State of Smilow Cancer Hospital and Yale Cancer Center 2021

November 16, 2021

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Yale Cancer Center Grands Rounds | November 16, 2021

Presented by: Dr. Nita Ahuja

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00:06So good afternoon, everybody.
00:08Welcome to the. Grand rounds for.
00:11Can't steal Cancer Center in
00:13Smilow Cancer Hospital today.
00:16As you know, it's really a
00:18reflection from the director
00:19on the state of the things.
00:21Essentially looking back at
00:22what we have accomplished,
00:24but also looking ahead for the next year.
00:28Next slide.
00:31OK, I think everybody knows who I am.
00:33At this point I've been serving as
00:35your interim Cancer Center director
00:37since March 1st and really has been a
00:40privilege and a pleasure to get to know
00:43this wonderful Community in more detail.
00:45Over the past few months next.
00:49Slide and I think the other point is of
00:51course we're in this state of anticipation,
00:54but mixed in with a little
00:55bit of I would say.
00:57Also you know what's coming,
00:59and I think everyone seen and met with Eric.
01:02And if you haven't,
01:03I know you're in for a treat.
01:04He was in our network committee meeting
01:07this morning and a wonderful human
01:09being and just couldn't be more excited
01:11that we've been able to recruit Eric,
01:13who as you know, is a former Yale alumni
01:15and will be joining us February 1st.
01:17But as.
01:18He has learned has been already a
01:20part and parcel of our community.
01:23As soon as you sign the job,
01:25you start to become involved,
01:26so we've been really excited to have
01:28Eric be a part of our community.
01:31Next slide.
01:32OK, so as we talk about sort of
01:35our Cancer Center and in Renee,
01:37you put the I guess, the.
01:40Can be code.
01:40I think it's helpful for maybe my
01:42perspective and maybe for those
01:43of you who are new and some of you
01:45may be who've been here for awhile.
01:47It's helpful to look at maybe
01:50how fast we have grown,
01:51and I think sometimes when
01:52you're in the midst of it,
01:54you forget how much we have done
01:57so you know just a little history.
01:59Lesson 1974.
02:00We started the Yale Cancer Center
02:01as a comprehensive Cancer Center.
02:03It's 2010 when the Smilow
02:05Cancer Hospital was built,
02:07and then the network was launched only 2012.
02:10So it's really recent.
02:12And then if you see the Cancer Biology
02:15Institute open on best Campus in 2015
02:17or phase one unit in 2016 and then
02:21in 2018 as Doctor Fuchs was here,
02:25Charlie were here.
02:26We went through our renewal and had
02:28an outstanding score along with what
02:31is fabulous is to see an increase in
02:33our research funding and then as you
02:35look today in 2021 in between bipan
02:37through EMR in the midst of a pandemic.
02:40But I think it's.
02:41Helpful to look from our perspective
02:43of where we are in the red starts.
02:45For those of you who are aware or
02:48care centers and those are scattered
02:50around the state of Connecticut.
02:52B are fortunate that we're
02:54the only academic institution
02:56in the state of Connecticut.
02:58And then what many people would be would
03:01love to see as a distributed delivery system,
03:05which is here.
03:06As you can see it exists through
03:08Connecticut and also through Rhode Island,
03:10as are cited.
03:11Best really,
03:12this is something that's unique
03:14and it's built up very much
03:16in the last few years.
03:18I think it's growing pains and
03:19in some of the stuff that is
03:21ongoing now that you feel.
03:23But as Eric comes on as Doctor Brian comes
03:25on, I hope all of you will think around.
03:27How do we connect all of
03:29this pieces together?
03:30And if you go to the next slide,
03:32Renee think the way we think about it is
03:34we want to build an academic health system.
03:36If you put our. Or signage,
03:40whether we call it by nature or Yale
03:43or whatever it is, why do we do this?
03:45It is to deliver care to our patients
03:47and we are in academic system,
03:49which means we're teaching organization.
03:51It's part of our tripartite mission and that
03:53means how to be educate the next generation,
03:56whether it's trainees or nursing
03:58or the next generation.
04:00How do we take resources and
04:02improve our patient care?
04:03But it can't be done in silo,
04:05and especially as we look at the Cancer
04:07Center in the distributed nature,
04:08not only at the sites.
04:10But off the constituencies,
04:12how many folks are involved there?
04:14Roughly 300 members of the
04:16Yale Cancer Center.
04:17And then if you look at the number of
04:19people we look at our nursing or staff.
04:21It's 2000 people, so that's a lot of people,
04:23many departments, many sites,
04:26and that talks about.
04:28It's a great.
04:29It's great to see it,
04:30but then the day today can
04:33sometimes feel sometimes difficult,
04:34sometimes fabulous,
04:35but it all means that we have
04:37to work together.
04:38And this is just one quote from Helen Keller.
04:41In talking about,
04:41it means that we have to learn
04:43to work with each other.
04:44Think about how we what we do great
04:47and where we have opportunities
04:48and that I think is probably
04:51more telling today as we look in
04:5318 months into a pandemic,
04:54that some things work wonderfully.
04:57But some things we know are health systems
04:59could do so much better next slide.
05:02So if this is important also in terms of
05:05thinking about what we do and why we do it,
05:08is this is our vision statement.
05:09I think sometimes these
05:11are put in on websites,
05:13but I want to think about how we deliver.
05:16Care is as health care teams.
05:19We deliver care one patient at a time,
05:22not in the abstract.
05:23It's it's one patient at a time.
05:25What it and its each and every interaction.
05:28So when we talk about the tripartite
05:31mission research, education.
05:32Clinical innovation and then
05:35increasingly at community,
05:36it becomes very real in
05:38the patient interactions.
05:39Whether it happens at best early
05:41or enter enter or in New Haven.
05:43And how do you conceptualize and
05:45deliver all of this transformative
05:48transformational care?
05:49It's easy to save,
05:51and I'm talking about in a PowerPoint.
05:53But then it's the teams that put it together,
05:55and those teams include our nursing or
05:58residents or staff or clinical trial list,
06:00our leadership,
06:01or administrators.
06:01And then I think you get the soup
06:04of what we're trying to do.
06:05We're trying to make magic
06:06each and every day and
06:08improve the lives of our patient. Next slide.
06:12OK, so when we look at this idea of
06:15what does the clinical care and of
06:17course we then use our SMILOW standards.
06:19The goals we would say is we want to
06:22deliver care that's easily accessible.
06:24So that means when we want
06:26the patient appointment,
06:27it's available to us as how you
06:29would want your family treated.
06:31I think the standards we hold for
06:34ourselves is that care is good
06:35in that can be defined as that it
06:38has good opinions or pathology,
06:40radiology, imaging those things.
06:42Matter, as it's been shown time
06:44and time again also means the clear
06:47delivery for a patient standpoint
06:48is multidisciplinary that the
06:50patient can see all the parts the
06:52specialists they need in a more
06:54streamlined rate rather than going
06:56in serial one after the other.
06:58That's not very patient centric,
07:00and of course we can use care pathways.
07:02We then need to focus about
07:03how to be improved care,
07:05but I think the other part and I want
07:07all of you to sort of take the you
07:09know as we think about this clearly,
07:11there's what we do today.
