04:02Fortunately,
04:02in the months that followed,
04:04we have been able to resume the vast
04:07majority of our normal operations,
04:10with the exception of one floor
04:12here or actually two floors here
04:14in the Smilow Pavilion,
04:16and many of our ambulatory operations
04:19are back in our normal positions.
04:22However,
04:22we continue to work with within
04:25an altered environment.
04:26We continue to care for a large number
04:29of covid patients here in New Haven
04:32and across our health care system,
04:34and this is required.
04:36Ongoing adaptations to how we
04:38provide care and do business.
04:40Fortunately,
04:40we are moving and is slow but steady
04:44way back to very normal operations
04:47and the rollout of this vaccination
04:49brings great hope for all of us.
04:53You'll hear more about that as
04:54we as we move along.
04:56One of the updates unrelated to Covid,
04:59but I think it is important for me
05:01to share with our smilow community
05:04is that our leader of the cancer
05:06centerin the Cancer hospital.
05:09For many years,
05:10Doctor Charlie Fuchs is not on
05:12the call this evening.
05:14Doctor Fuchs has as many of you know,
05:17taken a position with Genentech.
05:19Roche and he's gone on and left our
05:21organization to become the head of
05:24Global Drug Development in that very
05:26important industry. Partner for us.
05:29We miss Charlie terribly.
05:31Many of us.
05:32He had a profound impact on many of us.
05:36He, I think,
05:37elevated care to a new level and
05:40recruited many of our key leaders.
05:43And I will assure all of our community
05:46that the very important clinical
05:48initiatives that he spearheaded and
05:51started will continue in his absence.
05:54And Doctor Nita Ahuja,
05:55who is the chair of the Department
05:58of Surgery,
05:59has graciously stepped in and an
06:01interim role as Cancer Center director.
06:04Doctor Hujik could not be with
06:06us this evening,
06:08but I am absolutely confident
06:09that all of our key initiatives in
06:12our care signature will continue.
06:14Lori Pickens, who is our Senior
06:17VP of Cancer Care Services,
06:19also continues in his and her role,
06:22and many of our our key leaders.
06:25Are here to ensure that we
06:27have uninterrupted service.
06:28So with those quick updates Kim,
06:30let me just turn it over to you.
06:32I know you have a number of things
06:34to share with our community as well.
06:39Thank you Kevin and thank you
06:41everyone for joining us this evening.
06:43I think as you can see from my
06:46background or health system's been
06:48celebrating a week of gratitude
06:50across our whole entire organization,
06:53we have been taking time to
06:55purposefully engage with one another
06:57to acknowledge our blessings,
06:59share appreciation for getting
07:00through the hardships personally
07:02and professionally that we have
07:04experienced throughout the pandemic.
07:06As Kevin mentioned,
07:07we are really literally this week.
07:10One year in to this pandemic and we
07:12have been using this time to Createspace
07:14for all of us to cherish the moment
07:17and show our gratitude to one another
07:19and just seem so timely that this
07:21evening we're having this forum and I
07:23thought it would be a great opportunity for,
07:26on behalf of Smilow, to thank you
07:28for entrusting us with your care.
07:30Throughout this year,
07:31our patients and their loved
07:33ones inspire us every day,
07:34and we feel honored to be
07:36able to do the work we do.
07:39You really, truly.
07:40Inspire us to be our best selves.
07:44There are a few updates I
07:46wanted to share this evening as
07:48vaccination efforts continue and
07:50we experience a steady decrease in
07:54our covid hospitalised patients,
07:56we have expanded our Visitation
07:59for adult inpatient.
08:01In paid for an adult inpatients
08:04and that we are now allowing one
08:06visitor for patients that have a
08:09length of stay greater than 8 days.
08:11We know it has been very,
08:14very difficult throughout this
08:15pandemic to not be with loved ones.
08:18When you have to be hospitalised.
08:20So this is our first step to
08:22start to allow Visitation.
08:24Of course we continue with
08:26our other exceptions,
08:27allowing visitors for when a
08:29patient is requiring is ready for
08:31discharge and there are some complex.
08:34Discharge needs a visitor can or
08:36support person can come in close to
08:39that discharge date to hear those
08:42instructions with their loved ones and
08:45make sure that all questions are answered.
08:48We also allow Visitation for anyone
08:50with any type of disability requiring
08:53their support person to be with them
08:56to make sure that their needs are met.
08:59And also unfortunately,
09:01some of our patients do
09:03experience the end of their life.
09:06During their hospitalization
09:07and we want family members to be
09:10with them at that time as well.
09:12As far as our ambulatory Visitation,
09:14we're still trying to limit visitors
09:17just trying to continue to keep
09:19that social distancing and keeping
09:21our patients and our staff safe,
09:23but I want to remind our community
09:26that we are allowing support the
09:28support person to be with our
09:31patients during that first initial
09:33visit to one of our doctors and one
09:36of our with one of our care centers.
09:39We also allow Visitation during
09:41that first day of treatment.
09:43For patients,
09:44because we know that can be
09:46very overwhelming.
09:47And if we anticipate going over
09:49any test results that would require
09:51a change in your plan of care
09:54or treatment decisions,
09:55we would want to support person
09:57to be with you
09:59during that time as well.
10:01We continue to try to leverage technology.
10:04As Kevin mentioned,
10:05we do utilized Tele health
10:06and also when you physically
10:08come in for your appointments.
10:10We also encourage you to use.
10:13Our phones to call in your your support
10:16and your family members that they
10:18can engage in your care delivery.
10:21I know it's not ideal as them being with you,
10:24but we again want to encourage you to
10:27use technology to provide that support.
10:29While you're here by yourselves
10:31with our care team,
10:32I also wanted to take this opportunity
10:35to let you know how our staff have been
10:38doing in our regards to get vaccinated.
10:41I'm very proud to say that 83% of our
10:44smiling staff have been vaccinated.
