The State of Yale Cancer Center and Smilow Cancer Hospital

April 22, 2024

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April 19, 2024

Presented by: Dr. Eric Winer

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00:00What I would like to do this morning is talk a little
00:04bit about where the Cancer Center
00:08and Smilow are at the moment,
00:11give you a little update.
00:12For those who are more on the clinical side,
00:14you'll hear a little overview of what
00:18happened in terms of our overview of
00:21the Cancer Center and of our recent
00:24CCSG Cancer Center Support Grant.
00:27For those of you more on the research side,
00:29I'm going to talk a little bit about
00:32where we are clinically.
00:34There might be like a little bit of
00:37vision sprinkled in here and there.
00:39I'm gonna try not to offend large
00:41groups of people or individuals.
00:43I can assure you that there are
00:45individuals who I have not mentioned in
00:47the slides who I probably should have.
00:49And I apologize to you up front and you know,
00:54just doing my best.
00:57So let's talk about the the state
01:00of the Cancer Center and actually,
01:03Smilow, I tend to think of it
01:06all as one big entity.
01:08So
01:11this is our mission to reduce the
01:13burden of cancer in Connecticut
01:15and beyond through transformative
01:17science and community partnership,
01:19ensuring Health Equity and
01:21exceptional care for all.
01:23So there's not too much to argue with that.
01:27And to go a little further, in my mind,
01:32we strive to provide truly outstanding
01:35multidisciplinary care across the
01:38state through our network to all
01:42residents to conduct clinical trials
01:44to develop better cancer therapy,
01:45since where we are today is simply
01:49not good enough to integrate our
01:51care and clinical trials with basic
01:54translational and population science
01:56research to enhance population health.
01:58And by that I'm really referring
02:00to the fact that I think that
02:02in addition to treating cancer,
02:03we should be paying attention
02:05to the population,
02:06particularly the population of Connecticut,
02:08which for the cancer centers,
02:09our catchment area in terms
02:12of issues like prevention.
02:14We should be educating people about cancer.
02:17We should just be paying attention
02:19to those who are not necessarily
02:22our patients yet or perhaps ever.
02:25And of course,
02:26we want to educate and train the next
02:29generation of researchers and clinicians.
02:31I can't say how important that is.
02:34I don't speak a great deal in this
02:37talk about our fellowship program
02:40or other fellowship programs and
02:44residencies within the institution,
02:46but the training of people
02:49is really critical.
02:51So the Cancer Center has 309 members,
02:55it contains 6 research programs shown here.
02:59There are actually 7 shared resources.
03:02There's now 8 because we had one
03:05that was just newly approved or well,
03:08not officially yet.
03:11We have $95.7 million in Cancer
03:16Research funding annually.
03:19We'd like that number to go up and
03:21something in excess of 100 would
03:24be nice within the next year.
03:26And we have a lot of publications,
03:30including a lot of publications
03:32in high impact journals.
03:34I'll just mention that this year we
03:37took a much more stringent view of how
03:40we defined cancer related publications.
03:43The total number actually fell compared
03:45to past years because we were very,
03:48very specific about what counted
03:49as a Cancer Research publication
03:56after I arrived here and in preparation
03:59for the Cancer Center for grant,
04:01but sort of for general purposes beyond that,
04:05we did convene a a fairly large group
04:09of people to develop a strategic plan.
04:12And the themes of that plan
04:14are shown on this slide.
04:16Research, discovery and innovation,
04:19access and care, cancer burden
04:22and disparities, our own culture,
04:25equity and inclusion and education,
04:29training and career development.
04:30And we'll, we'll touch on
04:32some of these later.
04:34We also as part of the Cancer Center
04:38Core grant and beyond that for our own
04:41purposes had to identify priority cancers.
04:44This doesn't mean the cancers not
04:47included on this list are that
04:49that we don't care about or that
04:51we won't do research there or that
04:54we'll turn patients away never.
04:58But these four were the cancers that
05:01we identified as priority cancers.
05:03And they were identified as
05:05priority cancers either because,
05:07number one, they're very common,
05:10which is true for three of these
05:13#2 there are problems in terms
05:17of disparities in the state.
05:20And that is true of each of these.
05:23It's probably true for all cancer,
05:25but it's particularly true for each of these.
05:27And finally,
05:28we also wanted to focus on
05:31cancers where we had expertise or
05:33wanted to build the expertise.
05:35So this was quite carefully thought through.
05:39We also did something that
05:42is a little bit unusual,
05:44I think in in these Cancer Center
05:47core grants is that we also
05:49identified 4 cross cutting themes.
05:51And those themes were early onset cancer,
05:55meaning early age of onset defined
05:58practically as people who are diagnosed
06:01with cancer under the age of 50.
06:04In my mind,
06:0550s getting a little old
06:06for early age of onset.
06:07But in many tumor types,
06:10that's the definition that is used.
06:13And as people probably know,
06:15there has been a great deal in
06:17the press as a result of what has
06:20happened clinically in terms of the
06:22increasing incidence of certain
06:23cancers in young individuals,
06:25most notably colon cancer.