07:12But part of the mandate for
07:14academic health systems is how do
07:16we improve the care for tomorrow?
07:18And that means how do we take the,
07:20you know, the research,
07:22the quality to improve care,
07:24and I think you've seen that in the
07:26town halls that push that all of the
07:28teams come together to talk about,
07:29learn about each other.
07:31Whether it's how do our nursing teams
07:33interact and how do we deliver care?
07:35Or how is all this basic science
07:38related to something very granular?
07:40Like how do we deliver care
07:41to our patients sitting in?
07:42Front office, so this is the hard part,
07:45it's it's.
07:45It's why we're here,
07:47but it's also where we have to flex
07:50our muscles and work together next.
07:53Now as we look back in the year,
07:55it's been probably very much.
07:57I think sometimes we need to
07:58take a pause and breath and say
08:00how much have we done.
08:01We've done a lot and the fearless
08:03team you see on your left is our
08:06two leaders on our day-to-day
08:07clinical operations came Slusser,
08:10chief nursing Officer and Kevin Billingsley,
08:12who is our CMO and both of
08:15them have taken us on a lot.
08:17Whether it was through the pandemic and
08:19all the changes that happened and then
08:21how we regrouped and delivered care back.
08:24Again,
08:24and how we continue to do it.
08:26Of course I want to acknowledge
08:27that this year we went through
08:28magnet and that is really reflects
08:30the work of our nursing team and
08:32all the great work we do.
08:33I think as we look around all the
08:35teams and how this has been done,
08:38a lot of the stuff beyond re establishing
08:40care and I will say it's not all
08:43reestablishes where we expected.
08:45I think our bar has changed as we
08:47come back with all the changes
08:49of you know last year we
08:51moved from North Pavilion to SRC and
08:53clinics moved and then some came back.
08:56There's still some disruptions,
08:57but in the midst of it, we continue
08:59to train our nurses and our teams.
09:01We've continued to work on improving things,
09:04whether it's through this lean task project,
09:07for improving scheduling for infusions,
09:10launching patient experience forms,
09:12improving residency training,
09:14resident centered care,
09:15training for our teams,
09:17and then at the end of it,
09:18I think we have to think about how do
09:20we improve the patient experience.
09:21As you see this each team,
09:23and I'm not going to go through all of this,
09:25but each team.
09:26Has put in their goals for the next year.
09:28It is important for us to look back,
09:31acknowledge the hard work
09:32of each and every team,
09:33but also look ahead and say what do
09:35we want to do for the next year.
09:37And as you can see,
09:39they are obviously focused on many things.
09:41Certainly focusing on what
09:43is up front and centrals.
09:45How do we improve our recruitment
09:48and retention strategy?
09:49I think this is a nationwide
09:51but not phenomenal.
09:52It is most acute for health care
09:54as we're seeing that our teams
09:55that have worked through them.
09:57Pandemic we're seeing changes,
09:58so we need to think about how
10:01do we retain our best people.
10:03But there are other things.
10:04How do we improve care?
10:05How do we look at quality and
10:07morbidity and mortality conference?
10:09How do we look at our patient
10:10experience with our press Gainey,
10:11and enhance that and and this team
10:14you will see across is how do we
10:17think the Black Lives Matter engaged?
10:19All of the communities and we have
10:21been having a national conversation
10:23and that will be seen in the
10:25cancer domain so you can see.
10:27That they're focusing on culture engagement,
10:29and I this is looking inward,
10:31but also outward.
10:32We're going to have to do both,
10:34and this is the part that that this
10:37team is also looking next slide.
10:39So this just acknowledges,
10:41I think,
10:41the the all the arrows all it sees
10:45is all the stuff you all felt it.
10:48It was hard work.
10:49I think we can now smile and
10:51say it was great.
10:53I will still remember when we reopened
10:55the inner North pavilion floors
10:57and how much excitement there was.
10:59Unhappiness with our teams.
11:01But this kind of the chaos of this arrows
11:04reflect all the hard work you all did.
11:07I want to thank you all.
11:08I want you to acknowledge.
11:10Each and everyone of yourselves
11:11and Pat resolve on the back.
11:13It was hard work.
11:14Perhaps we never felt like we had a pause,
11:17because as soon as we moved,
11:19the work continued coming
11:20and continues coming.
11:22We're busier than ever,
11:23but I do think it's important
11:25for us to say we did it.
11:26We have that core and us,
11:28and as we look ahead,
11:29we have that ability in this next slide.
11:34However,
11:34things are not pristine and I want to be
11:37honest that it's things are still in flux.
11:40I've talked about the labor challenges.
11:42I think we are busy.
11:44If you don't see that, look at RED.
11:46It's always busy.
11:47Always about 60 to 80 patients
11:49waiting to be admitted and that
11:51means that are some of her places
11:53are not where we expect that.
11:55I'm not going to go through and
11:56reiterate all of the clinics that
11:58are probably still not where you all
12:00thought and perhaps some of that will
12:02mean that we may change overtime.
12:04That's not a good or a bad thing.
12:06It's how we look at it.
12:07I always see the glass is
12:08not half empty or half full.
12:10It's waiting for us to be filled
12:11with all the colors we want to see
12:13and the flavors we want to put.
12:15And that's what I want you
12:16to think about now.
12:17It does mean that spaces get type tight.
12:20We have to acknowledge
12:21that it's sometimes hard.
12:22It means that programmatic growth
12:24sometimes doesn't seem obvious
12:26or sometimes can be difficult.
12:28But I can guarantee you there's
12:30ingenuity and creativity in all of you.
12:33Whether it's the nursing team.
12:35Whether it's the trainees or
12:36whether it's the physicians,
12:38every one of us has that
12:40capacity and that skill set.
12:41Next slide.
12:44OK,
12:44so some of the other stuff besides
12:46talking about the pandemic,
12:47which I think we've spent a lot of time,
12:49is some of the good stuff that
12:51happened while we were just so
12:53busy catching our breath on doing
12:55routine care so often in crisis.
12:57Sometimes the best minds and best
12:59solutions are born and the hospital
13:01program was launched over the past
13:03year by Doctor Carrier Edelson along
13:05with Doctor Jensen Morris who haven't.
13:07If you haven't met,
13:08she runs our hospitals program,
13:10and although it's only been
13:12launched for a few short months,
13:13the early signal shows that.
13:15Having a dedicated team does
13:17improve things like length
13:18of stay in early discharge,
13:21so again it's a positive signal.
13:23It's something will continue to
13:24learn from and as Eric comes on
13:26this will be something for us to
13:28discuss and see how this relates
13:30to how we deliver our care,
13:31but also think about how does it
13:33impact our training experience?
13:35Are we thinking about all those facets
13:37and training the next generation?
13:39But I think early on really remarkable
13:42success or working across different
13:44programs and across our institution.
13:47Next slide.
13:48And other things are this
13:50next day initiative.
13:52I think if it's someone in your family,
13:54if you have a cancer diagnosis,
13:55we would all say we want to be
13:57seen as soon as we hear about it.
13:59And that's the right intent.