10:46I just think that's tremendous a
10:48commitment by our team to try to again
10:51ensure the safest environment for your care,
10:53and I'm hoping that you see that
10:55we are doing everything we can to
10:58provide that safe environment for you.
11:02Also, I just there's many of you on this
11:05call that may have received an invitation
11:08to take part in a survey, so I also I'm.
11:11I'm just so glad that we're here this
11:13evening because I'm able to personally
11:15thank you for completing that survey.
11:18We sent out a survey to almost
11:207000 smilow patients and 700
11:22patients replied to the survey,
11:24which I know that doesn't seem a lot
11:26when you think we sent it out to 6000,
11:29but for me we have 700 voices
11:32that have shared their thoughts.
11:34And ideas on how we can improve our care.
11:37We asked many questions as far as the Tele
11:40health that we have been doing during Covid.
11:42Would you like that to continue?
11:44In what ways would you want
11:46a Tele health visit?
11:48We've also asked questions that
11:50are our patients have replied to
11:52about whether you would like to see
11:54your physician or receive infusion
11:56services or other types of tests or
11:58procedures during nontraditional hours.
11:59You know, basically,
12:00we generally are open Monday
12:02through Friday 8:00 to 5:00.
12:04But would you like to come in on this?
12:07Saturday or would you like to have an
12:09evening visit so we're really taking
12:11all of that feedback as we continue to
12:14improve our access to care and I just
12:16wanted to thank you for sharing your
12:18voice and letting us know what would be
12:21beneficial to you and delivering care.
12:23And so with that I'm going to just
12:25turn it back over to Kevin for the
12:28rest of our program and I'm just really
12:30grateful to be here this evening.
12:32Looking forward to answering
12:34all of the questions.
12:38Thank thank you Kim.
12:39So I think I would like to do is
12:43just start by reiterating a few key
12:45points related to the vaccination
12:48rollout and I think that this is
12:51been one of the things that has
12:54challenged us as clinical care
12:56providers for cancer patients.
12:58But we are also aware that the
13:01vaccination rollout in the state of
13:03Connecticut has been in some ways
13:06challenging for our patients and families.
13:08Under the direction of Doctor of Governor
13:12Gut Ned Lamont and our state leaders.
13:16The the state government in Connecticut
13:19has elected to proceed with an
13:22age based rollout of the COVID-19
13:25vaccinations and at this time the
13:27state has approved access to the
13:30vaccine for for people 55 and over.
13:34Ineligibility really is determined
13:35by the state and, unfortunately,
13:38expanded access to patients under the
13:41age of 55 has not yet been granted.
13:44I assure you that we here at Smilow
13:47and throughout the health system are
13:49going to continue to monitor this and
13:51we will update you and your families as
13:53soon as any additional access is available.
13:57The vaccination is widely
13:59recommended both for patients with.
14:01Answer An for cancer survivors.
14:03So if you receive no other message
14:06from all of us this evening,
14:09we would recommend that.
14:11If you were 55 and over,
14:14please log into my chart and access
14:17the COVID-19 scheduling portal.
14:20Or go to wwinhhs.org where you will
14:23find a landing page an A clear access
14:27portal for the covid vaccination.
14:30You can also access Yale,
14:32New Haven health system through 1883.
14:35Ask why NHH.
14:37We will get into some more specifics
14:40related to both solid tumors as well
14:42as patients who have been treated
14:44with bone marrow transplant and
14:46stem cell transplant here shortly,
14:48but I want to take a minute to
14:52address what is a concern at the
14:54forefront of many of our patients.
14:58Lines about vaccination access.
15:00The reality is that as cancer
15:03patients and survivors,
15:05we we are aware that you are all
15:09vulnerable population and we have
15:12been in contact with state leadership
15:15about working with them to create
15:19enhanced access for our patients.
15:21At this point it does not seem
15:25to be logistically feasible.
15:28But I can assure our our community
15:31that this is something that we are
15:34in close dialogue with our state
15:36health care leaders about and they
15:39assure us that they are rolling out
15:42vaccination as quickly as they can
15:45through the age based protocol and the
15:48increased vaccine availability with
15:50the recent approval of the Johnson
15:52and Johnson product will increase the
15:55access and timetable on the rollout.
15:58I think one other point that it is
16:01critical to underscore is that there
16:04are three vaccine products available.
16:06I think as people know there's a product
16:09that has been produced by Moderna,
16:12one by Pfizer,
16:13by in tech and the more recently
16:16approved Johnson and Johnson,
16:18which on the package insert sometimes
16:20actually says it's a Janssen product.
16:23But that is really still a
16:26Johnson and Johnson vaccine.
16:29I cannot emphasize enough that all of
16:31the vaccines have been thoroughly tested.
16:34They are safe and they are efficacious.
16:37They have been tested in
16:39slightly different populations.
16:41The Johnson and Johnson Vaccine is a
16:44Windows vaccine that does work through a
16:48slightly different biological mechanism.
16:51Using an adeno virus which is killed,
16:53it is not a live vaccine.
16:55There is no chance of getting a
16:58viral infection from this vaccine.
17:01And in fact, the Johnson and Johnson vaccine
17:03has been tested in patient populations,
17:05in which some of these variants that we
17:08are now facing across the United States
17:12were present when the vaccine was tested.
17:15So the real key is to get the
17:19vaccination regardless of the type,
17:21and I would urge all of our
17:23patients and family members to
17:25take advantage of any opportunity,
17:28any access opportunity,
17:29regardless of what vaccine
17:31product is available,
17:32it is really getting the vaccine
17:34in your arm that's critical,
17:37not the specific product,
17:39and will certainly take more questions about
17:42those vaccination products as we go along.
17:46That is a general background.
17:48I think I'm going to turn
17:50to Doctor Adelson next.
17:52And Karen,
17:53maybe you could speak to our community about.
17:58Vaccination in our solid tumor population,
18:00particularly timing and the relationship
18:03of mammography to vaccination
18:05vaccination in the survivorship period.