06:26I will tell you for that,
06:28for the past 25 years,
06:30everyone has said to me yearly there's
06:32so much breast cancer in young women.
06:34It's increasing, it's increasing.
06:36The truth is it has increased
06:38a very tiny amount.
06:40But it, you know,
06:41it's very different from
06:42the colon cancer story,
06:44where in fact incidence of colon
06:47cancer in people under the age of 50
06:50has really gone up very substantially
06:53over the course of the past 20 years.
06:56So we also are focusing on brain metastases,
07:00which I think are an increasing
07:03problem as our treatments get better
07:05for disease outside of the brain.
07:07And often times disease from the
07:09brain seems to be more resistant
07:12for lots of different reasons,
07:15obesity and metabolism.
07:16And as people probably know,
07:19being overweight or obese is associated
07:21with an increase of incidence and in
07:24some cases an increase in mortality
07:27for 13 different tumor types.
07:29And finally,
07:29of course,
07:30the ubiquitous problem of tobacco use,
07:32which has gotten a little bit better
07:34throughout our country and in Connecticut
07:36over the past couple of decades.
07:38But it's still a major problem and
07:41a problem that is particularly
07:43relevant to underrepresented groups.
07:49And while we're touching on disparities,
07:52I'll just embarrass Tracy for a minute,
07:55who's sitting here in the the 3rd row.
08:00We have launched an initiative focused
08:02on on cancer disparities, particularly
08:05cancer disparities in Connecticut.
08:08As many of you may know,
08:11the the statistics are really quite alarming.
08:14If you're a 20 year old woman in the
08:16United States who happens to be black,
08:17you have twice the chance of being dead
08:20from breast cancer by the time you're 50.
08:23That's the most dramatic of
08:24the statistics that I know,
08:26but it's true really across the
08:29board and in all cancer types.
08:33Race is is a major issue.
08:38It's interesting that in many cancer types,
08:41being Hispanic or Latinay may make the
08:44course of treatment more challenging
08:46because people have trouble coming in,
08:49accessing treatment.
08:50But in some cases in breast
08:52cancer is one of them.
08:53Mortality is actually not compromised at
08:56all for reasons we don't fully understand.
09:00But we recruited Tracy Battaglia,
09:03who had a long career, well,
09:06not that long because she's still
09:08in the middle of her career,
09:10but Tracy who had been at Boston
09:14Medical Center at Boston University
09:16for an extended period of time,
09:18lots of experience focusing on
09:22ways to diminish disparities,
09:25largely through patient navigation.
09:28Tracy joined us on February 26th and we're
09:33all really happy that that happened.
09:36We also gave out some internal grants
09:39this past year totaling $500,000.
09:41That money came from a donor who
09:43specifically wanted to focus on this
09:45area and some of the topics are
09:47shown here and you're going to hear
09:49more and more about this over the
09:51course of the next couple of years.
09:54We also have a new initiative focused
09:57on early onset cancers and that's just
10:01getting off the ground and Beta Giri
10:04and Nancy Borselman are Co leading this.
10:07The idea is that we really want a
10:11statewide program across our entire
10:14network that focuses on younger
10:17individuals both to optimize care
10:20and perhaps even more importantly to
10:23try to understand what it is that
10:26these younger individuals face in
10:28terms of getting treatment and why
10:31some of them are developing cancer.
10:33So there will be a large research
10:35cohort that is established and then an
10:39opportunity to ask hypothesis driven
10:41questions within the within that context.
10:45And and we're excited about that.
10:50And I think that in many ways it's
10:53good for everything because we will
10:57help these younger individuals,
10:58we will learn from them for the health,
11:01for the for the for the health system.
11:05We will probably bring more
11:07younger individuals into
11:11the the system and it's
11:13just the right thing to do.
11:18Our research programs in the
11:20Cancer Center are shown here as
11:23well as the various leaders.
11:25It's, there's no particular reason why
11:27some have 3 leaders and some have two.
11:30It's, it's, it's not that we felt that
11:33the ones that have three that the people
11:36are somehow insufficient or inadequate,
11:38but it has just evolved this way in general.
11:41And most programs across the country,
11:44they're anywhere from 2 to 3 leaders.
11:46And it's possible than the programs
11:48that have two that we will add people.
11:51In my mind leading a,
11:53one of the research programs in
11:55the Cancer Center is, is,
11:56is something like a 10 year job.
11:58And I think it's important to remember
12:00that all of these positions are positions
12:02where we should have some turnover.
12:04And we've had some turnover
12:06over the past few years.
12:07And I think it's really important
12:09in terms of keeping the intellectual
12:12activity within the program very fresh.
12:17I want to talk for a couple of minutes about
12:21what I would call the transformation of the
12:24clinical research operation in early 22,
12:27which actually coincided with my arrival.
12:31The clinical trials office was not in great
12:34shape and I think we don't need to say a
12:37lot more other than accrual had fallen,
12:40protocol activation time was high.