14:00Do you know?
14:01We need to think about our patients,
14:03how we would want to be treated
14:05and they want to be seen next day.
14:06So this is an initiative
14:08launched by Sarah Mccallion,
14:09whose are ambulatory officer on with
14:11these Chomsky and the data shows that
14:14this has launched in several locations.
14:16I'm not going to name them on
14:17lot in southern Connecticut.
14:19Along with other areas and what has
14:21shown is that we are able to do this
14:23for things like Breast Cancer Care.
14:25About 15% of people are being seen by the
14:27next day and also we're seeing about 10%
14:30of people being seen in the next day.
14:31So there's a huge patient demand for
14:34this and offering this is something
14:37that we need to start doing,
14:39but the dynamics of it become hard
14:41because it does mean it puts stressors
14:43on the frontlines team to think about
14:45how do we work more intelligently
14:47around this rather than just making art?
14:50Please go longer next slide.
14:52And then the patient experience,
14:54which is critical around how we
14:56think as you know,
14:57Terra Sam presents a lot of this and she's
14:59helped by her director of patient experience,
15:02Michelle Kelby,
15:02Albert and some of the experiences
15:04that they have really done is
15:06the patient experience forums.
15:07We've talked about those and
15:09then we formed the P fact.
15:10These patient and family advisory
15:12councils for patients educate us on
15:14what are the missing things that we
15:16may never hear about or think about.
15:18And I think those are important
15:21dialogues because partly we live.
15:23And then we delivered this
15:25tripartite mission.
15:25They say we do it in a community.
15:27Some of that community is us as human beings,
15:30but we live in a community.
15:32I'm currently sitting in New Haven.
15:33Some of your sitting in Torrington or
15:36water for door investor Lior Greenwich.
15:38So what does that community think about us?
15:40And this is, I think,
15:41thinking how?
15:42How do we make these abstract notions
15:44very much local and important to our
15:47patients who live within that community?
15:49Next slide.
15:51OK, so some more data.
15:53In terms of thinking about new
15:55patient volumes,
15:56this is helpful.
15:57We had a lot of growth you can
15:59see up till 2017 I think.
16:01Think somethings plateaued down
16:02and and as we look in twenty 2021
16:05I think some things for us to
16:07look and pause and say there are
16:09areas where we need to focus on.
16:11Again,
16:12this is just more thinking about
16:13and as we think of our strategic
16:15framework and I know many of us spend
16:17a lot of time thinking about it next
16:19slide and then just add more data.
16:22And what are the worker views?
16:24Associated with their work.
16:25That's how one way of how we measure work.
16:27There many other ways,
16:28but this is how we measure one of our
16:30domains of the work and it just shows
16:32the data over the past few years.
16:34Next slide and then of course,
16:36even though we I shared the new patient data,
16:38of course,
16:39as we all know is you get busy busy
16:41people keep getting busier 'cause
16:43your patients continue they continue
16:45to follow us and you can see that
16:48that growth is exponential because
16:49those patients stay with us and
16:51I think this is an opportunity of working.
16:54How do we use telehealth in this population?
16:56How do we think as teams
16:58around our follow up visits?
17:00Is that always done the same way?
17:02Are there smarter ways of doing
17:04this as we look ahead next slide?
17:07And then just I want to make a point.
17:09This is a complicated slide.
17:11Going this is monthly starting
17:12in October on the X axis,
17:14going all the way to October 2021,
17:16and what you can see is in blue
17:19is in in person visits the the
17:21light blue color or whatever we
17:23call it is video and then that
17:25orangish color is telephone visits.
17:27We all know that telehealth took
17:30off as the pandemic happened.
17:32So you can see that although
17:34for cancer patients still need
17:36their infusion and need to.
17:38Visit us so we continue to do
17:39a lot of inpatient visit there
17:41as you know my other hat is.
17:43I'm the head of the Yale
17:44medicine practice plan.
17:45If you look telehealth across our
17:47health system, it was up to 3040%.
17:49But here was about 20% back in
17:52last year and this is the rest
17:54of the trend is not a typical
17:56we see that as things opened up,
17:58patients wanted to see us more in
18:01person and that's what we see here
18:03that the telehealth is declining.
18:05I think phone as you all know,
18:07was not reimbursed.
18:08Is is is there's some reimbursement,
18:10so we encourage video,
18:11but as we look ahead I don't
18:13think you should have banned.
18:15Until Yelp.
18:16I think there are opportunities
18:18similar to what I mentioned around.
18:21The follow up visits and I'm not.
18:23I'm what I mentioned early on as we look
18:25at our care centers and they're distributed.
18:29And if you're thinking of
18:30an academic health system,
18:31not everyone has that expertise.
18:33We look at, you know,
18:34in every domain and how do
18:36we bring the specialist?
18:38Can we use telehealth as a tactical
18:40way rather than everyone going
18:42to visit that patient to bring
18:44that specialist to remote sites?
18:46Again, this is not the answer is not today,
18:48but those conversations are happening.
18:50But.
18:51Delivering that will require
18:52some nuances as we pilot them
18:54out and think about it.
18:56I know certainly in surgery I've seen
18:58some nice areas and in Waterbury
19:00with thoracic doing this and I think
19:03there's opportunity for us to think
19:05and use it across as holistically.
19:08Next slide.
19:09OK, the now,
19:11although we are very distributed,
19:13there are four divisions that
19:14are part of the yield Cancer
19:16Center and I think it's important
19:17to think about what they do,
19:19'cause they're full time
19:20in the Cancer Center.
19:21So going Herbst runs the
19:22division of Medical Oncology,
19:24and although it's it's one of our
19:26largest division with about 80 people,
19:28clearly lot of work and I'm not
19:29going to be able to acknowledge it.
19:31Some of the key highlights as
19:33they have multiple spores.
19:34They're also trying to get faculty
19:37development and recruitment as
19:38we continue to be busy.
19:39Lots of drug approvals you can see in head,
19:42neck, lung and bladder cancer
19:44and I have to say this team has
19:46worked really well on faculty,
19:47staff and Wellness during the pandemic
19:49for next year they continue to.
19:51Think about faculty recruitment
19:53and development goals.
19:54Also, how do we bring that academic
19:56piece in the system is fellows come
19:58out and they want a much more different
20:00practice then perhaps in the past and
20:03they're looking at putting in a fourth
20:05score application in breast cancer.
20:07Next slide.
20:09Looking at division of Hematology
20:11led by the Stephanie Helene,
20:13who as you know took over the
20:15division over almost about two years
20:18ago and obviously focused on the
20:20tripartite mission as I mentioned,
20:22but also as I know Stephanie also
20:24think about how do we disseminate
20:26innovation throughout the world,
20:27'cause the research here is phenomenal.
20:30Now if you move to the next slide,
20:31I think what needs to happen is
20:33and what Doctor Helene is very
20:35much focused on is how do we bring
20:37that depth into all the programs?
20:38Because lymphoma is very different
20:40from leukemia and that the in
20:43especially as we think of the
20:45scientific innovations in this.
