September 1, 2021: A Smilow Patient and Family Forum

September 02, 2021

Information

Hosted by Nita Ahuja, MD, MBA

Presentations by Drs. Kevin Billingsley, Maryam Lustberg, Scott Huntington, James Yu, Ohm Deshpande and Kim Slusser and Lisa Barbarotta.

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00:00Welcome to the Smilow
00:02patient and Family Forum.
00:04It's my pleasure to welcome you back.
00:06For those of you who may have been
00:08here the last time we were together.
00:10But for those of you joining or the
00:12first time my name is Doctor Nita
00:14Uja I'm the interim director for the
00:16Yale Cancer Center and position in
00:18Chief for the Smilow Cancer Hospitals.
00:20My other job is the chair of the
00:22Department of Surgery and it's
00:24a pleasure to see all of you,
00:26or at least have you join us this evening.
00:29So with that? Maybe next slide.
00:31I think many of you join us
00:33and are connected with us in.
00:34In over with you and and with your
00:37families and it's I want to take
00:39just a few minutes to acknowledge
00:41the upcoming cancer awareness funds.
00:42And September I'm going to just
00:44say is a busy month for us.
00:47So first up is.
00:50Our prostate Cancer Awareness month and.
00:56Prostate cancer, as some of you may know,
00:58is one of the most diagnosed and treated
01:00cancer in men at smilow Cancer hospital,
01:02accounting for 17% of all male cancers.
01:06BC here and our oncologist, urologist,
01:09radiation oncologists and other specialists
01:12partner together to provide specialty
01:14care to men diagnosed with this disease.
01:17So if you have please talk to the
01:19men in your life to talk to their
01:21health care provider about screening.
01:23This is it screen screen cancer Next up.
01:26Also, is gynecological
01:28Cancer awareness month?
01:29And similarly our team of gynecological
01:32oncologists and other specialty
01:33physicians provide excellent care
01:35to women diagnosed with ovarian,
01:37cervical, endometrial and other cancers.
01:41And for nearly twenty years
01:42or discovery to cancer,
01:43cure program has led research projects
01:46for earlier detection of ovarian
01:49cancer and supported clinical care
01:51for women at Yale and in Smilow.
01:54Enable you move to the next slide.
01:56I I mentioned it's it.
01:57There's a lot of cancer awareness.
01:59September, I think it's so.
02:00It's want to acknowledge all of the all
02:03of those in terms of raising awareness.
02:06Next up is blood Cancer Awareness
02:08Month and the Smilow Cancer
02:09Hospital hematology program,
02:11led by Doctor Stephanie Lee,
02:13has expanded over the last several years
02:16to provide expert care to patients through
02:18our multiple myeloma and gammopathy
02:21program classical hematology program.
02:24Leukemia,
02:24lymphoma,
02:25stem cell transplant and these
02:27newer therapies.
02:28The car T cell programs that are
02:30available are transplant program is
02:32also a member of the National Marrow
02:34Donor program and is accredited
02:36as a major transplant center under
02:38Dr Stuart Seropian's leadership.
02:42I also want to acknowledge thyroid
02:44cancer Awareness month and the
02:46incidence of thyroid cancers.
02:48Unfortunately,
02:48actually rising in for women in Connecticut.
02:51Dash,
02:51Jennifer Ogilvie joins Milo Cancer
02:53Hospital earlier this year as Chief
02:56of Endocrine Surgery and is leading
02:57a team including her endocrinologist
02:59and medical oncologist to care for
03:02patients diagnosed with thyroid cancers
03:04are cancer prevention and control
03:07research program is also actively
03:09receives researching this rising incidence.
03:12To determine the causes of this
03:14and find ways to prevent it Next
03:16up and then last but not least is
03:19childhood Cancer Awareness Month.
03:20We also celebrate our littlest
03:22patients and the tremendous care or
03:25pediatric hematologist and oncologist
03:26in child Life team provided smilow
03:29cancer hospital and in the Yale
03:31New Haven Children's Hospital.
03:32I'm also really excited to announce
03:35that next month we'll welcome Doctor
03:37Lakshman Krishnamurthi as our new
03:39Chief of Pediatric Hematology
03:41Oncology and bone marrow transplant.
03:44Questionable through more seasoned,
03:46accomplished pediatric hematologist
03:47oncologist and an international
03:49leader in bone marrow transplant.
03:52He's joining us from Atlanta Berries,
03:53a professor of Pediatrics at Emory
03:55University School of Medicine
03:57and director of the bone Marrow
03:59Transplantation program there.
04:00So that was a lot of raising awareness
04:02of all the cancers that are this month.
04:05Next up,
04:06it's the closer to free bike ride.
04:08I know that this is an event that
04:10has been important to Connecticut
04:11and all of our all of our
04:13patients. In our families, etc.
04:15It's on Saturday, September 11th.
04:17I know we were briefly hoping
04:19it would become an in person,
04:21but it has once again moved to
04:23a virtual event to protect and
04:24give safety to all our writers,
04:26volunteers and community.
04:27I'm could guarantee you the spirit will
04:30be strong in all of the participants,
04:32so even though it's virtual,
04:34I know many of you participated in
04:36this and I encourage you to register
04:38and join the event online or donate
04:40to support a rider or ride closer to
04:43free dot or you can log on and on the
04:46site on right closer to free.org.
04:48100% of the funds go to support patch
04:51patient carrots Milo Cancer Hospital in
04:53Cancer Research at our Cancer Center.
04:56I thought I would also talk very briefly
04:58about COVID data from our what we are seeing.
05:01So in terms of if you're wondering,
05:04the hospital Yale New Haven Health
05:06System has made vaccination mandatory
05:09and over 27,000 of our employees
05:11have been vaccinated and in terms of
05:13how many vaccines we have delivered,
05:15I think you can see that over 200,000.
05:17And if you see the care that continues
05:20to happen along with cancer care,
05:22we continue to provide care to our camp
05:24COVID patients over 12,000 patients
05:26have been discharged and released,
05:28and as health system has had the lowest
05:30mortality in the statement compared
05:32to the all the hospitals I know we all
05:34contribute and we're proud of that
05:36of the care we provide to our Community.
05:38So just wanted to take a minute to
05:40acknowledge that because I know this
05:42is something we're all living with.
05:44Next slide, Renee, please.
05:46Alright.
05:47So if you have suggestions or questions.
05:49About these forms,
05:50I do want you to take the time to reach
05:52out to us and all the ways Facebook,
05:54Twitter, etc.
05:55You can use old fashioned emails,
05:57cancer and answers at yale.edu
05:59and follow us on social media.
06:02I know Renee Gadets team since a
06:04lot of information on the various
06:06social media formats,
06:07so again we want to hear from you.