12:42Lots of people had had had left the
12:47system partially because of the great
12:51resignation associated with COVID and and
12:55for other reasons before I was even here.
12:57I recruited Ian Krop,
12:59who joined us a month after I arrived,
13:03who then promptly recruited Alyssa
13:05Gateman as the Executive Director.
13:08And under their leadership,
13:10the CTO was totally reorganized,
13:12staffing was stabilized.
13:14Protocol activation times
13:16have dramatically declined.
13:18So more work to do for sure.
13:21Many more protocols were open,
13:23investigator initiated trials were
13:25prioritized and accrual has increased,
13:28not as much as we would like,
13:30but it's going up.
13:31And this is the accrual on
13:34interventional treatment trials.
13:36And what you can see is that it Nader
13:40in 2022 at just over 500 and the
13:44projected number for fiscal year 24
13:47which ends on June 30th is just over 700.
13:51But we really should be at 1000
13:54within a year or two.
13:56And this shows the proportion of patients
14:00who are recruited to interventional
14:03trials in New Haven versus at our
14:07external sites throughout the state.
14:10And I think we have room
14:12for improvement in both.
14:13As people know,
14:14one of the major changes that we have
14:17instituted in the network is that we're
14:20really focusing on sub specialized care.
14:22And the more sub specialized we get,
14:24I think naturally the more people will go on,
14:27on trials at sites around the state
14:31because it's really specialists who
14:34ultimately know the disease well and,
14:37and tend to be that much more committed
14:40to enrolling people in trials.
14:42And, you know,
14:43we appreciate all the efforts
14:45that have been put into this by
14:48people throughout the network.
14:49And we're also, I should add,
14:51trying to make sure that that,
14:53that doctors throughout the network
14:56have the necessary time both to
14:59be specialists and attend tumor
15:01boards and and do all of that,
15:03but then also to enroll people in trials,
15:06which takes longer than just
15:08doing standard care.
15:09We have done reasonably well from
15:11the standpoint of recruiting
15:13under represented groups.
15:14We want to do better.
15:16We are the proportion of patients
15:19who are largely Black and and Latin
15:22A who are recruited to trials in our
15:26system actually is sort of on par
15:29with the state population as a whole.
15:34But again, we can do much, much better.
15:40I want to touch on DEI.
15:42We recruited a new DEI leader in
15:46the Cancer Center, Faye Rogers,
15:48after a national search.
15:50And that national search LED us back home.
15:53And Faye, of course,
15:54is an associate professor
15:56in radiation oncology,
15:57has done a great deal related to
15:59DEI throughout the the School of
16:02Medicine and has just really done
16:05a great job over the past year.
16:08And she has recruited an assistant director,
16:12Iris Selfie,
16:13who actually also is the DEI
16:17representative for hematology and oncology
16:20within within the Department of Medicine.
16:24There are ongoing monthly
16:25meetings of the DEI Council.
16:27I'm sure if there's anyone here
16:29who's interested in the DEI council,
16:31please contact Faye.
16:33And in the fall,
16:35we had about 60 people together for a
16:39whole day for anti racism training.
16:43And it was remarkably both interesting
16:46and I think effective and eye opening.
16:51And it's gonna be repeated at least once,
16:55probably more than once
16:56with a broader audience.
17:00Community outreach and engagement
17:02is critically important.
17:04It's critically important for
17:05the Cancer Center Core Grant,
17:07but it's important for all of us.
17:10Our community outreach and engagement
17:12component of the of the grant
17:15is led by Marcella Nunes Smith.
17:17But let me just sort of take
17:20a step beyond the grant.
17:22We really need to embrace the community.
17:27And by the community,
17:28I mean not just the New Haven community,
17:31but the statewide community.
17:33It is remarkable to me that we live in a
17:38city that is a majority minority city,
17:41that there's inadequate care that is,
17:44that is available to people in our own city.
17:48And some of that is about lack of knowledge.
17:51Some of it is about being
17:53uncomfortable with all of us.
17:55And I truly believe we can make that better
17:57by reaching out and spending time in,
18:00in the community.
18:01And there are many opportunities to do that.
18:05And we're going to be tapping more
18:07and more of you to, to get involved.
18:11And finally, we're,
18:12we're coming to the end about
18:14the issues related to the,
18:16to the Cancer Center and,
18:18and the recent grant we put in.
18:20But of course, Cancer Research,
18:21education, training and coordination,
18:23which in the world of CCS
18:27GS is called Surtek,
18:28which is led by Harriet,
18:32has the has the oversight over education
18:36and training essentially for everyone.
18:39And they've done really a great job.
18:42But the goal is,
18:43is to start with students in high
18:46school and college and to continue
18:49efforts to support training all the
18:51way through post doctoral fellows and,
18:53and, and actually faculty.
18:56So thank goodness the CCSG is done.
18:59I thought it might kill me.
19:01It didn't, thankfully.
19:03And we did reasonably well,
19:06actually quite well.
19:07And it's because we have
19:10a truly amazing team.
19:12We have a great team of deputy directors and
19:15associate directors and countless others,
19:18all the program leaders and,
19:20you know,
19:21all of the people who work in administration.