20:46This kind of tells you about
20:48how diverse this team is,
20:50how large this team is,
20:51a couple points to make out point
20:54out here the yellow boxes show all
20:56the new team members they have and
20:59they are some of them are in here.
21:01Some of them are in the health system.
21:03One point to point out is that
21:06the classical theme is an area of.
21:08Huge growth and need partly reflects
21:11Connecticut as a state with an aging
21:14state population that many of our
21:16sites are inundated with benign heme,
21:19it's either an opportunity or a stressor.
21:22It certainly is a lot of demand,
21:24but how do we use it for our research,
21:26I think those are some things that I know.
21:28I know,
21:29the heme group is thinking with Bob
21:31Boehner and others also want to
21:32point out Marcus motion on the left.
21:34Some of you may not have met him is
21:36he is our inaugural director of CMC.
21:39Or central molecular clinical oncology.
21:41Dr Mission joined us last summer
21:44from City of Hope,
21:45accomplished Howard Hughes investigator,
21:47whose goal is to bring the physician
21:50scientist. How do we train them?
21:52And he's he's been able to recruit
21:54three people in his group.
21:55So really excited about how that
21:58comes across and then you can see
22:00how Stephanie's thinking about the
22:01network and all of the pieces.
22:03So I think this group will continue
22:04to get bigger over the next year,
22:06as Doctor Weiner joins us. Next slide.
22:10Neuron colleges led by Antonio Moral.
22:13They had the shanavia brain tumor front.
22:15You saw the announcement earlier this week.
22:18They also had a U 19 grant with
22:21Antonio Amaro and Ranchi and drawn
22:24launching the therapeutic network.
22:26They're continuing to do a lot
22:29of clinical trials and
22:31then for 2022 for this coming year.
22:32Their goals are to kind of optimize
22:36their inpatient services as well as
22:38launch a PO1 in the future and then.
22:40I know that they have also a
22:42recruitment needs in this group.
22:44Next slide. Alright,
22:47so therapeutic radiology or
22:49radiation oncology as well is the
22:52department led by Doctor Glaser,
22:54one of the top five programs in the country.
22:57Clearly very much definitely
22:59invested in building teams,
23:01translational science or what we mean by
23:03taking signs from the bench to the bedside.
23:05We have to acknowledge that they
23:07had the mosaic cyber attack and
23:09how this team worked tirelessly
23:11to make sure that no one's no
23:14patients treatment was interrupted,
23:15and I think that's a.
23:16Fabulous achievement in addition,
23:18Lynn Wilson has now stepped in as
23:21our new Deputy CMO for therapeutic
23:24radiology is the idea of a Cancer
23:27Center and being matrix that we need
23:29the connection so really want to
23:31welcome Lynn informally and on this in
23:34this role and then for the next year.
23:37I think all of us have heard the proton
23:40center that will be in in the Central
23:42Connecticut domain that started construction.
23:45They're working on building a spinal.
23:46Oncology program with neurosurgery
23:48and Woody Mendel.
23:49Dr Mendel just joined us and they're also
23:52looking at a spore grant in DNA repair.
23:54And of course,
23:55the team.
23:56If you've already heard continued
23:57recruitment back to the theme
23:59of the academic health System,
24:01Surgical services is broad.
24:02There are many,
24:03many department Dr.
24:04Goshen is our deputy CMO for
24:06surgical services working across
24:08the six Department of Surgery.
24:11Again,
24:11I'm not going to name the
24:13multiple recruitments,
24:13but they're here and the health system
24:16thing what has happened and this is.
24:18It kind of exciting is that we have
24:20been able to standardize some of the
24:22treatment delivery across the health system,
24:24especially in breast and some
24:26of the more structural works.
24:29I think looking ahead,
24:29this is about part of the theme
24:31of academic health system.
24:33How do we make sure that patients
24:36have access to surgical services
24:38in the health system?
24:39Doesn't make a lot of sense for
24:41surgeons to be going to these sites,
24:43but how do we think about that?
24:44That is an opportunity because
24:46when we look at smilow services.
24:49We are about 50% of the state,
24:51yet we look at surgical services
24:53across the six surgical department
24:55that's not congruent.
24:56We are only about 30% of the state,
24:58so there's an opportunity to
25:00grow our surgical services.
25:01There's a lot of destination programs that
25:04are being developed with multiple teams,
25:06and you can see all those things.
25:08We also need to think about
25:09how patients come to us,
25:10not only for trials but also
25:13novel treatment offerings.
25:14We've started the Hipec program
25:17with Alina Ratner and then.
25:19Our Division I just did a case
25:21last week for GI Surgical Oncology.
25:24How do we offer more advanced
25:25robotic cancer surgery?
25:26A lot of patients want to seek
25:28that out and
25:28so often those are the entries and we
25:30need to be really tactical on how we
25:32think about that for our patients.
25:34So they look here rather than going
25:36to New York. The last division is
25:38palliative care led by Jeff Capel,
25:40and they were able to get two Milbank grants,
25:42one to look at providing care,
25:44standardized care for palliative
25:46care services, and the Cancer Center.
25:48Also a dashboard.
25:50Development she general so is focused
25:52on developing a system right palliative
25:54care program and you can see her goals,
25:56which is to continue to build the
25:58ambulatory network for palliative
26:00care services.
26:01Because there is a huge need for how
26:03we think about that for our patients.
26:05Next slide.
26:08OK, I think you've heard all enough
26:09about this over the last few weeks.
26:11If you've been attending all of this,
26:13clearly are our clinical trials
26:16increased or dramatically?
26:18And then with the pandemic we had a.
26:21Shut down and now we are enrolling,
26:24but slowly as we have seen the
26:27labor disruption.
26:27This is what I want to stress.
26:29Here is what we are feeling is nationwide.
26:33If I look at all the Cancer
26:35Center director listservs,
26:36what we are seeing is every other center.
26:38So what I although it doesn't
26:41make the hard work easier,
26:43it just to recognize that what we
26:44are facing is something that the
26:46rest of the country is facing.
26:48I think part of the pieces that
26:50we're also doing in terms of.
26:51Thinking about is how do we deliver
26:54care in our darts or the Centers
26:56for Cancer care or vehicles for
26:59taking this tripartite mission and
27:01making it one patient at a time?
27:04And these are the cares the
27:06cancer care teams.
27:07Now some of them have been
27:09launched next slide formally,
27:10into thinking about all of the domains.
27:13So now thinking about the clinical teams,
27:15the research, the quality,
27:18the clinical trials,
27:20and this is Roy herbs in the long dream,
27:22which you can see it's.
27:23Truly multidisciplinary and you
27:24can see in the box all the services
27:27that go in delivering care services
27:29and also all the sites that have
27:31to think about it as we now have
27:33thoracics services.
27:34Cancer services in both Trumbull
27:37and Greenwich. Next slide.
27:39Similarly,
27:40Pam Kunz launched the Center
27:42for Gastrointestinal Cancers,
27:44and this is a large just in terms
27:46of thinking about GI cancers and
27:48has matrix with as a relationship
27:50with the digestive service line and
27:52you can see all the leaders and all
27:55the different specialty programs.
27:56Huge complex undertaking.
27:57I want to congratulate this team
28:00and working so inclusively across
28:02the entire system. Next slide.