06:09You are part of our community and
06:11we feel very connected with you
06:12and we want to make sure we're
06:14supporting you and all your questions.
06:17With that I'm going to share
06:19the agenda for tonight.
06:20First up is our new chief for Breast
06:22medical Oncology and the director of
06:24the Breast Center at Smilow Cancer
06:26Hospital will be Dr Maryam Lustberg,
06:27who has joined us recently
06:29from the Ohio State,
06:30and she's going to be talking about the
06:33impact of COVID on cancer survivorship.
06:35I would like you know she will talk
06:37and then we'll have Q&A and after
06:39that we're going to talk about,
06:40I suspect,
06:41which there going to be a lot
06:42of questions and answers.
06:43It's immunocompromised patients
06:45and 3rd dose vaccinations.
06:47And doctor Om Deshpande,
06:49who's our executive director in
06:50charge of this program for Yale,
06:52New Haven Health,
06:53has joined us.
06:54Thank you Doctor Deshpande
06:56doctor Kevin Billingsley.
06:57Many of you know him.
06:58He's our chief medical officer
07:00for Smilow Cancer Hospital and
07:02will be giving us the updates.
07:03And he's joined by a team and we want to
07:05make sure we answer all the questions.
07:07Lisa Barber ODA,
07:09who's the program director and oncology
07:11education Dr Huntington who is in
07:14hematology and can answer those very
07:16specific questions for hematology,
07:18hematologic malignancies, patients.
07:20Miss Lester, who I know many of you.
07:23If you've joined us in the past,
07:24know her she's her chief nursing
07:26officer and vice president.
07:27Patient services for hospital
07:29and then Dr Euhus,
07:30their associate CMO for radiation oncology,
07:33is also joining.
07:34Still everybody give a big babe so you can.
07:36They can see your faces in your names are on,
07:39but with that I'm going to turn
07:40it over to our very own doctor
07:42Lustberg to give you an update
07:44on cancer survivorship.
07:46Doctor Losfer take it away please.
07:48Thank you Doctor Raja and
07:50thank you to all the.
07:51Participants tonight in this town hall.
07:55It's wonderful that you're here.
07:57So that we can all have a conversation
08:00about the impact of COVID,
08:02which has changed many things in healthcare.
08:06As many of you know,
08:07and I'm sure many of you have
08:10also been personally impacted.
08:12By many of the changes that we have
08:15all gone through since early 2020,
08:18so this schema here is a.
08:22It captures the work of many of
08:26the collaborate collaborations
08:28that I've had throughout the
08:30country where we were observing.
08:32Kind of what was happening to
08:35healthcare delivery as essentially the
08:37healthcare system for valid reasons
08:39had to come to a halt with with the
08:43mounting cases of COVID in early 2020,
08:46and as you can see we've had multiple waves.
08:50So this is, uh,
08:51this was an artistic depiction
08:54of how multiple cancer survivors
08:56were affected by multiple waves of
08:59COVID as they each came through,
09:01and we with each wave.
09:03We thought this might be the last one,
09:04and so as we're currently
09:07experiencing or fourth wave,
09:08I think it's it's.
09:09It's a telling schema and so with with
09:13many of the national survivorship experts,
09:15I think we we we really had multiple
09:18dialogues in terms of how we could
09:21better support cancer survivors as
09:23they were going through the pandemic.
09:25And to make sure we're all on
09:27the same page in terms of the
09:29definition of a cancer survivor,
09:31because I know that can
09:33be confusing sometimes.
09:34Uhm,
09:34really,
09:35the official National Cancer
09:37Center definition.
09:38Is anyone diagnosed with cancer
09:40from the day one of diagnosis
09:43throughout the rest of their lives.
09:46And obviously there are many
09:48different types of cancer survivors,
09:50and this will also be relevant in
09:52the next segment of this town hall.
09:55When we talk about.
09:57Patients on active treatment versus
09:59patients were not active treatment,
10:01but what we noticed kind as as as
10:04as a COVID-19 was mounting that
10:08there needed to be best practice
10:09is set in place in terms of how we
10:12better communicated with with the
10:14many different cancer survivors,
10:16how we shared information and
10:18how we try to make the best of
10:21things during resource lean times.
10:23When we were going through this crisis so.
10:27Many of these themes you have
10:29seen because the health system
10:31here has really done a terrific
10:34job of responding to this crisis.
10:36But on top of the wave you can
10:38see the the the the box,
10:40assess and anticipate the COVID-19 burden.
10:43And this is exactly what was done.
10:45What is being done?
10:46What will be done?
10:47Which is we are constantly looking at
10:50what our case numbers are doing and
10:53really making decisions in terms of.
10:55You know what?
10:57Whether we need to scale
10:59back from certain events,
11:02whether to keep things fresh.
11:04Also can constantly being in
11:06touch with you in terms of how how
11:10the COVID-19 burden is is doing.
11:13Another theme that emerged for
11:15cancer survivorship and other other
11:17types of cancer care delivery
11:19was other emergence of increased
11:21reliance on Tele health,
11:22which which has been a wonderful asset.
11:27However, we also want to make sure that
11:30cancer survivors also know that it's also
11:32safe to enter the health care system.
11:35There was a lot of fear,
11:37specially in the early months of
11:39the pandemic where certain signs
11:41and symptoms of disease progression,
11:44where perhaps being being ignored
11:46because patients didn't feel safe
11:48to enter the hospital system.
11:50So Tele health absolutely has a place it.
11:53It absolutely enhances care delivery,
11:56but they are there.
11:57Also, instances where a physical
11:59exam is also important.
12:00So really educating our survivors in
12:03terms of signs and symptoms to look for
12:07and to come into the health care system.
12:10If they are very worried or
12:13have a concerning system,
12:14the next piece that really emerged
12:17during the pandemic was the importance
12:19of the health care team that in
12:22order to this is something we've
12:24always known but but COVID really
12:26brought it to to center stage,
12:29which is that the different
12:31health care providers needed to
12:33really work together from primary
12:34care specialists to to oncology
12:36specialist continued collaboration
12:38with nurses and advanced practice.
12:41Providers another area that impacted
12:44are cancer survivors with access to
12:47diagnostic imaging and services and
12:49this is something that we can reassure
12:51you now that that things are back open.
12:54We want you to come in for your screenings.
12:57This is a central component of cancer
13:02survivorship and these services are
13:05available now and it's really important to.
13:08To follow a guideline,
13:11concordant care and what we unfortunately
13:15saw during the pandemic in in some of
13:17the earlier waves was that there was
13:20a sharp drop off of cancer screenings,
13:22and now we're seeing that starting
13:25cancers are actually presenting
13:27at more more more advanced stages.