18:07All of those things I know
18:09are of concern to folks.
18:12Great,
18:12I have a
18:14few slides, so I'm going to share my screen.
18:18Welcome everybody and thank you for
18:20the opportunity to speak about vaccines
18:23and our solid tumor population.
18:26So all of the recommendations
18:28that I'm going to share.
18:30Come from a guidelines from a very
18:34important national organization
18:35called the National Cancer Care
18:37Network or the NCCN and a team
18:40of Cologist and hematologists.
18:42An infectious disease.
18:44Doctors from around the country have worked
18:46to develop these consensus guidelines,
18:49and doctor Seropian will also
18:51be sharing details in relation
18:54to the hematology population.
18:56So I'm going to focus a little bit
18:59on some of the recommendations
19:02for patients with solid tumors.
19:04With the exceptions of solid
19:06tumor patients who are undergoing
19:09any car T cell therapy,
19:11which is going to be more
19:14appropriately addressed,
19:15and Doctor Seropian section and
19:17that is a small population.
19:19So the first thing is that because the this
19:24Connecticut rollout is done solely by age,
19:27which you know,
19:28I think Doctor Billingsley addressed
19:30this and I think many patients
19:33with cancer in patients with.
19:36Her illness is an comorbidities,
19:38I think.
19:39Felt very disappointed that they were
19:42not put in the highest priority group.
19:44I think the the good side to this
19:47is that the state is moving quickly
19:50through the age based vaccine groups
19:53and every three weeks the group
19:57vaccinated becomes 10 years younger.
19:59So for patients with solid tumor,
20:02we just recommend that you get
20:04the vaccine and the highest
20:06priority group in which you fall.
20:08So as soon as your age is called up,
20:11we recommend that you go and
20:13get the vaccines doctor.
20:14Billingsley mentioned this,
20:16but all three Pfizer Moderna
20:18and Johnson and Johnson are
20:20safe and highly effective.
20:22And then
20:23in terms of
20:24solid tumor patients,
20:25we really don't know an there's been
20:28no studies looking at when getting the
20:31vaccine in regards to your treatment
20:33cycle or the day of your chemotherapy
20:36administration would yield the best response,
20:38and so the guidelines all really say just
20:42get the vaccine as soon as it's available.
20:45Anan that holds for patients,
20:47whether they're on weekly therapy
20:49or every two week therapy or
20:51every three weeks therapy,
20:53or whether they're being treated.
20:55With traditional chemotherapy or
20:57targeted therapy or immunotherapy,
20:58so we really just want the vaccine
21:02to be available and that you get it.
21:06It is important to know that if you
21:09are an immunosuppressive therapy,
21:11you may have less of an immune
21:13response to the vaccine.
21:15So while we know it's safe for you to get it,
21:20we're not entirely sure whether
21:22the vaccine of somebody who is
21:24immunosuppressed will be as effective
21:26as in the general population and the
21:29studies have not looked at this yet,
21:32so it's really important that you continue
21:34precautions like social distancing,
21:36mask wearing in hand sanitizing.
21:38Even after you receive the vaccine,
21:41that aside,
21:42who really believe that most of the
21:44therapies we given solid tumor affect
21:47the immune system in a different way
21:49than the immune system needs to be
21:52activated to respond to a vaccine,
21:54and we really do believe it will be
21:57tremendously helpful at preventing
21:59covid related complications in the
22:01population of patients on cancer treatment.
22:03We also,
22:04of course,
22:05recommend the vaccine for any
22:07cancer survivors and patients who
22:09no longer have active cancer.
22:11And for patients who are on
22:14hormonal therapies as well,
22:15and we
22:16do recommend that
22:18caregivers and household Contacts
22:19get immunized as well. But again,
22:22that depends on where they fall within
22:24their individual statewide priority group.
22:27Essentially based on age. So there
22:30has been a lot of hype and discussion.
22:32You know, when I realized I should
22:34have put this in in slide view,
22:36let me do that one second. Um?
22:40Mike, OK, there has been a fair amount of
22:45publicity about patients getting imaging
22:47studies done soon after their vaccine,
22:49and having swollen lymph nodes under the
22:52arm or in the axilla where the vaccine
22:55would have been in the arm it in which
22:59the vaccine had been administered.
23:01So I think it can be very scary to cancer
23:05patients to have an enlarged lymph node,
23:08but just know that lymph nodes in the time
23:11period really after vaccine administration.
23:14It's just a sign that the lymph node
23:17is that the vaccine is doing its job
23:19and it's generating an immune response
23:22and a proliferation of lymphocytes,
23:23which can be felt in the lymph node.
23:26And so this is normal, and if anything,
23:29it's a sign that the vaccine is working.
23:32So based on this though,
23:33and this phenomena which we're seeing
23:36in about 16% certainly of women who
23:38get mammograms after the vaccine,
23:40we do recommend that you wait four
23:42to six weeks after your vaccine.
23:44To get an imaging study or as long
23:46as your oncologist and surgeon feels
23:49it won't negatively impact your
23:51treatment and so we've seen these nodes
23:53not just on breast imaging studies,
23:55but we've seen them on PET scans and
23:59CT scans and ultrasounds as well.
24:01And so to just minimize confusion,
24:04if you do have a history of cancer
24:07on one side of your upper body,
24:10particularly a breast cancer,
24:11we recommend that you get the vaccine
24:14on the other side just to minimize
24:17fear and confusion,
24:18and then for the patients where they
24:21do identify these in large lymph nodes
24:24in the period after immunization,
24:26the the radiologists are just recommending
24:29relatively short term follow-up to
24:32repeat the image Ng and to hold off.
24:34I'm doing many potentially
24:38unnecessary biopsies.
24:40So that is it for my subject.
24:45Kevin,
24:45do we want to announce who's next in the yes?
24:49Karen, thank you very much.
24:51That was a terrific overview.