28:05And then the breast team just launched.
28:07As you know,
28:08Doctor Lustberg joined us recently
28:10from the Ohio State and has already
28:12been busy at work and has been building
28:14an inclusive team for breast cancer,
28:16which as you know,
28:17is distributed throughout our care sites.
28:20Next slide.
28:22OK,
28:22the other one as I mentioned
28:24is this genevier
28:25fund. As you know we got a $5 million
28:28grant gift from Lewis and depression
28:30appear earlier in the year and we just
28:33announced the three leaders Jennifer
28:35Moliterno as a clinical director,
28:37Antonio Morrow as a clinical trials and
28:39Ranjit Bindra's or scientific director
28:41and thinking about destination program.
28:44And also as we launch our
28:46neurosciences tower at SRC next slide.
28:49Now, why you know the how of what
28:51we do and what does it result?
28:53And if you look at it again,
28:54back to this network and how do we make
28:56it academic and how do we think about it?
28:58It's still relatively young
29:00as our integrated system,
29:02but we treat roughly 50% of our
29:05patients diagnosed in this state,
29:06and I think the part which I've
29:08mentioned that patients want to be
29:10seen especially for you know their
29:12day-to-day needs within closer to home.
29:14They may want to come for their
29:16complicated surgery here,
29:17but for the day today.
29:19I think thinking from a patient perspective,
29:21they want that care closer to home.
29:23So the goal is to get that smilow
29:25center within 30 minutes,
29:26and so they have 16 locations across
29:29Connecticut and Rhode Island next slide.
29:33So this is a great story.
29:34I love stories because I think stories
29:36stick with us more than you know,
29:37a bunch of factoids and dashboards.
29:40So Captain Simon is serves in the
29:42in the public health service and
29:44was diagnosed with multiple myeloma
29:47and was treated by Jason. How this?
29:50Atwater Ford and he needed a stem cell
29:53transplant and Jason contact it's two
29:55seropian who brought him here and he
29:58had his transplant and peace and was
30:00taken care of by the team and NP7.
30:03And then he's gone back to water
30:05Ford to get the rest of secure.
30:06I mean, that seems that's the kind I mean.
30:08We want more of this.
30:09It's not easy, but then it happens.
30:11It's like the right thing to do
30:13because you know, he got the majority
30:15of his care closer to home,
30:16but when he needed the complicated stuff,
30:18he came here to New Haven.
30:20Next slide.
30:23OK, so the other part of our care
30:25centers just some facts which I think
30:27it's always are good to know if you
30:30think about why NHH and Yale School of
30:32Medicine 8% of our people across our
30:34School of Medicine and the hospital
30:37come for access to clinical trials.
30:39That's not just in cancer,
30:41but if you look in cancer,
30:4325% of patients are in clinical trials.
30:45That's a pretty petty in our
30:47care sites and then care centers
30:49deliver 40% of our cancer care.
30:51So I think you get the idea that
30:52a lot of patients are patients.
30:54Are being treated on these care centers,
30:56but how do we improve upon as the
30:58next generation is we think about the
31:00evolution of the karcist centers that
31:02came together by consolidation of a
31:04lot of services. I mentioned already.
31:06How do we provide advanced services?
31:08Whether it's therapeutic radiology,
31:10whether it's palliative care
31:11or surgical services,
31:12how do we use telehealth more strategically?
31:15And I think also what we need to
31:18do is how do we highlight what is
31:21the strength of an academic system?
31:23Why is a good pathology?
31:26Diagnosis the right diagnosis
31:28and right staging important.
31:29It has an impact if you don't
31:31stage a person right the right time
31:33you can't go back and fix it.
31:35So I think this is something we need
31:37to do when we talk to our patients and
31:39our app work to highlight what is the
31:42value of an academic health system.
31:43Yes, clearly we want to have easy
31:46access but also what do we?
31:48What do we do?
31:49That's a differentiator from,
31:50say, the others in the market is
31:53something that really needs to
31:54be something that our patients.
31:56And our referring physicians
31:59and teams understand next slide.
32:02Right,
32:02this is all the recruitments we've
32:04seen this over in in Renee's weekly
32:07and in my monthly town halls
32:09and over the past year.
32:11But someone,
32:11some folks to point out is Doctor
32:14Isaac Kim who just joined us in
32:16October as the chair of Urology.
32:18Doctor Kim is a physician scientist.
32:20He joined us from Rutgers where he led
32:23the division of Urology and Clinical.
32:25He's an expert and robotic prostate,
32:27so bringing that destination,
32:28clinical expertise and research he
32:31does has been developing treatments.
32:33Or press resistant.
32:34Treatment resistant prostate cancers
32:36using pro tech modality which I
32:38know you've heard a lot from Joe
32:41Kim and Dan Patrick and Roy and
32:43others in the other recruits.
32:45Here to point out these continuous
32:47Dr Krishnamurthy who also just joined
32:49us recently as Chief of Pediatric
32:52Oncology from memory and he brings an
32:55expert in BMT and really excited to have him.
33:00You can see the rest both Tomahawk,
33:01the world who has done the world's first.
33:04This nation's first face transplant,
33:05but it's, uh,
33:06his daytime job?
33:07Is cancer reconstructive services
33:09is also here,
33:11from Brigham and I mentioned Dr Mandel,
33:14who's here from the Ohio State
33:16and leading probably one
33:17of the world's or nations,
33:18exported spinal oncology and
33:20recruited from neurosurgery.
33:24OK, so switching gears to
33:25some of our research mission.
33:27I spent a lot of time on the.
33:29Clinical mission on switching gears to
33:31our research mission and as we know,
33:33we are a comprehensive Cancer Center which
33:36means we're supported by a CCSG grant.
33:42And we have 300 full-time members of the
33:44grant needs a lot of work to manage it,
33:47and that work is done by Bob Garofalo,
33:49who has been leading the CCSD.
33:52Granted all of the administrative
33:53workload for us since 2015.
33:55He let us through a renewal.
33:58Bob is stepping down and add captain,
34:00who you all know will be taken over as
34:03associate Director for Research Affairs
34:05on January 1st for the next year.
34:07You can see their goals to
34:09continue to improve infrastructure,
34:10operational efficiency, and.
34:12Help leader re submission next slide.
34:16OK, this kind of graph speaks to itself.
34:18I think nice steady growth
34:20over grant funding.
34:22Important point to point out is
34:24our NIH NCI funding or cancer
34:26specific funding has increased.
34:30We also had these research programs.
34:32I'm not going to talk about them,
34:33but I think just to see out that these
34:35six research program represents our
34:37efforts for framework for engaging all
34:40of our Members in high impact science.
34:43So again, it's team work,
34:44similar to what we said on the clinical
34:46side in each program is often led
34:49by either by multiple leaders that
34:52bring complementary experience.
34:54And also, I think what the goal
34:56is to have synergy between them.
34:58And then in each of these programs
35:00thinks about how do you mentor
35:02new investigators and ultimately,
35:04how do we improve the number
35:06of teen science awards?
35:08That are going across our cancer centers.
35:12One of the successes is this,
35:15which is the the Doral trial?