19:23And it was really a huge team
19:26effort that I think really paid off.
19:28And it paid off not only because
19:31ultimately we'll get a adequate
19:33or much better than adequate,
19:35so we're going to get a good score,
19:37I believe.
19:38But it paid off because it really
19:42brought us all together and helped
19:44us all learn much more about
19:47what everybody else is doing,
19:49which is really critical.
19:51And with that in mind,
19:52I just want to put in a little
19:53plug for membership. In the YCC.
19:56There are a variety of criteria
19:59for membership.
20:00And in truth,
20:02if anyone doesn't meet those criteria,
20:04there are there are clinical
20:06memberships as well.
20:07And so we really want to
20:09get everyone involved.
20:13And finally, before leaving this whole area,
20:16we, we did have our conclave,
20:20which I guess for the past 10 or 12
20:22years has been the annual meeting where,
20:25or meeting event where,
20:28where awards are given.
20:30I will confess that I
20:32personally hate the name.
20:34You know, we're not trying to
20:37run a papal selection in secrecy.
20:39And if you, if you actually look up conclave,
20:42it talks about choosing the Pope.
20:44It also talks about meetings in general that
20:47are basically held in private dark rooms.
20:50And that's not really what Conclave is about.
20:54And so next year look for a new name.
20:57But I, I just want to congratulate all
21:00of these people who who received awards.
21:05So let's talk about sort of the
21:08clinical end of the world.
21:11And 1st, I think it's important for
21:15everyone to realize that there's been a
21:19real change over the past couple of years.
21:22And this is not a change
21:24because of my arrival.
21:25It's something that's been bubbling up
21:28through the organizations for a lot longer.
21:32And that is that there is a real
21:35integration and desire for alignment
21:37between Yale New Haven Health
21:40System and Yale School of Medicine.
21:43And at the risk of sharing too much,
21:46I will say that I think there were
21:49problems for many years in the past.
21:51And in my own view,
21:54there's plenty of guilt to go
21:56around or blame to go around,
21:58I think on the health system
22:00side for many years.
22:01And, and I'm,
22:03I'm,
22:03I'm actually remembering back to when I
22:07was a resident just a decade or two ago,
22:10but certainly at that time,
22:13and I think more recently,
22:14the health system didn't necessarily
22:17appreciate that having Yale physicians,
22:20having an academic Medical Center
22:23feeding into a health system
22:26was particularly valuable.
22:28And it was hard for people to
22:31distinguish a community Dr.
22:33not that not that they didn't
22:35practice great medicine and not
22:37that they weren't valuable,
22:38but it was they didn't really see any
22:42benefit from having academic physicians.
22:45And in truth,
22:46on the school side,
22:47which I think endlessly frustrated
22:50the healthcare system for years,
22:52there were plenty of clinicians who
22:54thought that being a clinician was
22:57seeing two patients every three days.
22:59And you know, in many, many ways,
23:01and this this actually now dates
23:04back to when I was a resident,
23:06clinical medicine wasn't part of an
23:10integral and it wasn't a critical
23:13element in the School of Medicine for many,
23:15many years.
23:16And, and all of these things have changed.
23:19And what has led to this view that
23:22alignment is so critical is that I
23:25think everybody realizes that we can
23:27just be so much better if we work together.
23:30So that's what's going on.
23:32In truth, as Lori Pickens
23:34points out repeatedly in Smilo,
23:37in the Cancer Center,
23:39we've been much more aligned for a long time.
23:41And I think that's true,
23:42but it's gone further.
23:45So as part of this alignment,
23:48I was appointed as president of Smilo.
23:51Lori continued in her very critical
23:53role in Smilo and was appointed the
23:57Chief Administrative Officer for YCC.
24:00So both of us have roles on both
24:03sides of the street and I somehow
24:06managed to convince Lori to move
24:08to the office across from me,
24:10which actually enhances communication hugely.
24:17We have an increasing number of
24:20administrative positions where
24:22people work at the moment still
24:24for either the healthcare system
24:25or the School of Medicine,
24:26but their responsibilities on what
24:28I will continue to refer to as both
24:32sides of the street for the moment,
24:34probably not the best way of doing it in.
24:37In terms of philanthropy,
24:38we have a new assistant vice president
24:41for cancer philanthropy who was hired
24:43by the school but who now overseas
24:46fundraising in both YCC and Smilo.
24:48And in my own view,
24:50we have left millions of dollars
24:52on the table from generous donors
24:54because we just didn't do it right
24:57and in a coordinated fashion.
24:59And Sue, for those of you who
25:02have not met her is great and it's
25:06somebody I worked with in from 2000,
25:104 to 2009 or 10 at Dana Farber.
25:14And totally by luck,
25:15she called me up and was just wanted to
25:19chat the day we opened up this position.
25:23And it turned out she had just
25:25left the job and it was great.
25:27And the overall goals are to eliminate
25:30duplicative processes and to have
25:32seamless interactions and we have to do that.