13:30You'll hear a lot more about the next box,
13:33which is the concept of risk stratification.
13:36We we we want to be really giving
13:40personalized care to all of you,
13:42which means your vaccine recommendations
13:44and a lot of your care.
13:47Recommendations and cautions are
13:48dictated by your level of risk,
13:51which is in many ways determined
13:54by the type of cancer you have and
13:56the type of cancer treatments that
13:58you are receiving.
14:00So a lot more information will come
14:02up in the next segment of the town
14:04hall and also in the panel discussion.
14:07And uhm.
14:08The next box focusing on outreach
14:11and education.
14:12This is something that we feel very
14:15passionately about and inspire low,
14:16and we this is one of the many reasons
14:19we're having town halls like this
14:22is that we're one community and we
14:24want to share with you information
14:27as it becomes available and to really
14:30focus on state of the art patient
14:33education through our websites,
14:35social media as well as these types
14:37of live events.
14:39And then most importantly,
14:41I think it's important to take a pause.
14:43All of us and really acknowledge what,
14:46what, what, what, these past year,
14:49year and a half has done to us
14:51and in our workforce and our
14:54families in our relationships.
14:55I think it's up there.
14:58There has been a significant like the
15:02social impact of COVID-19 It's important
15:05to to take a moment and realize that,
15:08and also know that there are
15:11many resources available to.
15:13To address these psychosocial needs and to
15:16be able to ask for help to to know that.
15:20Social distancing does not necessarily
15:22have to mean social isolation and
15:24that there are different ways
15:25that we can all reach out to each
15:28other and support one another.
15:29And you're part of our community,
15:32and so I just want to encourage
15:34you to continue to to reach out.
15:37So this was the schema was initially created
15:40by my colleagues early on in the pandemic,
15:43and the next figure reiterates the similar
15:47themes that I'm not going to go over,
15:50but it highlights how we
15:52thought that the pandemic.
15:53Was over and then into 2021 we realized.
15:56Gosh we needed to reassess.
15:58What are survivor needs were and
16:00you can see a lot of the same
16:02themes that I already covered,
16:04including you know do not delay
16:07needed and in person visits.
16:09Uhm,
16:10really it would continue to focus on
16:13healthy habits and healthy behaviors.
16:17And additional themes emerged,
16:19including the financial impact of
16:22COVID-19 because it was impacting
16:25survivors in terms of.
16:27Many different issues in terms
16:29of changes and work patterns,
16:31and this may have impacted their ability,
16:35ability to access health insurance,
16:38or be able to pay for certain services so.
16:43Or I think it just highlighted that
16:46these needs continued even into
16:49the into the third and 4th wave.
16:53And that the main upshot was to really
16:58be open to using the health care facilities,
17:01acknowledge the impact of COVID,
17:03and know that you know many
17:05cancer services cannot wait that
17:08that that that cancer itself is.
17:10Is not an elective procedure that
17:12was one of the other myths that that
17:14sometimes emerges like Oh well,
17:16cancer surgery can be can be postponed
17:18or a bit, but we we we really,
17:21I think,
17:22have a better understanding that all
17:25our patients and cancer survivors
17:27need ongoing care and we are.
17:30We are committed to providing that
17:33with you and in the subsequent segments
17:35of this town hall you'll hear more
17:38about how we can help optimize your health.
17:41As we continue to go through this 4th wave,
17:44so I'll stop there to make sure we have
17:46time for other segments and for questions.
17:49Thank
17:49you doctor. Lustberg I think
17:50will save the questions.
17:51There are some questions
17:53around protecting survivors.
17:54I'm going to leave it at the end
17:55because I think a lot of the next
17:57discussion will also address this.
17:58I think the points that I heard
18:00which I loved, social distancing,
18:02doesn't mean social isolation.
18:04We need to remember this part of her
18:06can taking care of our community,
18:08and I think if everyone didn't
18:10get this then make sure you get.
18:12While you're screening done because
18:13I think last year we did see a
18:16lot of gaps as things shut down,
18:17so thank you so much I I suspect there
18:20will be more and more questions,
18:21but I want to sort of come I
18:24someone saying they cannot hear me.
18:27Uhm? Or others hearing me,
18:29just give me a thumbs up if you can hear me.
18:31OK doctor Deshpande.
18:32Others OK miss our fee I'm hoping
18:35that we can get you connected or
18:37enable reach out to you offline
18:39but I'm going to move on to the
18:41next segment because I suspect
18:43there are lots and lots and lots of
18:45questions around the booster shots.
18:46So with that Doctor Deshpande,
18:48I think you're starting this segment.
18:51Or Doctor Billingslea or Miss
18:52Barbarito I I am actually I'm going
18:54to pass it on to the panel so.
18:57OK, I think we could probably tag team and,
19:00uh, but uh, thank you Doctor Who
19:02and thank you for having me so.
19:05You know, as was mentioned earlier,
19:08the health system has actually
19:10done over 450,000 vaccinations and
19:13has vaccinated approximately 200
19:15and 15,000 people individually.
19:17You know on the point that Doctor
19:20Who brought up that are about
19:22our health care workers.
19:23We jointly with our other
19:26hospitals in in the state,
19:29had really committed to a vaccine
19:32mandate and we were at 81% of
19:35our of our full workforce.
19:37Which includes our medical staff
19:39prior to the mandate and we are
19:41making significant progress.
19:43Our deadline for the first dose
19:44was actually yesterday and we're
19:45still waiting on the final data,
19:47but we're we are making a lot of
19:49progress and we anticipate that we
19:51will get to our goal by the end of September,
19:54which is, you know,
19:55part of our ongoing commitment to providing,
19:57you know, the really safest care
19:58to all of our patients.
20:00And of course,
20:02most importantly are those who
20:04are had increased vulnerability.
20:06With regards to the immunocompromised
20:09population there,
20:10I'm sure most of you are aware
20:13of the fact that a third dose was
20:17approved sometime ago and thus
20:19far in the state of Connecticut,
20:20about 10,000 of these doses have
20:22been administered and around
20:248:00 or 900 of these doses have
20:26been administered at Yale,
20:27New Haven Health,
20:28so the process really has not changed
20:31from our first from our first wave,
20:34the first two doses it's very easy to.
20:37To go through the process and get scheduled,
20:40uh,
20:40the the website is is on the
20:42bottom of this slide.
20:43You can also call our call center at 833.
20:46Ask why NHH and they can also
20:49telephonically schedule you.
20:51The process is fairly seamless
20:54and straightforward.
20:55You really have to attest to the fact
20:58that you you meet the definition of
21:00them in a compromise and as a part of
21:03that workflow we really do highlight
21:05the different things that that.