35:18Which was led by Boy Herbs and
35:20the correlative work for this
35:22by done by Katy Perry.
35:23And this is for EGFR mutated
35:25non small cell lung cancer.
35:27Anything the Kaplan Meier for
35:29the folks who could see it is.
35:31You can see when you're treated
35:32with this new drug was merited,
35:34which is an EGFR receptor.
35:36You can see the improvement in
35:38survival from placebo from 61% to 97%.
35:41I think that graph speaks for itself
35:43and that this is a great trial in
35:46improving outcomes for our stage
35:48two and three eight patients.
35:50But also says that how I think.
35:52What this highlights is how the
35:53clinical team and the translational
35:55teams and all the teams are working
35:57together and how we what we do here,
35:59then changes clinical management
36:01across the country next slide.
36:04Lots and lots of awards.
36:06I think we can probably can't cover them all,
36:08but some few ones to think about
36:11as highlight or obviously.
36:13Two people who got inducted into
36:15the National Academy of Science,
36:16doctor Liping Chen and Scott
36:18Miller were inducted,
36:19which is one of the highest
36:21honors in the country,
36:22along with National Academy of
36:24Medicine doctor Marcella Nunez Smith.
36:26You can see Pankun Scott,
36:27woman oncologists at the year and
36:29that led to a lot of national
36:32excitement over pants.
36:35Support on this next slide.
36:38OK, so talking about our associate director,
36:41Doctor Mark Lemon runs the is the associate
36:44director of basic science research.
36:47And as as I mentioned,
36:50the Cancer Biology Institute
36:51is on the West campus.
36:53He's been able to recruit six members
36:55who were really in fostering research.
36:57The goal here is to foster basic science
36:59and bring it to a translational end.
37:01And you can see the Doctor Lemons goals
37:04for the next year to help Foster continued
37:07part of this translational research.
37:11And how do you work across the other
37:13associate directors in data science
37:14and which I know is an area that
37:17Doctor Lemon is really focused on.
37:19Because as we know that genomics is
37:21becoming part and parcel of our lights.
37:24Next OK, so the next program dot Roy Herbst,
37:29also runs the translation
37:30and clinical research as the
37:32Associate Cancer Center director,
37:33and here they focused very successfully.
37:36Used the tier team science mechanism
37:39and also are fostering this too,
37:41for leading to spores NPO ones I know.
37:44He would be very excited and as I
37:46might to mention that the diversity
37:48training both in a T32 program as well
37:51as the BMS diversity program which
37:53is led by Nabi Fast for next year.
37:55Of course I think.
37:56We would all agree that improving
37:58optimizing the CTO office is critical
38:01along with submitting at least
38:03one news for grant next slide.
38:06These are all the drug approvals
38:08that have led from Yale LED studies.
38:10Kind of highlighting our continued
38:12success in this arena, except.
38:15And then for the C2,
38:16I think many of you've seen this slide,
38:18but as part of improved optimizing and
38:21acknowledging our distributed system,
38:23we've announced two more medical directors,
38:26Stacy Stein and Neil Fishback,
38:28along with Stephanie.
38:29Hillary, who runs the labs.
38:31Alyssa Gateman is our interim director
38:33for the C2 office and Margaret Gil
38:36Shannon came on full time as part of the
38:39Cancer Center as their new deputy director.
38:42And then I think you've all heard that
38:44urine is helping us to see how do we do?
38:46Things more in optimized way without
38:48improving our infrastructure excellent.
38:51And then these centers,
38:52I think,
38:53are also important bridges that
38:55think about our darks and how do
38:57we then continue to engage in this.
38:59Once we called matrix and how do we recruit
39:02new people and have them be successful?
39:04So I mentioned Cancer Biology
39:06Institute as one example.
39:08We will also mention CMCO
39:10Marcus missions program.
39:11He just recruited David Braman was
39:13going to focus on renal cancers and
39:16you can see all the copper program.
39:18It's very successful and I want
39:20to point out by CIO which.
39:22It's launched as a bridge was launched
39:24as a bridge program several years ago,
39:26and as between the Cancer Center
39:29and Immunobiology,
39:31and Marcus was appointed as the full
39:33time director recently this year.
39:34Next slide.
39:36So our 84 population and then the sports,
39:39which I think you can see the
39:41data for itself,
39:42how much funding they bring in the
39:44leaders of these three scores.
39:45And I think you've heard that there's
39:47goals to at least put one or two new
39:49sports for the upcoming year next week.
39:53So Melinda Irvine runs.
39:54Are is the associate director
39:55for population science and the
39:57goal here is how do you improve?
39:59Think about our research and
40:00focusing on our catchment area and
40:02her goals for the next year to see.
40:04How do we take our genomic
40:06signs and connected.
40:07We are all connected by Epic,
40:09so how do you use this data science and
40:12leverage or electronic health record?
40:14With our research to be more sort of,
40:18you know cloud would be make call cloud
40:20analytics is something that everybody
40:21is thinking along with as you saw Mark.
40:24Simon is also thinking about that,
40:25and then of course,
40:28foster collaborations next.
40:29And a pet Larussa runs the
40:32experimental therapeutics program.
40:33Of course,
40:34this is focused on how do we take
40:37our faculty and position science and
40:39do investigator initiated trials?
40:41Think things to think about
40:42is how do we also increase URM
40:44recruitment to set clinical trials?
40:46And one of the ways pad is thinking
40:48about is decentralizing clinical trials,
40:50bringing them closer.
40:51Sometimes it's hard to get here,
40:53and this is where clinical trials
40:55or geography helps us in that those
40:58trials are available to our patients.
41:00Except.
41:02And then if you think about
41:04our catchment area,
41:04our catchment is the state of
41:07Connecticut in 97% of our cases
41:09come from the state of Connecticut.
41:11Now it's important to note that
41:13Connecticut is in the highest
41:14second highest quintile in the
41:16country for cancer incidence and
41:185% higher than the US average,
41:20in particular Hispanic or Latino
41:21population is a 20% percent higher
41:24cancer rate and that gives us,
41:27as we think about our different sites.
41:29How do we think about our research and and?
41:32Will be improved care and then
41:34of course in New Haven.
41:35We know we have higher rates of
41:37smoking and obesity which are also
41:40cancer risk factors explained.
41:41Now,
41:42one of the ways to improve is
41:43how do you address the needs.
41:45This is one example by Andrea Silber,
41:47who has the owner trial,
41:48which is goal is to improve minority
41:51enrollment in clinical trials.
41:52This is and breast cancer.
41:54And how do we offer that to our communities?
41:56In our local community.
41:58In addition,
41:59these trials are supported not only
42:02by the the CCSG or the NCI grant,
42:04but also by foundational funding by BMS,
42:07Genentech, etc.
42:08In terms of trying to improve
42:10care to our communities.
42:11Next site,
42:12but this is like I love this story.
42:14So Maryland Barber was having
42:16some symptoms and she kind of
42:18went to her primary care even was,
42:20you know had her levels checked in,
42:22including her CEO on 25 all normal
42:24she went to a health fair and you
42:26can see some of her team from
42:28our health fairs and really had
42:30a nagging feeling in in.