24:54You know, I think that one of the
24:58most complicated situations arises
24:59in our patients who are immuno
25:02suppressed or have had bone marrow
25:05transplant stem cell therapy or
25:07car T therapy and what we have
25:10learned is that is that the timing
25:13of the vaccine is is complicated
25:16and this group of of individuals.
25:19At this point I think I am going
25:22to ask Doctor Seropian to address.
25:25Those issues in that particular patient
25:28population of which he knows so well.
25:32But thanks, Kevin. Apologize,
25:35I don't have slides to show.
25:39And I know that not everyone on
25:42the call has had a stem cell
25:45transplant or car T therapy.
25:47Um, my comments are really going
25:50to be very specific to a small
25:52group of patients that are,
25:54as Kevin mentioned, a little bit.
25:57Different in this regard and I'll start
25:59by making the general comment that.
26:03All of the patients who've
26:05undergone these therapies should
26:06get vaccinated at some point.
26:08We still think it's quite important.
26:12Patients who have these therapies
26:14are really very vulnerable.
26:15I and we also encourage all of their
26:18family members who are eligible to
26:21get vaccinated as soon as they can.
26:23I and I the only thing that's
26:26really different about this patient
26:28population is that we've known for
26:30decades that vaccines are often
26:32less effective in patients who
26:35undergo these therapies if they're
26:37not given at an appropriate time.
26:39When there is been some chance
26:41for the immune system to recover
26:44from those treatments.
26:46I the guidelines for this that have
26:48been set forward by the transplant
26:51societies in the American Society
26:54of Hematology encourage all
26:56patients to get vaccinated.
26:58However,
26:58the guidelines suggest that the earliest
27:01this should be pursued as three months
27:05after a transplant or car T therapy,
27:08and there is not specific guidance for
27:11exactly when after these treatments,
27:14vaccinations should be initiated
27:16because all patients really are
27:19different in terms of the clinical
27:22course and variations on their
27:24treatment in the temple with with
27:27their immune system recovers.
27:30There clearly are patients for which
27:32we have good data for all vaccines.
27:36That conditions may prove that the
27:38vaccine will provide no response.
27:41These include people less than
27:43three months after transplant,
27:45or patients who are on high doses
27:49of immunosuppressive agents and in
27:51many cases we can make adjustments
27:54to people's treatment to enhance the
27:57chances of successful vaccination.
27:59I I do get asked well,
28:01isn't getting vaccinated even
28:03if we think it will work?
28:06Better than nothing.
28:07Well,
28:08the long answer is yes,
28:10we want everyone to be vaccinated,
28:13but we don't have an unlimited supply of
28:17vaccine and a patient that we vaccinate.
28:21Inappropriate time may not have an
28:24opportunity to be vaccinated within the
28:27next year at a time when we can have
28:30at least a reasonable chance of success.
28:33But I would say that more than 3/4
28:36of patients who've undergone these
28:38procedures really are not going
28:40to need to wait to get vaccinated.
28:42The advice will be they just get
28:45vaccinated as soon as possible and we
28:48are fielding phone calls and clinical
28:50visits to try and get these answers
28:52to our patients as quickly as we can.
28:55There will be a small group of
28:58patients where adjustments in
28:59medication or blood testing to
29:01examine immune function will help us.
29:03Determine the appropriate timing of response.
29:11Apologize phones ringing in the house.
29:16So I I, many of you who have undergone
29:19these procedures received a letter
29:20from us urging you to reach out to
29:23your transplant provider or your other
29:26providers who we can also speak to
29:28really just to discuss the issue of the
29:32advisability of the timing of the vaccine.
29:35And if you didn't get that notification and
29:39you had a transplant or or had car T therapy.
29:44Then then I I do encourage you
29:46to reach out to your providers.
29:48There may be people who transplant
29:50more than six or seven years ago.
29:52That may not have received the mailing
29:54because they're there that far out,
29:56but this really applies to everyone
29:59who's had these kinds of therapy.
30:01And we're happy to give advice to anyone
30:05and everyone who's had these types of
30:09therapy to help guide them regarding
30:12the particular vaccines safety wise.
30:16Although there is limited data so far
30:19in these patient populations there
30:22is some experience and some data.
30:26This issue was recently reviewed at our
30:30yearly transplant society meetings.
30:32There has been no evidence that these
30:35vaccines are unsafe in patient populations
30:39such as transplant or Carty Mississippians.
30:43So there is also no.
30:46Good medical or biological reason
30:48for us to consider that they would
30:52be unsafe in our patients as Doctor
30:55Billingslea illustrated.
30:57The J&J product is not a live virus.
31:00It's incapable of replicating an
31:03the Moderna and the Pfizer vaccines
31:06are not viruses at all.
31:09Their protein stimulated
31:10immune response to the virus,
31:13so they appear to be very safe
31:17and currently there is no good.
31:20Efficacy data to push us towards
31:23one or the other.
31:25Vaccine so we will be talking individually
31:28with all our patients about what we
31:31think the best route to get a vaccine
31:34as quickly as possible would be.
31:36And there may be shortages
31:38that arise intermittently,
31:39so we encourage people to choose.
31:43What is what is most readily available
31:45when they try to schedule faxing?
31:53Doctor Seropian, thank you for that
31:55really great overview and I do appreciate
31:59you taking our audience back again
32:02through the very important biology
32:04of these vaccines just to underscore
32:07that they have different mechanisms.
32:10But the thing that unites them
32:13is that they are all safe.
32:15There is no live biologic product that
32:20is that is injected in any of these.
32:24Vaccinations. Sotera doctor Sant.
32:28Maybe we could turn to you for a minute.
32:32I see
32:32you had your
32:34partner on board.
32:35She may have different
32:36crime, but you know there is no
32:39doubt that we have all weathered.
32:42Really, a stressful period in our
32:46personal and professional lives.
32:49Local. For families. And.
32:54These things take a toll
32:57on us as individuals and.