25:35So where are we in terms of clinical trends?
25:38And you know this looks at all sorts of
25:42different types of of events of care,
25:47infusion surgery cases,
25:48radiation oncology treatments,
25:50what have you.
25:51And what you can see is that overall there
25:55is growth in terms of Medonc and hematology,
25:58new visits up 6% last year,
26:037% this year, surgery is up,
26:06radiation oncology is up.
26:09This is all good.
26:11And you know,
26:12this is the kind of growth that
26:15one would like to see in a,
26:17in a healthy organization,
26:19double digit growth is pretty hard
26:21to deal with.
26:22So you know, this,
26:24this kind of growth is something
26:26that we can deal with focusing
26:29down on Med onc and and hematology.
26:34In terms of hematology,
26:37you can see that there's a mix
26:40of both classical heme,
26:42which all of us for a while were perplexed.
26:45But the truth is this is an
26:47area that is growing hugely.
26:49Alfred has done a great job as the the
26:52chief of classical hematology And it's,
26:55it's, it's a huge growth area.
26:58I used to think that it was because
27:01in primary care nobody knew anything
27:03about how to work up anemia any longer,
27:05and that the world has just
27:07changed in the minute someone sees
27:09a value with the Red Star,
27:10they say call hematologist.
27:12But I think that it's also very
27:15much part of the fact that with our
27:17more complicated medical treatments,
27:20there are just way more hematologic
27:23problems and acute hematologic problems
27:26than was the case many years ago.
27:29And they are really busy and you can see
27:34the very large solid tumor volume we have.
27:39And in terms of this just shows a
27:42little snapshot of new patient visits
27:45across a variety of of different areas.
27:48These are the four sort of biggest solid
27:51tumor areas and you can see
27:53that there is continued growth.
27:58I want to point out that we're all
28:00over Connecticut for the most part.
28:02I mean we're, we don't have a huge
28:05presence up in the northeast corner
28:08in Windham County and Tolland County,
28:12but we, we are obviously distributed very
28:16well across the shoreline and up towards
28:20Waterbury and increasingly towards Hartford.
28:23And assuming that everything moves
28:26forward with the Prospect acquisition,
28:29we we will be that have that much of A
28:34stronger presence in Waterbury as well as
28:37in Manchester right outside of of Hartford.
28:40And at the moment we see about 50%
28:43of patients who were diagnosed
28:45with cancer in Connecticut.
28:47I think that in truth that percentage
28:50should be much higher and it's
28:52going to be higher by continuing to
28:55raise the profile of care here and
28:57its sites around the state.
29:00And again,
29:02having having disease specialized care at
29:04each and every one of our sites is really
29:08something that's going to be critical.
29:11So in my mind,
29:12what we're doing is developing A
29:14statewide academic oncology program
29:16that provides sub specialized
29:19state-of-the-art multidisciplinary
29:20care enhanced by the most important
29:23and forward-looking trials.
29:25Do you want to take this moment
29:28to emphasize that cancer is a
29:30team sport and that it in this?
29:34It's not so much true in leukemia and
29:37lymphoma where medical oncologists
29:38do most of the work,
29:41but in all of the solid tumors,
29:45it is a partnership between the
29:47surgeon and the radiation oncologist
29:50and the medical oncologist.
29:52And although there's this tendency,
29:54I think for structural reasons
29:56to think of the Cancer Center
29:58as more about medical oncology,
30:00because in truth,
30:01the medical oncology and
30:03hematology actually sit
30:06in the Cancer Center. From a,
30:08from a financial standpoint, I am.
30:13And the Cancer Center as a whole is
30:17every bit as much focused on the
30:19surgeons and radiation oncologists as
30:21we are on the medical oncologists.
30:23And I can add to that,
30:24you know, pathologists and,
30:26and imaging people and everybody else.
30:32I will confess that I have gone back
30:34and forth about how we name the, the,
30:37the each of the individual programs and
30:39what's the center of excellence and what's
30:42a clinical research team and what have you.
30:45And I've gone back and forth on this,
30:47but I think this is pretty final and I,
30:52I guess I'm presenting it here.
30:54And if you have any major problems,
30:56you can tell me later.
30:58But I think within each and
31:00every one of our diseases,
31:01we have essentially a large center of
31:05excellence with a director or several code,
31:08one or two or three Co directors.
31:11I think within that we have a clinical
31:13program that focuses on clinical growth,
31:15clinical performance,
31:16clinical pathways,
31:17everything you can imagine.
31:19There's a translational research team with
31:22a lead that's trying to bring together
31:25the translational researchers and then
31:27a very critical clinical research team.
31:31And in some cases,
31:33leadership may be in multiple places
31:36the same person, and in others,
31:38it may be a different name in every place.
31:40And I think what's important is to make
31:44sure that we have leaders who are,
31:47who both have the time and the
31:50interest to tackle each of these areas.
31:52And of course,
31:53the centers of excellence are not
31:55the the academic home of the faculty.
31:57The academic home for the faculty
32:00continues to to remain in the departments.
32:03Oh
32:06yeah, oh, that's right.