21:07Are there constituting any compromise
21:09per the CDC's recommendation,
21:11and the language has changed a fair
21:13amount over the last few weeks of thing
21:15as things have gotten better and better,
21:17so I think that our language as you
21:20actually schedule through the website,
21:22it has been updated.
21:23I don't know.
21:24There are website where it talks about LVK
21:27seen eligibility has been fully updated,
21:29so just stay tuned.
21:30That will also be updated
21:32by tomorrow morning.
21:33Kevin Lisa, if you do,
21:35do you want us to go through the specific?
21:37I can't.
21:38OK there we go.
21:39Thank you doctor. Just pandi.
21:41You know, I I'd like to just
21:43build on a couple of the comments
21:46made by my colleagues. First off,
21:49to echo Dr Lustberg we fully understand.
21:53On behalf of our patients and their
21:57families that navigating a cancer
21:59diagnosis and cancer care and
22:01getting through the cancer journey
22:04is difficult and trying at best.
22:07But when our patients and families
22:09confront the challenges of a global
22:12pandemic layered on top of their diagnosis,
22:15it truly creates a difficult mix.
22:19Our goal is your cancer care team is to make.
22:23Navigating that difficult mix as easy
22:26as possible and as safe as possible.
22:30And as Doctor Deshpande indicated.
22:34Part of that is that we,
22:36as health care providers,
22:38are committed to getting vaccinated
22:40ourselves so that when you come
22:42into our facilities or offices,
22:44you know you're safe.
22:45Our health care system has been in
22:48the lead in the state of Connecticut
22:50and vaccinating people over 250.
22:52Fifteen thousand people vaccinated,
22:55and we're still rolling.
22:57Now with this third dose.
23:00And the question is, you know,
23:02as Doctor Despond indicated,
23:03this has been a moving target and we
23:07have just updated our recommendations.
23:09The original description was for
23:12immuno compromised patients to be
23:14immediately eligible for a third dose
23:17vaccination to boost their immunity
23:20and the truth is that the vast
23:23majority of our patients are actually
23:26within this eligibility criteria.
23:28So just to go through this in a
23:30little bit more detail and you can
23:32certainly read along with me if you
23:34are this is and this is part of our
23:37attestation language on our website.
23:39If you are an individual who has
23:41a diagnosis of cancer and you've
23:43met at least one of these criteria,
23:45you are eligible for an immediate
23:48vaccination either within our system
23:50or within one of the commercial
23:52sites around the state.
23:54Meaning that you have received
23:56some cancer therapy,
23:57including really the entire
23:58spectrum of treatment for cancer.
24:01For a solid tumor within one year of your
24:04initial COVID-19 vaccination series.
24:06Or you or someone who may not
24:09have started your treatment,
24:10but you've been diagnosed with
24:12cancer or recurrent cancer and you
24:15have a treatment plan in place that
24:17will be moving forward that will
24:19include chemotherapy, immunotherapy,
24:21radiation therapy.
24:22And we are even including surgery in that.
24:26Or you were one of these?
24:27One of our patients who were
24:30facing a hematologic disease or
24:33blood cancer diagnosis.
24:34For example, leukemia,
24:35lymphoma, myeloma, or Milo,
24:38dysplastic syndrome,
24:39or other chronic myeloproliferative
24:41conditions.
24:42You are also eligible and that
24:46eligibility is broadly spanning in time.
24:50Or you were a patient who's received
24:52a stem cell transplant or car T
24:55therapy at virtually any time here
24:57at the Smilow cancer hospital.
24:59So.
25:00We're really creating a broad
25:03eligibility structure for patients
25:06to derive the additional protective
25:08effect of that third dose vaccine,
25:12and we are in alliance in alignment
25:16with our peer institutions through the
25:19National Comprehensive Cancer Network,
25:22as well as the updated CDC guidelines.
25:28Next slide.
25:33That actually may be the end
25:35of our slides. Renee, UM.
25:40Yeah, I think we want to
25:42leave time for questions.
25:43Doctor Billingslea,
25:43so I think there's a lot of questions.
25:45The first one is from Miss Monaghan.
25:47Asking for advice for caregivers,
25:49spouses, Visa V protecting cancer
25:52survivors from COVID would be appreciated.
25:58And I also want to make sure
26:01that we introduce our panelists.
26:04Uh, I see my colleague Doctor Huntington
26:08who's also available to answer
26:10questions in the heme malignancy space.
26:12Uhm, we introduce these folks earlier,
26:14but Kim Slusser at least brought
26:16us so all can help with answering
26:18the answering our question.
26:20Would you like to take that one for
26:22sure? I know it's a.
26:23It's a great question on highlighting.
26:26The importance of caregivers. First of all,
26:29thank you for all that you do come.
26:32It's a way we are only the thing stages are
26:36truly recognizing what impact caregivers
26:39actually have during the cancer continuum.
26:43But to specifically answer your question,
26:46the the biggest thing you can do is to be
26:49normally vaccinated for standard of care
26:52as well as continuing to practice masking.
26:56In high risk situations,
26:59good hygiene, and if there are any,
27:02any symptoms that that,
27:04that that that raises the question in
27:06your head is could this be covered?
27:08Could this happy Kovit getting tested?
27:11Because testing it is is available
27:14and so those are those are the
27:18precautions that you can take as
27:21caregivers to to protect higher risk
27:23individuals at this point in time.
27:27Thank you, Mary. Come next question.
27:30I think this may be doctor
27:32Deshpande your alley.
27:33Should there be a delay between the
27:35flu shot and the third COVID dose?
27:37If So what is the suggested time frame?
27:39I know you've answered it,
27:41but maybe just give some more details.
27:43Thank you.
27:46So the Advisory Committee
27:48on Immunization Practices,
27:49which is sort of the the Group of
27:52expert who helps us create the
27:54guidelines for administration here,
27:55have reviewed the data across the
27:57board and have determined that it's.
27:59It seems it appears to be completely safe to
28:02get multiple vaccinations at the same time,
28:04so there's really no reason to could
28:06be concerned that you know either the
28:08flu or the code vaccine would be less
28:11effective by getting them at the same time.
28:13Again, the only thing is that you
28:14know if you get both of them.
28:16The COVID vaccine is likely to result
28:18in some transient side effects.
28:20The usual muscle aches a little bit of fever,
28:23headaches, things of that nature which
28:26all resolved within two to three days.
28:28So you you are going to you.
28:31You can easily experience those things,
28:33but again, those are.
28:34Those would be experienced regardless,
28:35so it is completely safe to
28:36get them both at the same time.
28:38And actually as we are planning
28:40forward for our health care workers,
28:42we are,
28:43we're figuring out the workflow to
28:44do that exactly that so it there's no
28:47reason to be concerned in that regard.