33:00Particularly when we are caring for a friend,
33:04family loved one who may be
33:07battling cancer as well as trying
33:10to navigate life in a pandemic.
33:13You coordinate many of
33:15our supportive services.
33:18Can you update our audience on
33:20on special services that they
33:22may want to avail themselves of?
33:25Where do we stand with those things?
33:28How iaccessible are they?
33:30Any particular recommendations
33:31from your standpoint?
33:33Yeah,
33:33thanks Kevin. I think it's just a
33:36really nice time to reflect back.
33:38About a year ago and to look at where
33:41we were and and where we are now.
33:45And to thank everyone for
33:46sticking with our community here,
33:48you know, I think that.
33:51Are we were we were here in this
33:53together and and we stuck together as a
33:56team and and I love that we have these
33:59forums where we can communicate with.
34:01Each other, and that's one thing
34:03that came out of this pandemic
34:06that I think is here to stay in
34:09terms of improved communication.
34:11But in terms of how each
34:13individual is doing or coping,
34:15you know certainly.
34:18Anxiety levels are have never been
34:20higher in order to comfort ourselves,
34:23we're off and going to the extreme
34:25of too much that we find comforting,
34:29so or either numbing with too much
34:32Netflix or screen time or sedentary
34:34time or cheese and crackers and soup.
34:37For some people, it's it's too much.
34:40Things like alcohol and and I
34:43think that that's true for any
34:46individual who feels anxiety or fear.
34:48Um, it's normal,
34:49but if you're someone who needs
34:52some help with all of that,
34:53we certainly have many,
34:55many resources to support you
34:57and your loved ones and anyone
34:59who's going through a difficult
35:01time during this pandemic.
35:02I do have a slide just to remind people that.
35:10We have support groups here.
35:12Our support groups went online once
35:15the pandemic hit an I think that just
35:18today one of my patients in clinic
35:21said how helpful this was to her.
35:24We've even had covid related
35:26support groups as well.
35:28The integrative medicine team has done
35:31an amazing job of coordinating so many
35:36supportive services that are all virtual.
35:40And I'd like to put a plug in for the
35:43integrative konsult service which
35:44talks about all different ways to
35:47comfort ourselves in healthy ways,
35:49either as you're going through cancer
35:52treatment or supporting someone who is.
35:55And then the of course,
35:58the palliative care and survivorship
36:01services continue both inpatient
36:04outpatient in person and virtual.
36:06This is just an example of the
36:09integrative medicine weekly events.
36:11This is from January,
36:13but I assure you that every
36:16week they are updated.
36:18I just printed one out from my patient
36:21today and there's all types of ways
36:24to connect to receive meditation
36:26and to participate in movement.
36:29Even though you may still be
36:32feeling restricted to your home.
36:35We're here for you as a community.
36:39We thank you for your wonderful support,
36:42an words of gratitude.
36:44Every time you write something
36:46nice that you say thank you,
36:49say something nice to us.
36:51It really does impact us in
36:54a really powerful way.
36:56And so thank you for all of that.
36:59We're here.
37:00Reach out with any questions,
37:03concerns, needs, or words of gratitude,
37:06because we always appreciate.
37:08And when we feel connected to
37:09you and I'll stop talking there.
37:19Tara, thank you.
37:20I think it's hard to overstate the
37:23importance of self care for all of us,
37:27and taking advantage of the resources
37:30that we that we have available.
37:34You know, I think without any
37:36further commentary there are a lot
37:39of really great questions coming
37:41forth in the Q&A and I have some
37:44here that Renee prepared for us,
37:46and I think we should just
37:48jump right into it.
37:50We're here to be available
37:52to answer your questions,
37:53and I'm just going to start with one for.
37:58Doctor Adelson,
37:58I think you kind of touched on this,
38:01but this this just to revisit
38:03that this individual is asking.
38:05I am scheduled to get my second
38:07dose this week March 10th and have a
38:10mammogram scheduled for the following week.
38:12Should I try to reschedule my
38:14mammogram to make sure that there
38:17are no false positives on that
38:19side of my body?
38:21So, um, so
38:22if it's fine with your doctors, we
38:25would recommend delaying your mammogram by
38:27four to six weeks.
38:28I would say that there is a backlog
38:31in mammography due to the first
38:33wave of Coed an A slowdown of
38:37radio graphic imaging studies,
38:38so I would call and make sure
38:41that you're able to reschedule
38:43it and to let them know why,
38:46but we would recommend that you wait.
38:49And that you get your vaccine.
38:51And then you wait to get the mammogram.
38:56Thank you, Karen. You know,
39:00I may take this one,
39:01but I'll ask anyone to chime in.
39:06And this is from the question and answer box.
39:11This person says we had our
39:14second Pfizer vaccine on Monday,
39:17but we still have intermittent fever,
39:20fatigue and sluggish thinking.
39:22Is this normal? Might it persist?
39:25And you know what I would say to
39:29that is that we have seen an entire
39:33spectrum of post vaccine reactions.
39:36Fortunately, the vast majority
39:38of them are annoyances and are.
39:41Mild and self limited.
39:43It is not uncommon for these symptoms
39:46of fever, malaise, even body aches,
39:49sometimes poor appetite to last for
39:52several days after vaccination.
39:54I think it's perfectly fine to
39:56treat them with anti inflammatories,
39:59rest fluids, common sense,
40:01and I'm not hearing anything
40:03here that is that is concerning.
40:06I have tended to remind people
40:10that we actually.
40:11It's not bad to see some
40:13inflammatory response.
40:14It means that our bodies are
40:16doing well that they should be
40:17in response to these vaccines.
40:19Do any of the other clinicians on our
40:22panel have anything to add to that?
40:27Just just like
40:28you said Kevin, there is a full
40:31range of responses and some people
40:33really can feel pretty sick for,
40:36you know a week at a time,
40:39some some will even have some
40:41responses that go out longer,
40:43but but that's not the norm,
40:45but it's absolutely normal. That
40:47makes sense, thank you.