32:07There was nothing written on the errors.
32:09This was my animation to remember
32:11to say how important radiation
32:13oncology and surgery are.
32:18So as you know we have divided up
32:22into divisions based on disease.
32:25And I just want to point
32:27out that in hematology,
32:29I'm residing is now the chief
32:32of malignant hematology or he
32:34malignancies as I usually call it.
32:36And Alfred for for now over a
32:38year has been the chief in,
32:41in hematology and they are working very,
32:45very closely together and I think very,
32:48very well. And I just want to point
32:52out that this picture of Alfred
32:54must be at least 15 years old.
32:58He's not here.
32:59So it's it,
33:00it doesn't have the same effect.
33:02Oh, he is
33:09so Alfred, I, you know,
33:10I just couldn't resist. He does look.
33:13He he, he, he looks good.
33:15But I saw that picture and
33:16I said like, you know,
33:17is that his bar mitzvah picture?
33:22No.
33:24So, and these are the faculty
33:27and before I was talking about
33:29the faculty in the Cancer Center.
33:31These there are 151 faculty in
33:33the Cancer Center and you can
33:35see how they're distributed.
33:39I hate to talk about funds flow,
33:43but I, I think there are people
33:45who remain very interested in this.
33:47And so I'm just going to
33:50briefly say a few words.
33:52So in the Cancer Center,
33:54the the this applies to the
33:58medical oncologist, hematologist,
33:59neuro oncologist and palliative
34:01care physicians.
34:02In the old days,
34:04meaning more than a year ago,
34:05the hospital backed the salaries
34:07of all clinicians.
34:08Anybody who did more than 20% clinical
34:10work had their salary essentially
34:12covered by the hospital if they
34:15didn't have other sorts of funding.
34:17In the new era,
34:19your Cancer Center director is
34:22provided with funds based on RVUS,
34:24and I have to make it all work.
34:26The model provides for some protected
34:29time for some people who are actively
34:31engaged in unfunded research,
34:33particularly clinical trials.
34:35It's a model that I dare say is a little
34:40more generous than some people have.
34:42And it is because everyone in the system,
34:45in both the school and in
34:47the healthcare system,
34:48recognize that it takes time to develop
34:51clinical trials and that cancer care
34:54can't be done without clinical trials.
34:57And I think the most important
35:00message is don't worry,
35:01'cause I'm worrying for all of you and I'm
35:05not trying to be paternalistic about that.
35:07But I really,
35:08I will tell you,
35:09there are departments where people
35:11are really panicked about this.
35:14There is no reason to panic and
35:17I do want everyone to who who is
35:20within these areas to pay attention
35:23to RV us and to do their best to
35:25maximize their generation of RV us.
35:27But I don't want anyone to feel tortured
35:29that they're supposed to, you know,
35:31suddenly as a result of funds flow,
35:33see 10 extra patients a week.
35:35Just just make sure that you're
35:36that we're getting paid for what you
35:38do and take good care of people.
35:40Yes, yes,
35:42I just want
35:47to make sure folks grow up.
35:49Oh the oh, absolutely.
35:49The pay, you know,
35:50the where all of the fund,
35:52you know, so it used to be that,
35:54that that the system, the healthcare
35:56system used to just fund the salaries.
35:58Now they fund the payments that come
36:01that that support the and the whole idea
36:05here is a much tighter collaboration.
36:08We've had a lot of recruits in 2023 and 2024.
36:16What happened?
36:17Oh, I hit the wrong one.
36:19And we have more recruits coming.
36:21We have two recruits to the to CMCO,
36:24the Center for Molecular and Cellular
36:27Oncology and that's Sarah and
36:29Corleen on either end of the top.
36:31We have recruits in the solid
36:34tumors and in he malignancies.
36:37And I'll just point out someone who
36:40none of you know who's Raghav Sundar,
36:43who's who's actually coming
36:45from Singapore that Pam *****
36:48recruited and will be here in
36:50the next couple of months.
36:55So my my friend for many years,
36:59Hal Burstein used to always talk
37:00about the lightning rounds where he
37:02went through things very quickly.
37:03So these are my lightning announcements
37:07that we have an ongoing search
37:09for chief of Neuro oncology.
37:11We're looking for many classical
37:14hematologists and Alfred's
37:15taking the lead on that because
37:18they are hugely understaffed.
37:20We have a soon to be launched search
37:22for a senior clinician scientist to lead
37:25cellular therapies as soon to be launched,
37:27search for a lymphoma leader
37:29that Amar is going to champion.
37:33We're going to expand the development office.
37:35We have an ongoing recruitment
37:38of a new biostatistical leader.
37:41Our present leader has been great,
37:42but hasn't had the time to be full
37:45time in the Cancer Center and we we
37:49have the search ongoing for that.
37:53We're going to be hiring at least
37:55two to three physician scientists,
37:56probably one in the area of breast cancer.
37:59There are three spores that are
38:02in planning stages.
38:03We have an ongoing search for an SVP
38:06of patient care services and much more.