28:49OK,
28:50thanks, start responding.
28:51I think the next one,
28:52which is also important and I suspect
28:55front and center on following the
28:57question that doctor lost forgot.
28:59When will the caregivers of cancer
29:01patients be eligible for the booster?
29:04I know this is an area that's up and sort
29:06of there's a lot of data I don't know.
29:08Doctor Billingslea,
29:08are you taking this one?
29:12I'd be happy to you know.
29:15What I think we all would like to
29:18share is that this is. One of these.
29:23Areas that is evolving very quickly
29:26and I think that if you follow the
29:30CDC commentary and the advice of
29:33governing bodies around the country,
29:36there is accelerating movement
29:38towards opening accessibility for the
29:41general population for a third dose of
29:44vaccination in the very near term. Now,
29:47like the original rollout of the vaccine,
29:50I suspect that there will be a staged.
29:54Approach to this with the most high
29:57risk individuals being encouraged
29:59to seek that third dose the soonest
30:02particularly paid folks in in
30:05long term care facilities,
30:06the elderly,
30:07and probably health care personnel.
30:10But I think that that very,
30:12very quickly you will be seeing
30:16broad eligibility for a third dose.
30:19Doctor
30:20Deshpande, anything else you'd
30:21like to point out 'cause you manage
30:23this for the entire health system?
30:24Anything else we should point?
30:26I know this is a we'll be seeing
30:28more information. I suspect. Pretty
30:29short. Yeah, yeah we will
30:31be seeing more information.
30:32I I think that you know and I believe
30:34in the some of the documents that
30:35were some of the questions that
30:37had been submitted previously.
30:39Someone had asked to comment on a
30:40New York Times article that speaks
30:42to the sort of the controversies
30:44around waning immunity.
30:45And it gets a little complicated,
30:49so I'll try not to get too deep.
30:50Into the weeds,
30:51but I think the key thing here is
30:53that there are individuals who are
30:55clearly immunosuppressed or for
30:57some reason immunity does truly win.
30:59And you know the cancer patients and
31:02you know everyone who's receiving the
31:04therapy is that doctor Billingsley just
31:07outlined clearly fall into that category.
31:09Other people who are also probably
31:11in that category of people over
31:13the age of 65 and have you know,
31:15even if they have no other
31:17comorbid conditions.
31:18It is a little less clear about
31:21younger people and who may
31:23not have these comorbidities,
31:25so I think that is some of the
31:27data that has to be parsed.
31:29I do think you know,
31:30based on the the signaling
31:31from the White House,
31:32there was a desire to make this,
31:34you know available across the board
31:36and we were planning frankly for that
31:39eventuality towards the end of September.
31:41But I think we're also hoping that
31:42there's a little more clarity
31:44about who will actually benefit
31:45'cause the New York Times article,
31:47that that was sort of that
31:48was in the questions.
31:49Highlighted the fact that you
31:51know four people who are otherwise
31:53healthy and of our it's it's really.
31:55There are certain groups that clearly
31:57will benefit and then there are.
31:58There may be others who don't.
31:59So I think that we just need a
32:01little more information and with
32:02regards to the original question is
32:04to when caregivers will be eligible.
32:07It really depends on the national
32:09guidelines that are that are
32:11released in the meantime.
32:12Of course you know the key
32:14things that you know.
32:16Mask wearing,
32:16universal mask wearing hand hygiene
32:18and being particularly careful about.
32:20All the other infection prevention
32:23behaviours are or absolutely
32:24obviously continue to be critical.
32:28Thank you and I think you know
32:29the New York Times articles.
32:30For those of you may not have read it,
32:32I think talks about you know the
32:34risk benefit, and I think this
32:35is an area we continue to learn.
32:36I think 18 months later we know
32:38a lot more of this disease,
32:40but it also changes,
32:41so I think it's it gets into
32:43a lot of details around this.
32:44I think. Certainly there are clear
32:46categories with immuno suppression.
32:47Bear it's beneficial but you
32:49know if you're young and healthy.
32:51Do you benefit from a booster?
32:52I think it's something will bill figure out,
32:54but I think we're all learning a lot
32:57with this disease also and collectively.
32:59Uhm, dealing with this, uh,
33:02there's a question around
33:03getting the Moderna.
33:04If you got your last two doses of Moderna
33:06and now you're trying to get your booster,
33:09someone saying I can't get
33:10an appointment at Yale.
33:12They're waiting on a shipment Lisa,
33:13would you like to take this
33:15one or doctor Deshpande?
33:16I don't know who wants to take this one.
33:18It looks like it's gonna
33:19say that responded probably.
33:21I know it is.
33:22I figured that I would just give him a break.
33:24It's OK, no problem.
33:26So yeah, we so the good thing is
33:29that there really is enough vaccine.
33:31That's available so we can
33:33absolutely are ordering a.
33:35We are certainly ordering enough and
33:36we will have it available. You know,
33:39the number of for this initial group.
33:41We've only we've opened a
33:43limited number of of sites,
33:45mostly in RMG sites,
33:46and we're working to create some
33:48popups for smilow clinics as well.
33:51But there there is absolutely availability
33:53and we will make sure that Moderna
33:55will be an option that will that
33:57will that we will certainly offer.
33:59I think when when all is.
34:02Told the split between Moderna and Pfizer.
34:05I think we actually administered
34:06more Pfizer than Moderna were.
34:07Actually I'm sorry.
34:08More Moderna than Pfizer so
34:10we will absolutely have those
34:12available as we go forward.
34:14That responded don't go away I.
34:16I think there's another
34:17question following this.
34:18If you got Pfizer initially should you?
34:21Can you get the Moderner Moderna initially?
34:23Can you switch to Pfizer?
34:24So can you sort of share
34:27the combinations? Yeah,
34:28it's a. It's a great question and you know
34:30the the bottom line is that we really have.
34:33We are following the CDC's guidelines,
34:35which are really saying that you
34:36have to get the same version of the
34:39vaccine that you got originally.
34:41There's a lot of interest.
34:42There's a lot of research.
34:44That's actively going on here.
34:47There's a theoretically a lot of
34:49people have sort of had played
34:51out the value of vaccine mixing,
34:53but it really needs to be fully
34:54studied in a rigorous fashion,
34:56and we don't have those data to say
34:58that it's safe and truly efficacious,
34:59so we're waiting for those trials.
35:01At present, the the the.
35:05The guideline,
35:06the recommendation that we are following,
35:07is that you you get the same kind of
35:10vaccine that you got the first time.
35:11The first two times and
35:13we did get some questions on
35:15email prior to this event,
35:16as people register the last
35:17one on this and there were two
35:19questions which seem similar.