40:49There's another one in the Q&A that
40:52I think is important that Stuart.
40:54I think you can provide some insight on this.
40:58Individual asks what are the vaccination
41:00recommendations for traditional blood
41:02cancer patients not on path for
41:04stem cell transplant and or Carty.
41:08So I I think. It is a good idea
41:13for patients who are on treatment.
41:15To discuss the vaccine timing
41:18with their physicians,
41:20I just with regard to.
41:23Review of any medicines that are
41:27being received that might blunt
41:30the response to the vaccine.
41:33the American Society Hematology
41:36guidelines do suggest at least
41:39consideration of an adjustment of the
41:42schedule for treatment if it's feasible.
41:46But just like in most of the solid tumor,
41:50patients getting vaccinated is better
41:52than not getting vaccinated and adjusting
41:54treatment isn't always advisable.
41:56So I just this would be a situation
41:59where patients should reach out
42:01to their provider just for the
42:04general information of the audience.
42:07The medication that is most likely to
42:09blunt response to the vaccine are steroids,
42:13so these are medicines like Prednisone
42:15and dexamethasone and these are used
42:18frequently and treatment of blood cancers.
42:20So there may be used in some solid tumors,
42:24but they're quite common in the
42:27treatment of multiple myeloma.
42:29Non Hodgkin's lymphoma.
42:31In some types of leukemia and sometimes
42:34this may be an issue of skipping a
42:37week of a steroid medicine or reducing
42:40the dose temporarily in the two weeks
42:43after the first dose of the vaccine.
42:46So that is considered.
42:48I so this has been discussed.
42:51I in hematology section.
42:52The faculty are aware of this option,
42:55and of course patients who are on
42:58treatment or being seen frequently so they
43:01can discuss this with their their providers.
43:04There are other agents,
43:06such as the monoclonal antibodies,
43:08like we talk soon AB.
43:10These are medicines that reduce the
43:13the function in the quality of our
43:18lymphocytes that make antibodies very
43:21effective treatments for lymphomas.
43:24But they may also blunt the
43:28response to the vaccine.
43:30I so patients receive these drugs again
43:33should be talking to their providers.
43:35In most cases they should just get
43:37the vaccine and we will consider
43:39that it's better to get it,
43:41even if it might be less effective.
43:45So and and just to reiterate,
43:47and I think you already mentioned this.
43:51In these patient populations,
43:54receiving the vaccine does not
43:56allow us to dispense with our
43:59social distance seen or mass.
44:01Skiing or are avoiding exposure.
44:03Real patients,
44:04we really still need to be careful.
44:08I even after after getting vaccinated.
44:17Thank you Ann.
44:18You know on that last piece,
44:20I think there are some questions
44:22about that that I think it's
44:25worth taking up and any of the
44:28clinicians can jump in on this.
44:29There was a particularly.
44:34Poignant question here that I think
44:36we should do our best to address.
44:40This individual asks is it now safe?
44:43I assume after vaccination to go
44:46visit an hugger grandchildren.
44:48Oh after our second vaccination while masked
44:52even maybe. I I can address that,
44:55I would be interested to
44:58hear what other people say,
45:00but I I am a member of the Smilow or
45:02the Yale New Haven Committee that
45:05is addressing vaccination issues
45:07in immunocompromised patients.
45:09So that includes a lot of the patients
45:13who are on this call clearly.
45:16And this was discussed just last
45:18night based on an article that
45:20came out in the New York Times.
45:23A lot of people saw in regard to the CDC's.
45:27I recommendation that this might be
45:30OK for grandparents to be getting
45:34together with grandkids in houses
45:37where they've been vaccinated.
45:40There is still a lot of concern
45:44and uncertainty.
45:45About the asymptomatic carriage of the virus,
45:49even in patients who've been vaccinated.
45:53And while the data suggests that
45:56getting vaccinated reduces the
45:57likelihood of carrying the virus around,
46:00if you were to be exposed.
46:03It doesn't eliminate it entirely.
46:06So I can.
46:07I can just report that the infectious
46:10disease experts that we work with.
46:13Are still concerned about letting
46:17our guard down.
46:19In the midst of the vaccination rollout,
46:22when it's only 17% of the state
46:24less than that around the country
46:28have been vaccinated.
46:29So I think the official word that's
46:32going to come from our committee
46:35is to stay tuned and keep social
46:38distancing and wearing your mask.
46:41It doesn't mean you can't see family members,
46:43particularly if everyone's been
46:45vaccinated and people are being safe.
46:47But I think we still need to be careful.
46:52So go ahead, Karen.
46:54So I just want to sort of say that
46:57we are all walking a really hard
47:00line right now between doing what is
47:03safest and desperately needing to
47:06live our lives and see our loved ones
47:09an sometimes there's not a clear,
47:12right and wrong answer.
47:13I will say that for the older
47:16population who have just less time
47:19left to live and for patients who
47:22have advanced and metastatic cancer.
47:25This year has been incredibly
47:27painful because it has felt like.
47:29You are losing time an you don't have
47:32a lot of time and I think that in all
47:36of our decisions we need to balance
47:39safety and emotional well being.
47:42And the answer may not be the
47:45same for everybody.
47:46And you know,
47:48we just ask you to be thoughtful
47:51and be as safe as possible,
47:53but recognize that it may be really
47:56important to see your grandchildren.
48:02Karen, thank you for that
48:04really thoughtful reflection.
48:06I think that that captures
48:08beautifully what we're all.
48:12Working hard to to manage. One person asks.
48:21In a way actually says and then
48:23ask I'm most comfortable being
48:25administered vaccine through my
48:26smilow care team as they best
48:29know me and my treatment plan.
48:30Will this be an option?
48:33Kim, do you want to maybe give a start
48:36with that one in any of our other panelists?
48:38Might pick up on that as well.
48:41Sure, yeah, I can get.