38:12I want to call out some people for
38:16special thanks and, or some groups.
38:19You know, none of us could do everything
38:22we do on the clinical side without
38:24the nurses and both the nurses that
38:27staff the clinics and the nurses
38:30that staff the infusion rooms and the
38:33inpatient units and of course the APPS.
38:36And we have a lot of APPS and we need them.
38:44We couldn't do what we do without the
38:47administrative professionals of all types,
38:48from the most senior people
38:51to the most junior people,
38:53both in Smilo and the YCC.
38:54We couldn't do it without the social
38:57workers and the pharmacists and of course
39:00our patients and their families and the
39:03clinical trials staff and the clinical
39:05trials participants and the students,
39:07residents,
39:07fellows and postdocs and many others.
39:10And let me just mention that we
39:13couldn't do this with a the,
39:15the team of people who take care
39:18of the OR oversee the operations
39:21in Smilo like Kevin and Sarah and,
39:24and at the moment Tracy and so many others.
39:31We are in the news.
39:32Just want to point this out.
39:34Many of you may have seen the billboards and,
39:37and if you haven't,
39:38I thought I would show you this
39:42slide and this is my last slide.
39:45And you know,
39:46it's often said that culture
39:48eats strategy for breakfast.
39:50And the question is what?
39:51What's culture about?
39:52So I actually did a little Google
39:55search last night and I found many,
39:58many different definitions of what
40:01constitutes a positive culture.
40:03And I picked out the.
40:08Adjectives,
40:08the characteristics that I thought
40:11were most important and I decided
40:13not to try to rank them or to
40:16try to pick the top five,
40:18although I probably could pick the top five,
40:20but just list them.
40:21So trust, transparency, equity,
40:25emotional intelligence, respect.
40:28Next one I think is actually pretty
40:30important support for and confidence
40:32in risk taking and innovation,
40:34a sense of purpose and then
40:36the three CS cooperation,
40:37caring and competence.
40:39And you know,
40:40this is really what I hope we can all
40:43strive for because it really is true
40:45that it is having the right culture
40:47that allows us to do so much better work,
40:51whether it's work in the laboratory,
40:53work in in the wet laboratory,
40:57dry laboratory, clinical trials,
40:59and of course in the care of
41:02the people who need our care.
41:05So, you know,
41:06it's something we should all
41:09really think about.
41:10And thanks.
41:11I deliberately left 1520 minutes so
41:14that there would be time for questions.
41:17Thanks.
41:27There are questions.
41:27You just have to eat bagels.
41:36Yes, I know like many of us,
41:39you were spending a lot of time
41:40thinking about Wellness for our
41:44clinicians and teams. It's an ongoing
41:49addition to funds flow.
41:51It's another worry on your mind. Maybe
41:55you could share some of your
41:57thoughts. We're all here
42:01to help. So I think funds flow actually
42:04helps with it in the sense that I think,
42:08you know, it's important to be in
42:11control of our own destiny and we can
42:14be very clear about expectations with
42:16funds flow and we have the ability
42:18to protect time for some people.
42:22But you know, it it of course
42:25goes way beyond that.
42:26And you know, the one thing that has
42:30been shown repeatedly in efforts
42:32to enhance clinician well-being,
42:34and I don't think we should focus
42:36just on physicians here.
42:40What doesn't work are things like massages.
42:44And you can give a gift certificate
42:46for a massage and I think somebody
42:49feels better for about 15 minutes.
42:52And, and that this has been,
42:54this has been shown across the country,
42:56but we have to focus on on ways that on,
43:01on all of the things that
43:04make clinicians frustrated.
43:06And so the systems in that presently
43:12exist that just drive everyone mad,
43:16like some of which we have control over,
43:19some of which we don't insurance
43:22approvals and writing notes
43:24and endless clicks and this,
43:26that and the other.
43:29And you know, it's, it's a slow process,
43:31but we can get there.
43:33I will tell people and you should
43:34feel good about this.
43:35Although I had a conversation with
43:37Sarah about this and she's not
43:39convinced that she's going to buy in,
43:40But I am absolutely convinced
43:42that within the next two years,
43:44you're going to be able to walk
43:45into a room and talk to a patient
43:47and a note will be generated.
43:49And personally,
43:50Sarah thinks that she she that
43:52it won't be as good as her note.
43:55But sorry to embarrass you,
44:00but but I think that that's a
44:03huge step forward for a lot of
44:05us and we'll make things better.
44:07And we just have to keep focusing on this.
44:09And I, you know,
44:10I think the other thing though,
44:11is it really helps, you know,
44:14to have the right culture.
44:16And you know, as you all know,
44:20I also believe that having the
44:24right kinds of relationships
44:26with for the clinicians,
44:29with the people we take care of,
44:30and I will extend this
44:32now to the researchers,
44:33having the right kind of relationship with
44:36the people you work with every day and,
44:39you know,
44:40with everyone around us really
44:42makes our lives better.
44:45So,
44:47Roy,
44:47do
44:49you like your picture?
