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Smilow: Celebrating a Decade of Cancer Care

February 28, 2020

In October of 2009, the first patients walked into the new Smilow Cancer Hospital at Yale New Haven. Cancer care has not been the same since. “Our 10th anniversary is so exciting because Smilow catalyzed one of the most impressive trajectories of clinical care, cancer research, and education and training that has ever been witnessed in an NCI-designated cancer center,” said Charles Fuchs, MD, MPH, Physician-in-Chief of Smilow and Director of Yale Cancer Center. “The opening of Smilow was transformative. It has had an extraordinary impact in terms of discovery and clinical care, not only regionally, but nationally and internationally as well.”

The hospital is named for the generous philanthropist who made it happen, Joel Smilow. “The dream of the hospital leadership,” said Roy S. Herbst, MD, PhD, Ensign Professor of Medicine, Chief of Medical Oncology at Yale Cancer Center and Smilow Cancer Hospital, and Associate Cancer Center Director for Translational Research, “was to have a cancer hospital with everything there—one-stop shopping. You could get your biopsy, your blood work, your echocardiogram. You could see your oncologist, your surgeon, your radiation oncologist, all together. Their vision, transformed the care of our patients.”

Dr. Herbst remembers walking around the Smilow construction site in a hard hat when he was being recruited from MD Anderson Cancer Center in Houston and getting excited by the ambitious plans for the hospital. Needless to say, he signed up.

“Having the beds and state-of-the-art operating rooms and clinical spaces helped us recruit top doctors and nurses,” he said. “We populated the space with the best people, the best technology, the best innovative medicine, and the best clinical trials. We had a vision to build personalized care in terms of the patient’s feelings and experiences. I have to give big credit for all this to Tom Lynch, Abe Lopman and Cathy Lyons.”

Dr. Herbst is referring to the trio who steered Smilow into existence and then into national prominence, and who set the hospital’s guiding principles: Thomas J. Lynch, Jr., MD, Smilow’s founding Physician-in-Chief; Abe Lopman, the hospital’s founding Executive Director; and Catherine A. Lyons, RN, MS, the inaugural Chief Nursing Officer. While they have moved on, their legacy continues.

Smilow’s trajectory over the last 10 years shows vectors of rapid expansion in every area. A few statistics tell part of the story. The staff at Smilow has grown by 55 percent, to nearly 2,000 people. The number of patient visits has risen steeply, from 179,000 in 2014 to 236,000 in 2019, a figure that Dr. Fuchs says rivals any of the major cancer centers in the United States. In Connecticut, about 48 percent of all patients newly diagnosed with cancer are cared for by a Smilow physician. “That’s an incredibly impressive statistic, considering that Smilow opened only 10 years ago,” said Dr. Fuchs.

The hospital has also expanded geographically. Fifteen Smilow Cancer Hospital Care Centers are scattered across Connecticut and, with the recent addition of a Center in Westerly, Rhode Island, Smilow has started to bring its services to the broader region. Another new Center will open this year [2020] in Springfield, Massachusetts and planning has started for one in Westchester, New York. About a quarter of all Smilow patients are enrolled in clinical trials at the Care Centers, rare among major cancer center networks.

“We are dedicated to addressing the clinical care needs of the wider community,” said Dr. Fuchs. “Our commitment is that patients should not have to travel more than 30 minutes to get destination cancer care, which allows us to provide care across the state and beyond. We want to make clinical research and clinical trials available to patients throughout the region.” He points out that 85 percent of the cancer patients in the United States don’t receive their care from academic research cancer centers such as Smilow because such centers are few and far between. The NCI has designated only 51 institutions as comprehensive cancer centers; Smilow/Yale Cancer Center is the only one in Connecticut.

Clinical trials are another area that has boomed at Smilow over the last 10 years. When the hospital opened, about 250 patients were enrolled in trials. That number is now close to 900 per year.

But numbers alone don’t tell the story. In the last decade, discoveries from clinical trials at Smilow have altered the treatment of cancer patients worldwide. Breakthroughs in immunotherapy pioneered by Lieping Chen, MD, PhD, United Technologies Corporation Professor in Cancer Research and Professor of Immunobiology, of Dermatology, and of Medical Oncology, and tested in trials at Smilow by Yale clinicians, have led to six FDA-approved checkpoint inhibitors that have revolutionized the standard of care in more than a dozen types of cancer. Dr. Chen’s newest checkpoint inhibitor, targeting Siglec-15, is now in early trials and may usher in a new generation of important immunotherapies. Smilow is also in the forefront for other advances. Early last year [2019] Smilow launched a program that delivers CAR T-Cell therapy to appropriate patients, an exciting new immunotherapy that collects and alters a patient’s own T cells, then injects them back into the patient to fight cancer. Smilow scientists are also developing and testing therapies based on protein degradation, DNA repair, and other biological opportunities.

Dr. Fuchs points out that just in the past 18 months, more than half a dozen studies and trials by Smilow scientists have significantly changed medicine’s understanding of lung, gastric, bladder, head and neck, colon, endometrial, and urothelial cancers. “Each of these is practice-changing,” said Dr. Fuchs, “leading to new FDA approvals. Most cancer centers, if they get just one of these in five years, that’s a sign of success.”

As Smilow’s reputation has grown, so has its research funding—from $58 million in 2012 to $99 million. The institution’s most recent CCSG (Cancer Center Support Grant) from the NCI increased in funding by 73 percent. “A pretty unprecedented increase,” said Dr. Fuchs. The next highest increase for a cancer center was 38 percent.

Success creates its own challenges. The hospital’s 15 floors are always full. “Smilow is bursting at the seams,” explained Dr. Fuchs. “We have to think innovatively about how we use the space and create new space. And as we grow the clinical operation, we have to make sure we do not lose the important intimacy between the patient, their family, and the clinicians. That’s paramount. We also have to make sure our caregivers—and by that I mean everybody in the hospital, not just doctors and nurses but the people who clean rooms, who provide meals, who enroll people in clinical trials—that we make sure we create an environment that recognizes their contribution. Because we not only want to be the best place to receive care, but the best place to work in healthcare.”

The leadership are working together on many plans to make Smilow’s second decade as impressive as its first. All are aimed at maximizing the hospital’s impact on patient care, cancer science, and the community. The community has responded. Everyone at Smilow has stories. Dr. Herbst remembers going to a restaurant one evening with his daughter, who was wearing a Smilow jacket. The couple at the table next to them noticed and said they were visiting their child in Smilow, where everyone had been wonderful to them.

Dr. Fuchs started hearing such stories from patients and their families as soon as he arrived from Harvard three years ago. “It’s an amazing hospital,” he said. “It has been far beyond my expectations. The talent here, the commitment of the university and the system to invest in Smilow and the Cancer Center, the commitment to our mission by our faculty and staff and everyone involved is inspiring. It’s a privilege to work here every day.”

Submitted by Emily Montemerlo on February 28, 2020