42:31Really got some information
42:32at this health fair.
42:33Came to see Alice Andrew Santino
42:36actually had ovarian cancer was treated
42:39by our team and kind of tells you.
42:41That this is these fairs and I also have a
42:44teaching responsibility to our community.
42:47And this in this case we had,
42:50you know, an early patients diagnosis
42:52and helped this patient next.
42:56OK, and and then this is
42:58part of back doors at NCI.
43:00Grant that community outreach and engagement
43:02is a critical part of our mission.
43:05As in as a comprehensive Cancer Center
43:08and Marcella Nunez Smith leads this.
43:11Our community outreach and engagement
43:13program with the goal to reduce or
43:16eliminate disparities in our catchment
43:18area and the goal here is to use data
43:20or dashboards to then understand the
43:22burden and then use it to outreach back
43:24to the communities to then improve.
43:26Here, I think increasingly then,
43:28as once you understand what the problems are.
43:30Also, how do you ask the right questions?
43:32And how do you develop your
43:34research around that?
43:34Is something that I know more as Marcelo
43:37steps away from our White House duties is
43:40looking to develop further next slide.
43:43And then last but not least,
43:45Barbara Burtness was appointed
43:46as a new interim.
43:4780 for diversity, equity and inclusion.
43:49Again, I mentioned this earlier on
43:51in our talk that this is going to be
43:53an area that's important to us and
43:55Barbara is a huge champion of this.
43:57Having done this work locally,
43:58both in swimming and the Deans
44:00committees and nationally for E.
44:01COG already since starting,
44:02she's been doing a lot of training
44:05and implicit bias for trainees.
44:07For physicians,
44:08a lot of communication initiatives.
44:10As you've been seeing that
44:12on Smilow Connect and.
44:13In future obviously that as you see it,
44:16there's a climate survey going on.
44:17Then of course we want to eventually get
44:20a permanent lady for this role next time.
44:22And she's already launched A DE Council.
44:25It's obviously highly inclusive and diverse,
44:28and this committee I know will
44:30continue to look at all of our parts
44:32of our functions and to see how can
44:35we think about all these issues.
44:37And in equity, HealthEquity next slide.
44:41And then Harry Cougar runs our
44:43education and training.
44:44She's the associate director for that.
44:47Their program is looking at how
44:49do you use metrics to improve and
44:52optimize training outcomes and
44:53also how do we look at the entire
44:55pipeline of students and trainings and
44:58optimize their research experience?
44:59Because This is why they come to us.
45:01Some of the other things to
45:03highlight here is the cancer student
45:04interest group that has launched,
45:06including initiative for MD PHD's.
45:09You can see the other training
45:10for APR ends for residents,
45:12something of pride to us,
45:13or 25% of our class is URM this year.
45:17And of course,
45:18the fellowship will be expanding from 8
45:20to 10 trainings which also looking ahead.
45:24Next slide,
45:25so I want to take a moment.
45:26First of all,
45:27I want to thank you know I couldn't
45:29have done this all of the months,
45:31and although I'm going to be your Cancer
45:33Center director for the next few months,
45:35I may not have many more opportunities
45:37with the holiday season.
45:38I want to take a moment to acknowledge
45:40the people who were silent,
45:41but helping me every minute,
45:43every hour. Lori Pickens, who as you know,
45:46is our Senior VP, is is phenomenal.
45:49She has always figured out ways to make.
45:51As I ran two departments,
45:52my life easier and.
45:54Really has never made it that even
45:56if I called her on a weekend.
45:58Never blinked.
45:59Think Dan is de Mayo is one of the
46:02most understated and thoughtful people,
46:04and I pushed him in so much of the
46:07research and helping me in all of
46:08this and has been an incredible help
46:11as our deputy director Margaret,
46:13as I mentioned,
46:14just came on and was doing two jobs
46:16and then I pushed her for a lot of
46:18things and she never let it on even
46:20though she was new to our role.
46:22Obviously there are many other folks.
46:23I can't mention them all.
46:24I do.
46:25One acknowledge Brian Smith and Tisha
46:27Johnson for all the help and the CTO office,
46:29what they did and what Nancy and
46:31Dan Brown and and Keith Church
46:33will have done as we have think,
46:35thought about the C2 and all the.
46:38Things about what a contemporary
46:40clinical trials office looks like.
46:43Think I want some of the surgeons
46:44may be an unlikely.
46:46It's known they're probably all
46:47in the operating room,
46:48but I also want to acknowledge
46:49my department they did lose my
46:51attention and that's my faculty.
46:53Might chiefs who took on many,
46:54many other roles for being
46:56wonderful citizens.
46:57I do love this Cancer Center bell,
46:59so look forward to giving my cheeks
47:01and my faculty my time and attention.
47:04So I want to thank all of the folks
47:06we've been really incredible partners,
47:08and then I want to end on a note.
47:09As we look ahead next slide, please.
47:11Of what you know,
47:13as we reflect on pause as Eric comes on,
47:16I look forward to working with Eric
47:18over the next few months to transition.
47:19We've already been working together on
47:22recruitments etc, so I think you is.
47:25He has a big job but he is obviously
47:27very experienced and he has a lot of support,
47:29but I want to think come back to how
47:31you all can think about what you do
47:34and how that helps us eaten every day.
47:36We are one academic cancer health
47:37system we have to think about.
47:39Why do we all come here?
47:40Whether it's the nurses,
47:42the staff.
47:43The environment that everyone
47:44comes with a calling.
47:46You think this was very clear when
47:47I was here during the pandemic and I
47:50saw our environmental health services
47:52and there was an empty hospital.
47:54But nursing working in units,
47:56but quiet that everybody has
47:58a calling health care is hard,
48:00but it comes from the heart and
48:02we all want to think about why
48:03we came to do this job.
48:05It's important to acknowledge that there
48:07is a lot of heart in doing this work.
48:10It's not just all dashboards
48:12and data and planning.
48:13I think to do this well,
48:14of course we need to have
48:16what I call connectivity
48:17or collaboration.
48:18I gave you some examples,
48:20but there are times when it
48:21doesn't work right and there are
48:23times when it works beautifully.
48:24It is something we were going to
48:26continue to evolve and learn to
48:28work across and how we connect,
48:31whether it's in the research arena,
48:32in the clinical arena, in quality,
48:35safety, whatever we do,
48:36but we have to do it more nimbly,
48:38so we do not make it so hard
48:40for each and everyone of us.
48:42And then how does it lead to a community?
48:45Some of it is internal to
48:46us on how we think about us,
48:48because all of these seeds
48:50lead to appropriate engagement.
48:51Why we are happy at work and not happy haha,
48:55but why we feel satisfied with their jobs?
48:57So community building is all within us.
49:00It has to be local at the end of the
49:03day it can't come from 8 zoom meeting.
49:06It is sometimes sitting and
49:08having lunch together.
49:09It's shared in the hallway with a smile.
49:12How we greet each other.
49:13But that community has to
49:15come from all of us,
49:16whether I see the DeLuca Awards
49:17and I saw all the nursing teams
49:19hanging out with each other.
49:20That's community.