48:43We would love to be able to have enough
48:46vaccine supply to be able to vaccinate
48:49our cancer patients in our clinic.
48:51But really, with the best way
48:54we can vaccinate all people.
48:57I in the state of Connecticut is
49:00through our mass vaccination process.
49:05There are there so many operational
49:08challenges with the storage and the
49:12way we need to keep the vaccine.
49:14We want to use every single dose that
49:17we get available to us in the state of
49:21Connecticut and our vaccination sites
49:24have been very efficient and effective in
49:28administering as many doses as we receive.
49:31Actually, our state.
49:33I wish I knew the actual statistic now.
49:37But our state has been very,
49:40very successful in getting what we call
49:43vaccine into the arms of our residents.
49:45So right now we are just really focusing
49:48on those mass vaccination sites,
49:51because that's where we can get everyone
49:54vaccinated as soon as absolutely possible.
49:56So that gets evaluated all the time
49:59based on the supply that our state gets.
50:03So I just want this community to know that.
50:07Our organization is always looking
50:09at this and we are making decisions
50:12based on the supply that we get and
50:16how we can how we can get it to all
50:18of our patients as soon as possible.
50:21So right now the answer is we won't
50:24be providing it in our smilow sites
50:27and we are really encouraging all
50:29of our patients to go through the
50:32mass vaccination sites,
50:33but it is something we evaluate an account
50:36on a continuous basis depending on supply.
50:39And I don't know if anybody has
50:41any additional comments.
50:46Kim, I think that was incredibly
50:48comprehensive and you do.
50:52So eloquently speak to the
50:55R. What I can best describe is our
50:58ambivalence about this. We oncology
51:01clinicians really.
51:02In an ideal world, would deliver.
51:05Comprehensive services to our patients,
51:08but we do balance that against the larger
51:11public health mission that the state
51:14is outlined in and that we want to be
51:18in collaboration and compliance with.
51:21And I think you know I will use that as
51:24an opportunity to to bring forward a
51:27related question that one individual asks,
51:29and I think is on the mind of a mini
51:32of our of our patients and families.
51:36And the question that I'm specifically
51:38looking at reads as such.
51:40Any insight as to why cancer patients
51:42and people with illnesses were
51:44taken out of the vaccine rollout?
51:47Our group was supposed to be in line,
51:50now it's by age only.
51:52Well again, very difficult situation
51:54for us is oncologists.
51:55We do feel like we care for the
51:58most vulnerable patients and they
52:00should be first in line.
52:03That being said.
52:06Decision-making amongst individuals
52:08who have any range of complicating
52:13underlying illnesses or comorbidities
52:16including autoimmune diseases.
52:18Cardiac diseases.
52:21Obesity chronic pulmonary disease.
52:26Hypertension, various medications.
52:30All put people at some increased risk in
52:33addition to people who were on
52:36cancer treatment or recovering
52:38from cancer treatment. So I think.
52:41Creating an equitable framework in
52:43which people with comorbidities
52:46would be prioritized versus age
52:48is and would be a daunting task,
52:52and I think that as much as
52:56we struggle with this, our
52:59colleagues in the state health Department
53:02are understandably pursuing a path
53:05that likely will get the most
53:09vaccine in the most people.
53:12In the most efficacious way and the
53:15current rollout strategy in the meantime,
53:18I think our biggest obligation
53:20is to stay vigilant, stay safe,
53:23and continue diligently with social
53:25distancing and mask wearing and
53:27thoughtful practices about where
53:29we are and what we're doing.
53:36Anything to add to to that
53:38commentary from my colleagues?
53:44I think I just want to acknowledge.
53:47How frustrating it is for people.
53:50Ann, you know there is one comment
53:52in the chat from somebody who is
53:55young but has a stage three breast
53:58cancer in her younger sister who's?
54:01Healthy got a vaccination before she did
54:04because she works as a teacher or she
54:07works in the education system and there
54:10is a profound feeling of unfairness.
54:12Ann, I think there are so many
54:15groups of people who feel like.
54:18This current rollout is leaving them out
54:21or delaying them or putting them at risk,
54:23and I think it's just so hard
54:26to get it right,
54:27and I think what the governor
54:29picked was something that was
54:31simple and that he could move fast
54:33so that ultimately everybody,
54:35even even the younger adults,
54:37will be able to get their vaccine
54:39in a relatively short time period.
54:42So I think no matter how you approach it,
54:45there are there are people who will feel
54:47left out and who actually will be left out.
54:50But but I promise that everybody will
54:53be gotten to in the near future.
54:59You know one of the questions.
55:00Thank you, Karen.
55:01One of the questions that is coming
55:04forward from a variety of folks is is
55:06there a role for antibody testing if.
55:09People have been on any kind of
55:12treatment to assess vaccine response.
55:16And I guess that I I will say
55:19there is no defined role for
55:21antibody testing after vaccination.
55:23But Doctor Seropian doing
55:24away in on that too.
55:26Yeah I I would
55:28just qualify that to say there
55:30there is currently no defined role,
55:33but this is being studied.
55:34It will continue to be studied we we
55:37have plans to study vaccine responses,
55:40not just antibody,
55:41but there are other email logic tests to
55:44assess other parts of the immune system.
55:47There are. Cordant will be studying
55:50this in the transplant patients
55:54and the group that is considering.
55:57Issues around vaccination.
55:59Immunocompromised patients
56:01has taken this up too.
56:04To review the issue and I just
56:07for people's general knowledge,
56:09'cause it may seem straightforward to say.
56:12Well, I had the vaccine if I have
56:14an antibody test that's positive.
56:17It worked right.
56:18Unfortunately,
56:18that that's not clearly the case, it's it's.
56:22It's far more complicated.
56:23The available antibody tests
56:25that are on the market now.
56:28Have not really been qualified
56:30to prove immunity to covid,
56:33and not only are they not really qualified
56:36to prove the people at protection,
56:38there's very little information on
56:40the durability of these antibodies.