35:20People who had the J&J vaccine,
35:23should they be getting a
35:24booster from Pfizer Moderna
35:25or wait to see what J&J does?
35:28Yeah, so this is all we have to wait.
35:30At present we are not able to provide
35:32an M RNA vaccine for them at President.
35:34Did JJ has concluded a trial.
35:37Of the a second booster, because you'll
35:40recall that the J&J is a one shot,
35:42was was a one shot vaccine and we
35:45are still waiting for the actual
35:48trial data to understand what benefit
35:50and how how great the benefit is.
35:52So they they've issued a press release
35:54but we can't go by press releases.
35:56We have to wait until we have.
35:57We really have full transparency
35:59to the outcomes data.
36:00Thank you.
36:03I think the next one is for you Doctor
36:06Huntington neutropenia with with.
36:08Angus, I probably said it wrong,
36:10but no treatment yet qualify
36:12for third vaccine. Yeah,
36:14I. I think you know our
36:16guidance has evolved over time.
36:17So I think initially the CDC really
36:20was focused on active treatment.
36:22But for him malignancies oftentimes
36:25we won't actually vaccinate before we
36:27start the most oppressive therapy.
36:28And so I think our current guidance
36:30would be that some of that has engulfed
36:33neutropenia foramina suppressed and they
36:34would fall under the new category of
36:36of being allowed to have a third dose.
36:38Just want to.
36:39Had one UM, kind of feature about
36:41think about third dose versus booster.
36:43Many of my patients didn't respond to
36:45the first 22 doses and so our goal of
36:47the third dose is really to get those
36:49folks that didn't have any antibody
36:51response to having a response a little
36:53bit different when we think about the
36:55Community about people that you know,
36:5795% of the people on those Moderna
36:59and Pfizer vaccines made antibodies.
37:01Many of our patients were
37:03not those of those folks.
37:05They don't have antibodies,
37:05and so the third dose for them
37:07is a little bit different,
37:08so that's why I think the timing is.
37:09Also a little bit more nuanced in
37:11terms of not waiting eight months,
37:12but really within 28 days or
37:14more after a second dose,
37:16you can get a third
37:16dose. Thank you Doctor Huntington.
37:18You answered the question that came
37:20through our chat earlier and you
37:23answered that that immunosuppressed
37:24people do not mount a response,
37:26so they need their third dose a little
37:29sooner versus those of us who mounted and
37:32gaining immunity are waiting the time.
37:34I think this has been answered,
37:35but doctor Lustberg would you
37:37like to just add more detail?
37:38Those taking anastrozole?
37:39Daily basis count as amino suppression
37:42and can you get a boost right?
37:43Think the answer is yes,
37:45but anything else you want to add for
37:47other types of hormonal therapies etc.
37:49Yes, so no. I completely agree as my
37:52colleague hasn't happened have answered
37:53and that we want to be as broad as
37:56possible and be as inclusive as possible.
37:58It's absolutely true that you know
38:00compared to a patient on immunotherapy
38:03or chemotherapy the the level of
38:05immunosuppression from anastrozole is
38:07is not equivalent, but we we want to.
38:10Protect all our cancer survivors
38:12at various levels of training.
38:14So this is this is this is to be as
38:16inclusive as possible and protect
38:18as many patients as possible.
38:20So yes, any type of hormonal therapy and
38:22I also saw a question on other types of
38:26oral therapy such as PARP inhibitors.
38:28So that applies to that as well,
38:31which is that if you're on any
38:32type of treatment,
38:33go ahead and know that you
38:35are eligible for the booster.
38:38Thank you doctor you,
38:39you've been quiet, you know.
38:41Is there a benefit?
38:41Should you do it after that?
38:43Your booster after six months or eight
38:45months you know people want to know.
38:47Would you wait six months or eight months?
38:49Well, so as a
38:50radiation oncologist it's very
38:52question for me to answer, but I would say
38:55if you the NCCN is trying to be
38:57as broad as possible, and so if
38:59you fit the category of of getting
39:02a booster right away.
39:04You know, I don't think there's a downside to
39:06going ahead and getting
39:07it now. Is there a rush?
39:09I mean there was.
39:09I think there was a question
39:11in there about a patient would
39:12just finish radiation treatment.
39:14Just finished chemo.
39:15I would assume if they had had their
39:17immunization within a couple months,
39:19it's OK to kind of recover from that.
39:20And and there's no extreme rush
39:23to get the the third booster,
39:25so I would say fit it in your schedule
39:27and your lifestyle and know that the
39:29NCCN is being broadened recommending
39:31the booster as soon as it it fits.
39:36Thank you, I'm going to switch to
39:38the question answers, let's see.
39:39Uhm, perhaps I don't know Kim,
39:41do you want answer this?
39:43When are we going to have
39:45psychosocial services?
39:46I have nerd not heard
39:47of any or offered any.
39:50Oh OK, thank you.
39:51I'm so I'm so sorry that you
39:53haven't been offered psychosocial
39:55services due to the pandemic we
39:58have had to alter the way we
40:00offer a lot of those services,
40:02but we do have a lot of our social
40:05work team back in our clinic areas in
40:08some capacity to meet with patients.
40:11And then they also have the ability
40:13to meet virtually with our patients.
40:15So if you have not I, I really apologize.
40:19We're happy to follow up specifically.
40:21And then also on our Yale Cancer Center site,
40:25we have all of our listings of
40:27our integrative medicine offerings
40:29that are all done virtually now.
40:31And we actually saw that patients
40:33liked to do a lot of these things
40:36like meditation and yoga,
40:37right from the comfort of their home.
40:39So we still have those.
40:41And along with our support groups,
40:42so we have a, uh,
40:44a series of many different support groups
40:46and those are being provided virtually now.
40:49I know that some people.
40:51May not have all the technology
40:52they need and we are very sensitive
40:54to that and we are trying to bring
40:57those services back,
40:58but we're also trying to make sure
41:00we still maintain safe distancing.
41:02Social distancing in our clinical areas,
41:05and so it is a balance and we
41:08appreciate our patients flexibility
41:09through this and but please know that
41:12we want to provide these services.
41:15We have our our entire multidisciplinary
41:18multi departmental team here
41:20to take care of you.
41:21And we apologize if those
41:23services have not been offered,
41:24and again,
41:25happy to follow up individually
41:26and and make sure you're connected
41:28with the resources that you need.
41:31Thank you and our Renee.
41:34God has already put a couple
41:35of links on the integrative
41:36Medicine Office offerings
41:37and support group structure.
41:39Less for do you wanna add
41:41any more information?
41:41I thought it was pretty comprehensive,
41:43but if there's something
41:44else you'd like to add
41:45right now, can get such an amazing job.