49:21And then we also have to think
49:24increasingly as the conversation
49:25is happening on and whether
49:27receive vaccine rollouts or others.
49:29How important health equity is
49:31in how outcomes are seen,
49:33we may do the best science,
49:35but at the end of the day that has
49:37to be done in the where we live and
49:39that's our patience and they may
49:41have social determinants of health that may.
49:44Make the best treatments.
49:45If they can't access them,
49:46it's irrelevant,
49:47so that is also a community.
49:49I want you to think about.
49:51So with the next few months I will be here.
49:53I will be engaged and but I will
49:56also work with Eric.
49:57I look forward to welcoming him
49:58and having a smooth transition.
50:00I want to thank you all for giving
50:02me the privilege of being your leader
50:04and with that I hope I leave a few
50:07minutes for question and answers.
50:08So thank you so much.
50:21So we can open for questions and it is zoom.
50:25It's not a webinar for once,
50:26so it's OK to raise your hand and ask
50:28a question or put it in the chat.
50:34I'm going to leave leadoff
50:37Kevin Billingsley here.
50:39Just want to say thank you
50:42for your incredible service
50:44over these past many months.
50:47So I can only imagine what has
50:50been involved in running the
50:52complexities of the Cancer Center and.
50:55And the department,
50:56and I think that although we have had,
51:00we still have challenges in front of us.
51:02I think all of us are really
51:04excited for the future,
51:06and we see the growth and
51:08we see the opportunity.
51:09And I think it's it's a very
51:12bright time for our organization.
51:18Thank you Kevin for highlighting
51:20because I think if you didn't
51:21sense it from my excitement, I think we are.
51:24We have a fabulous institution and the
51:26best is yet to come and be a great people.
51:30NATO this is Lori.
51:32I have to echo Cabman and.
51:35Since I got here a little
51:36over three years ago,
51:37you were one of the first people that
51:39I came to see and the collaboration
51:42that you have had with with us and
51:45cancer from day one has been just.
51:48Uh, amazing.
51:49It's just been fabulous and
51:52there's a part of me that has
51:53to apologize a little bit for.
51:56Trying to get you over here to
51:58serve as our interim 'cause
51:59it's a part of me that feels
52:00guilty at this point as well,
52:02but you have just really stepped
52:04into this and just been an
52:06incredible partner for all of us,
52:08and I probably didn't realize quite
52:10how much you would be taking on,
52:11but I just want to thank you from
52:14the bottom of my heart because your
52:16partnership has always been so valuable
52:18and having you here over the last.
52:20I don't know what 6 to 8
52:21months working with us like.
52:23This has just come.
52:24It's just been terrific and
52:26and really thank you for me
52:27and thank you from all of us.
52:29Thank you, Lori.
52:41Quiet group, I'm going to give a minute
52:43or so if someone wants to ask a question.
52:45It's alright Roy. Go ahead. I knew
52:48it so thank you. It's been and will
52:51continue to work a lot together.
52:53Great working with you and especially
52:54as we've had to work through
52:56the clinical trials together.
52:57It's just been.
52:58Your leadership has been just enormous.
53:00I'll ask now that you've seen
53:02the Cancer Center.
53:03And as you go back to be chief of surgery,
53:06which it sounds like it's a pretty big job.
53:09What have you learned?
53:10How can we build better
53:11multi modality clinics?
53:12So one of the things that we really want,
53:14I think to increase our care.
53:17Our reputation is to really be seeing
53:18patients with tumor boards and
53:20multimodality way across the system
53:21and is wondering what you've gleaned
53:23from this experience that you know
53:25could help us as we move forward.
53:27You know, really, in good
53:29question. I think as.
53:33First of all, thank you for
53:34all the hard work you've done.
53:35I think I put surgeon
53:36hours with you every day,
53:38so thank you for hand bearing with me.
53:41I've had a chance to visit
53:42some of the care centers.
53:43Unfortunately I didn't have a chance
53:45to visit each and everyone of them,
53:46but I think what struck me is how
53:49connected the patients were for their
53:52local community and how incredible the
53:55service and and the team work was.
53:57Think at least my department wasn't
53:59as distributed until we came and
54:01then some of the folks like Nina
54:04Horowitz and others were incredible
54:06champions of taking breast care.
54:07But I think there's opportunity
54:09for us in even.
54:11Sites like water,
54:12Ferd and Torrington.
54:13I think the part that we have to
54:15figure out is how do we make it not so.
54:20Difficult because it's not
54:21efficient for us to put everybody
54:23in the clinic at the same time,
54:24so I think some of the pieces will be and
54:26I kind of put the telehealth piece to me.
54:29That is an opportunity around thinking
54:32for the specialty cares for some
54:34of the care like breast cancer.
54:36We may want to think about
54:38should breast cancer.
54:39All of the services be
54:41available at every site.
54:42And again this is work.
54:43I know Liz is star Herbert is thinking
54:46about with the rest of the teams and
54:48the Jeremy and and and others but.
54:50This is the pieces that we have
54:52to think about on the part.
54:54Now there are some challenges
54:56of thinking about this.
54:57Sometimes our teams are
54:59multiple employment models.
55:01It doesn't mean it's good or bad,
55:03we just have to think tactically around.
55:05If imaging is not yield
55:07medicine but someone else,
55:08how do we make sure we're still working
55:10as a team and thinking on these systems?
55:14The last piece I'm going to
55:15tell in this is an opinion,
55:16so please,
55:17but I do think.
55:20That there's still a lot of education
55:22that's needed on the importance
55:24of multidisciplinary management,
55:26not into our patients who are.
55:29Ultimately it's their health and not
55:32to the physicians, but to our patients.
55:35And our primary care doctors,
55:36especially in southern Connecticut,
55:38where there's a lot of people whose
55:40first thought is to go to New York,
55:42and in my mind that should never happen.
55:45If you were a patient in Connecticut,
55:47and you have Yale Cancer Center
55:49in your background.
55:50They should know all of us,
55:52but I can tell you there are many
55:54times they don't know all of us
55:55and they call me and I answered
55:57these phones and I'm like.
55:58Well, here's the world's best expert in XYZ,
56:02but they are not aware so that
56:04education is upon all of us.
56:06Every interaction is an educational
56:09opportunity and that is what we have
56:12to do to educate our communities
56:14on what we bring in language
56:16that they can understand.
56:19And it's easy to explain.
56:20So again,
56:21that's what I mean by a distributed health
56:24system to explain what is whether
56:26it's therapeutic importance of giving
56:28I MRT radiation, or whether it's
56:31proton or whether it's complicated
56:33clinical trials or complicated surgery.
56:36But there's a huge opportunity and and
56:39obviously we will be working with your
56:41teams to sort of make that happen.
56:44Alright, it's 1258.
56:44I want to give people two minutes back.
56:47I hope everyone had lunch, but thank you all.
56:49You are an amazing group.
56:51We are very large.
56:52We are strong and I want you to
56:55acknowledge yourself and I want to thank
56:57each and everyone of you for making this.
57:00You know for coming through the
57:02pandemic and containing growth.
57:03Thank you everybody.
57:04Have a great rest of the day.