56:42Many of the commercially available
56:44tests are different from each other.
56:47Many of them don't give us
56:49quantitative analysis of the
56:51magnitude of the antibody response.
56:53So in other words,
56:55someone could have a positive test of a
56:59small amount of a weak antibody to the virus.
57:02That isn't very meaningful.
57:04So this is an area of study.
57:07It's particularly important for
57:09populations like our cancer patients
57:12because they may not respond well.
57:14Um,
57:15so I I certainly I would,
57:17I and have been encouraging all
57:19of the patients I see in the
57:23transplant program to discuss with
57:25me donating research samples so
57:27we can try and figure this out.
57:30And if people hear of other studies,
57:33they can participate that
57:35that certainly is encouraged,
57:36but there will be more information on this,
57:39so I think probably later in the year,
57:42many of the patients on this
57:45call who have been vaccinated.
57:48May have the opportunity to get a test
57:51to see whether it worked well I would.
57:55I think I would discourage people from
57:58spending their money on commercially
58:01available tests because they heard
58:04another patient went and did this.
58:06Because the tests haven't really
58:08been validated in a way that we can
58:11use them sensibly to advise people.
58:13So it is more to come on this,
58:16and I think we will be doing
58:17it in the future,
58:19but we're not quite ready yet.
58:23Thank you, I think that's really helpful.
58:26As the surgeon on the group,
58:27I do want to take up
58:29kind of a broad based answer to
58:32a few questions that I've seen.
58:34One is a question from a.
58:40Woman who has had bilateral mastectomy's
58:42and lymph node surgery in both axilla
58:45both armpits and her question is,
58:48should she receive the vaccine
58:51someplace else in her body? You
58:53know, I think that is.
58:57Concerning, but overall extremely
59:00safe. The risk of developing lymphoedema
59:04after one of these vaccinations is remote.
59:09You know, quite appropriately if
59:11you do have access to lymph nodes,
59:14there may be some reaction,
59:17but there there is.
59:19There is a very, very little likelihood
59:22of developing Cellulitis at the injection
59:25site which would cause lymphoedema.
59:28What about other operations?
59:29In general, the primary reasons were
59:32waiting vaccination in the postoperative
59:34period is so that symptoms such as
59:36fever can be correctly attributed
59:39to the surgery versus a vaccination,
59:41so we would not encourage you to
59:44have your vaccination and then have
59:46your surgery at day or two later.
59:49Our general guideline is about 2 weeks.
59:54It may be a little bit longer if you're
59:57having a complex operation like splenectomy.
01:00:00And it was probably best to wait a
01:00:03few weeks after a complex operation,
01:00:06such as an abdominal procedure
01:00:08before having vaccination.
01:00:10But in general we we are encouraging
01:00:13people to proceed with vaccination.
01:00:17In a timely way. Um? You know,
01:00:22I think I want to be mindful of the hour.
01:00:26I hope we have answered the vast majority
01:00:28of our communities questions and I
01:00:30just like to give our our panelists
01:00:33an opportunity to share any last
01:00:35thoughts with our patients and families.
01:00:42So I'm Kevin, thank you.
01:00:44I'll just say real quick that I want to
01:00:47thank everyone for joining us tonight.
01:00:50As many of our panelists have said,
01:00:52you know, we just want to make sure that
01:00:55we're doing everything to help you and
01:00:58your loved ones stay safe as we continue
01:01:01down this path together and we're
01:01:03here with you every step of the way.
01:01:06And we're here to answer your questions.
01:01:09If there were questions that we
01:01:11did not answer tonight, we we will.
01:01:14Follow up and we will continue to
01:01:16have these forms, but you know,
01:01:19we we encourage our patients that
01:01:21when you can get the vaccine to get
01:01:24vaccinated and that still continue
01:01:25though with all the other safety
01:01:28precautions as well and we are doing the
01:01:31same here we are getting vaccinated.
01:01:33We are social distancing.
01:01:35We are wearing our masks.
01:01:37We are washing our hands and you know,
01:01:40we're just here to go through this with you.
01:01:47Thank you Kim. Kevin
01:01:50farm I can give a really quick
01:01:53answer to a couple of questions
01:01:55I saw that I thought should not
01:01:58be left unanswered tonight.
01:01:59Thank you Stuart that there were
01:02:01a few questions from patients who
01:02:03have histories of anaphylaxis.
01:02:05It wasn't specified exactly what
01:02:07they were anaphylactic too,
01:02:08but this is one of the few potential
01:02:11contraindications to getting the vaccine.
01:02:13That's quite important,
01:02:14so people have anaphylaxis.
01:02:15Need to contact their doctor?
01:02:17It it may be advisable to consult either
01:02:19with an immunologist for an infectious
01:02:22disease specialist 'cause it may not be safe.
01:02:25Oh, I didn't see the details of those
01:02:28people who asked about what they were.
01:02:31Allergic to,
01:02:31but it's it's clearly anaphylaxis.
01:02:34Other vaccines.
01:02:35But there are other medicines,
01:02:37including components of
01:02:39some chemotherapy drugs.
01:02:41That can cross react with the vaccine,
01:02:42so if someone said anaphylaxis to anything.
01:02:45If they go and sign up for the vaccine,
01:02:48they might be rejected when they
01:02:49show up because of their history.
01:02:51They need to talk to their doctor first.
01:02:56That's a really important point and
01:02:59I I do think that this is one of
01:03:02these things that is so variable
01:03:04that it is difficult to answer
01:03:07that question in chat format.
01:03:09Clinician would really needs to
01:03:11know what the the details of your
01:03:13history and reaction are. Maybe
01:03:16we can say when in doubt, reach out.
01:03:22I think that's perfect,
01:03:24and on that note we wish all
01:03:27of our our patients and their
01:03:30families continued safety and
01:03:31we hope to see you soon.
01:03:34Have a good evening.