41:48Yeah, I was just speaking to one of
41:50our social workers and she echoed.
41:51Exactly what this cluster referred to,
41:55and this psychosocial gaps are a common
41:59theme and cancer survivorship throughout
42:02the country not making excuses,
42:06but simply sharing that this is an evolving
42:09area that we're continuing to to to work on,
42:13and it it it really necessitates using
42:17both university and academic resources.
42:20In addition to also liaisoning with our
42:23community of mental health resources so,
42:25so you're going to see that that that
42:28theme continued to be discussed and
42:29we would love to partner with you to
42:32additionally understand the gaps that you
42:34have experienced so that we can make it
42:36better for you as well as other patients.
42:39Thank you, I'm also looking at questions
42:41that we've received beforehand.
42:42There was a question on I am a patient at
42:45Smilow Cancer Hospital in Waterford and
42:47there are eligible for the third dose,
42:50but I think the vaccine appointments
42:52are not available in New London.
42:55When will they be available?
42:56They could only find an option in Trumbull,
42:58so these are Kim or Kevin.
43:00Would you like to take that one?
43:03Sorry, it's quite specific.
43:04I know this might always keep
43:07saying yeah, I might.
43:08Maybe I can take that. Thank you
43:10Doctor Deshpande. We are. We're
43:12administering vaccines at a Northeast
43:15Medical Group site in New London.
43:18It is available periodically so
43:20I I think maybe please do check
43:23back on the website but I as of.
43:26As of yesterday, I believe we were.
43:27We were vaccinating there and it's
43:29been available for for about a week
43:31so I just please do check back.
43:33It is available.
43:34OK. Thank you so much. There are a
43:37lot of questions around antibodies.
43:39Should you be checking on antibodies?
43:41When should you do the third dose?
43:43So maybe someone who's a very
43:45good immunologist can take this.
43:47One is for this. Who's going to be
43:50brave enough to answer this one?
43:51I think we know the answer is no,
43:53you shouldn't,
43:53but I want someone to answer the question.
43:55I'm happy to you know,
43:57should you be doing routine antibody
43:59tests after your second dose,
44:02patients with multiple myeloma?
44:04Should they take their response
44:06to the vaccine so not everybody
44:08raise their hand all at once.
44:10I think this is,
44:11I think this is a doctor Huntington
44:13and Lisa Barbara question first.
44:18I could do the broad
44:19strokes cotton you could fill in through
44:21details so you know the CDC and our.
44:24You know our oncology national groups do
44:27not recommend routine antibody testing as a
44:30means of measuring response to vaccination
44:33or kind of advising on timing of third dose.
44:37There's a variety of currently available
44:40antibody tests and there's not a real
44:43standardization in those tests which make
44:46it difficult to implement one standard.
44:48So outside of the context
44:50of a research setting,
44:52we're not recommending antibody
44:54testing for our patients today,
44:57and so I think one of the questions was,
44:59well, how do we, you know,
45:00have this information that advises
45:02these third doses and the answer to
45:06that is that antibody testing was done
45:08in the context of big research studies
45:11in labs that are doing good antibody
45:14testing and have given us this data.
45:17And we're hoping to learn more.
45:19This is obviously a very hot topic,
45:21and I think one that will continue
45:23to learn more about and ultimately
45:25hopefully have some standardized
45:27testing in the near future.
45:30But Scott,
45:30I don't know if you want to fill
45:32in any other because we just don't
45:35know how to interpret with the
45:37antibiotics mean in terms of whether
45:38that's clinically relevant and
45:40whether we should be tailoring a,
45:41you know,
45:42not giving a third dose to
45:43someone that has antibodies,
45:44and so the antibodies weren't really part of.
45:48Now giving a third dose and broad
45:50booster regiments if you think
45:52about other nations like Israel,
45:54and so I think the data that supports
45:57what we're doing is not really
45:59requiring the antibody levels.
46:01We do have ongoing clinical
46:02trial or not clinical trials,
46:04but observational prospective studies
46:06available for patients with blood cancer.
46:09So certainly folks that are interested
46:11in kind of contributing to science,
46:13and we have that available
46:16to get antibody test.
46:17But after the second dose.
46:20And also after the third dose
46:21in that month thereafter.
46:23So try and take them while you're
46:24answering all the immunotherapy.
46:26How long should I wait after receiving
46:28immunotherapy to receive the booster?
46:30Yeah, so you know, I think these are
46:32broad strokes in the sense that we
46:33do think that most of our patients
46:35should be having a third dose.
46:36The actual nuances about when the
46:38best timing is is really I think the
46:40discussion that many folks should
46:42have with their treating provider,
46:44particularly those unactive cancer therapy,
46:46including immunotherapy.
46:47There's some medications,
46:50and I use where I would typically
46:51try to wait three months,
46:53perhaps even six months after,
46:55because that blunt antibody response,
46:57but for other therapies it may be
46:58best to give it right, you know,
47:00during treatment.
47:01So I think those sort of questions
47:03you're seeing your provider regularly
47:04on treatment definitely ask them
47:06about the timing of the third dose.
47:08Thank you Lisa. Thank you, Scott.
47:11Anyone else? Anything else?
47:12We want to add Doctor Deshpande, anyone else?
47:15OK, Doctor Lustberg,
47:17there's a question here or whoever
47:18wants else wants to answer.
47:20This was received prior on a prescription
47:23drug for psoriatic arthritis tremfya.
47:26Their primary care has
47:27recommended an additional dose.
47:29Can they schedule an appointment for an
47:31additional dose of the Moderna vaccine?
47:33I'm going to hazard, yes,
47:34'cause it's a immunosuppressive,
47:36but I'd like someone else to just.
47:38Confirm yes, that's that's correct.
47:41Alright, good thanks Yep.
47:44Thank you,
47:45can I just add on the scheduling website?
47:48There is a list of immunosuppressive drugs.
47:51It's not a comprehensive list,
47:52but it does provide some guidance
47:54if patients are wondering if the
47:56drugs they're on meet criteria,
47:57and if you're unsure,
47:59I think Renee included
48:00the call center number on the list
48:02and you can also consult with your
48:05provider that prescribes that
48:07medication to get guidance,
48:09right? Yeah, I did actually check that list.
48:12Trump fire is not on it. So again,
48:13to this point it's not comprehensive.
48:15But it is a interleukin 23 inhibitor
48:17I think, so it it it it buys.
48:19I mean it's it suppresses your
48:22immune system so absolutely.
48:24There's a question also on.
48:26I've received my third Pfizer
48:28shot outside of the system.
48:29How do I mark that on my chart?
48:32I think that's a good question,
48:33and if someone can sure
48:35yes. I mean the nice thing about as long as
48:38you receive that in the state of Connecticut,
48:40there's a there's a statewide database
48:43that every vaccine provider sends data to.
48:46And as of about two months ago,
48:49I believe our Yale New Haven
48:52Health version of EPIC downloads.
48:54All the data, so it doesn't really matter
48:57whether or not you got it through us or or
49:00someone else in the state of Connecticut,
49:02those data are automatically
49:04populated and will show up in epic.
49:06Now if you did get it out of state.
49:10I believe we have a process through my chart
49:12that we're working on putting together.
49:14I don't know that it's it's fully baked,
49:17but if you if you did receive it somewhere
49:19anywhere in the state of Connecticut,
49:21that data will automatically
49:22show up in an epic.
49:24That's wonderful, I think this is,
49:27you know, I'm still grappling my
49:28and I think many of us are still
49:30understanding about the third dose.
49:31But someone asked when will
49:33you need another booster?
49:34How many months after Will
49:364th doses be recommended so?
49:38Really insightful questions.
49:40I'm from Doctor Deshpande.
49:42You're going to take that one again. Also,
49:44I I can get. I can hazard a guess.
49:45I mean, I, you know, I think the the key
49:48thing is these vaccines are are great,
49:51but I think one of what we are
49:53seeing is that as the virus changes,
49:56the vaccines that currently that
49:58were initially programmed may be less
50:00effective against the the changing
50:02physical nature of these viruses.
50:04So I think the question about when are we
50:06in need another dose depends on how the.
50:09Pandemic looks globally if another type of
50:13variant of of of COVID-19 evolves at that.
50:17Against which our current vaccines
50:18are current or less affected.
50:20You know, on the positive side,
50:21these companies have the ability
50:23to so called, you know,
50:25essentially reprogram the vaccine
50:27fairly quickly and trot out new
50:29versions as the as the virus evolves.
50:32We haven't seen that the second
50:33that you know,
50:34the 2.0 version of these vaccines yet,
50:37but just the nature of especially
50:38the M RNA technology,
50:40is such that the time to develop a
50:42a the next version is very rapid,
50:44so it it really depends on when as the.
50:47How the pandemic goes,
50:48but it might be a year from now.
50:50It really depends on what vaccines
50:51were there variants excuse me,
50:53arise
50:53yeah and I think part of it of
50:55course depends not only on what
50:56the variants arise of course,
50:57and also how in Connecticut has done
51:00a fabulous job on things like social
51:03distancing and respiratory's and all
51:04the protection and hand hygiene.
51:05So again, I think good questions.
51:08Things will will keep these forms going
51:10to just keep all of you informed.
51:13Thank you Renee for putting
51:14the phone number 833.
51:16Ask why NHH for vaccine information and.
51:18To schedule the website information is there,
51:22I think the last there's another
51:23question about I've had two Pfizer
51:25shots and the booster and they
51:27never got a physical reaction.
51:29And I think a lot of us, you know,
51:31think that we get a physical reaction.
51:33I'm forming antibody.
51:34How true is that?
51:37Doctor Deshpande, I think you're it. OK,
51:40yeah, it it. Actually you know,
51:43I think the the physical reactions,
51:45the side effects that
51:46that you may experience.
51:48Our confirmatory,
51:49but they are not required,
51:50so the the it's it was very well
51:53characterized that there were
51:55individuals who really, you know,
51:57went through the the two dose series
51:59without any issues with really feeling.
52:01Just great not having anything and
52:03they absolutely had equivalent or
52:05the same sort of protection in terms
52:08of getting symptomatic COVID-19.
52:09And certainly you know,
52:11being hospitalized from COVID-19
52:12so the vaccines can protect you.
52:14The fact that you don't have these
52:16reactions doesn't really mean anything.
52:18Doctor Huntington, Dr Billingsly
52:20anything else you'd like to add for
52:22our cancer patients in regards to that?
52:28No, I I do want to make sure.
52:31Have we touched on any questions
52:33about the Johnson and Johnson vaccine
52:35we did be talking. There were a couple
52:37longsword addressing that
52:39a little bit because I.
52:42I have gotten some questions
52:43from my own patients about that,
52:45and it's a small number and I I just
52:48do want to underscore to our patients
52:50and families that there will we that
52:53if you've had J&J you've not been
52:55forgotten and there will be more
52:57information coming very quickly.
53:01I think I'd just like to add
53:04that even with a third dose,
53:05there may be patients out there
53:06that they don't have a response
53:08to the antibody treatment,
53:08and I think we're really fortunate
53:10enough to have a backup,
53:12which is the monoclonal code
53:14antibody therapy that I think
53:15Gail's done a really good job.
53:17Integrating into the care of patients
53:19with cancer and without cancer.
53:20And so if there's any concern of COVID
53:23when they've been vaccine or not,
53:25vaccinate getting tested
53:26and if it's positive,
53:28calling your provider kind of immediately
53:29to get the monoclonal antibodies.
53:31I really think reduces hospitalizations
53:33and likely saves lives in
53:35particularly these vulnerable
53:36patients that they may not respond
53:38even through the three vaccines.
53:40So I think that that's important.
53:43Any closing words from doctor
53:45you came slosser others any other
53:47closing words from all of you eye
53:49on things we haven't covered?
53:51I covered a lot.
53:52I have to tell you there
53:53were a lot of good questions.
53:55I would just say that that for those
53:57of you at home who are wondering,
53:58you know, do I delay care because
54:00I haven't gotten the booster
54:01or this or that.
54:02Please know that the hospital
54:03is a very safe place to be.
54:04Do not delay your care if you
54:07have any uncertainty, talk
54:09to your care provider.
54:11But cancer is. Is a very
54:13important thing to get treated even
54:15when there's a COVID virus floating
54:17around, so do not delay your care
54:19and we're here for you.
54:20Thank you, doctor you.
54:21I think doctor Lustberg.
54:22I think you commented earlier in
54:24the the hour about how we saw delays
54:27last year and that we're seeing on.
54:29So please, please, please do your cancer
54:32screenings if your or your surveillance.
54:34Those are important.
54:36And then Mr. Armstrong.
54:38I think we did it. You know,
54:39if if it isn't clear enable reach out.
54:41But no, we're not testing for.
54:43Antibodies after the vaccine
54:44to see how we responded.
54:47Once again thank you to
54:48all of you for joining in.
54:49We will keep these as as repeating
54:52sessions as we learn more as hopefully we
54:55understand more about the booster for J&J,
54:57or as we hear more about cancer,
55:00people who care givers and
55:01then they would be eligible.
55:02'cause I sensed a lot of
55:05questions around that.
55:06As always,
55:07please reach out to us as
55:09cancer answers at yale.edu.