44:51I do, you know, I've yet to see it,
44:52but I, I need a picture from
44:54my mother so you can send.
44:56Would you want me?
44:57Do you want me to e-mail her this slide?
44:58That would be great. It's Passover.
45:00Well, Eric, that was a great talk.
45:01So I wanted to ask, you know,
45:03a question forward thinking the future of
45:05oncology and how we're going to cure cancer.
45:06So I'm struck by, you know,
45:08we're at Yale and I think our advantage is,
45:10you know, an amazing university.
45:12We're actually #4 right
45:13now in Blue Ridge funding,
45:14which is looking at all the medical schools.
45:16We've got so much going on in every area.
45:19So finishing up your ASCO presidency
45:21with everything you've seen,
45:22what are a couple of areas where we
45:24could take the science of Yale and
45:25really be the leaders, you know,
45:27something new and an exciting technology and,
45:29and how can we all get together and,
45:31and, and make that happen?
45:33Well, you know, I think it's,
45:35it is a challenging problem, but I,
45:38you know, I really believe that by,
45:41you know, sometimes
45:45form helps function.
45:47And I think that by setting up
45:50programs such that clinicians and
45:54scientists are talking to each other,
45:57you can take it that, you know,
46:00you can take a step forward.
46:01And, you know, the Cancer Center is meant
46:04to be a highly translational entity.
46:08So, you know, there's a lot of
46:12great science at Yale and we
46:15need to start or we need to.
46:17We don't need to start.
46:18It's well started. As you know,
46:20we need to increase what's going on.
46:23And of course,
46:24we all know that there are certain
46:27cancers that are a particular
46:29challenge where we really
46:30haven't made that much progress.
46:36And I'm going to take one where
46:37it's not like that, you know,
46:39breast cancer, you know,
46:41we'll probably be at the point in 10 years
46:43with breast cancer where we can say,
46:45you know, the vast, vast, vast, you know,
46:4898% of people will will be cured or will
46:51not have to die from the disease if
46:53they have treatment available to them.
46:55We're nowhere nearly there in terms of
46:58pancreatic cancer and glioblastoma.
47:01And, you know, we have to sort of
47:04redouble our efforts there. Thanks.
47:16There's somehow I miss the fact
47:18that Yang was had like taken
47:19on this role of passing around
47:21the microphone. Thanks so much.
47:24Yeah, no, I know. I know. It's good.
47:27Hi. Thank you. Eric, I was curious,
47:31I know within your the first slides
47:34that the patient experience was
47:37really embedded in your priorities.
47:39And I just wondered if you could
47:41speak a little more specifically
47:43to that and what you think are the,
47:45the priorities that we should be
47:48expecting and focusing on for the whole
47:50enterprise should be in that area.
47:55You know, I don't, I, I, I will say,
47:58I don't think we do badly in general
48:01from a patient experience standpoint.
48:04I think when people come,
48:06they do feel that they're cared for.
48:09But, you know, in my mind,
48:12we need to make it from the minute somebody
48:14calls until they no longer need us.
48:16And so people from day one
48:18need to feel like they get,
48:20you know, they need two things.
48:22They need great care,
48:24great care in terms of technical expertise,
48:28but they also need people
48:30who care about them.
48:31And, you know, in my mind,
48:35that's having the right
48:36partnerships between clinicians and,
48:38and, and patients.
48:43I think it's something that is
48:46comes out of both the right kind
48:50of systems and the right culture.
48:53And, you know, there are a number of
48:56cancer centers where there are great
48:59doctors and I think pretty bad culture.
49:02And you can tell because of what patients
49:05say about their experience there.
49:07And then there are places where
49:10the culture is right or better and
49:13where there's a real focus on making
49:16sure that the patient is cared for.
49:19And that's what we have to just
49:21keep striving for.
49:22I will tell you that, you know,
49:23we're not there yet as a whole system,
49:26and we're not there even in the
49:28Cancer Center by any means.
49:30But
49:34we need to fix our access
49:36problem across the whole system.
49:39You know, when you call up and
49:41you need an appointment with
49:42a rheumatologist and you get,
49:44you know, an appointment,
49:46you call in March and you get
49:48an appointment in September.
49:49Like that doesn't work.
49:52So, you know, we need to be available,
49:54we need to care, we need to have expert care.
49:58And finally, we,
49:59we all need to take care of each other,
50:06which is a part of, you know,
50:08like Roy's pushed for this,
50:09I've pushed for this.
50:10Part of the reason we want more
50:13and more people back at work,
50:14not 100% of the time, but most of the time.
50:17And, and working a little less from
50:20home is it's really hard to do the
50:23culture thing from a distance.
50:25You know, I, I think that and that
50:27now I'm just sort of going off,
50:29but I think that, you know,
50:31it's much easier to have sort
50:34of contentious on the one hand,
50:36contentious, on the other hand,
50:38unproductive interactions by Zoom and,
50:40and in person it works better.
50:49And the follow up question is,
50:52oh, change gears.
50:53But thank you for the, the other answer.
50:56And I agree, I think access is,
50:59is really critical.
51:00But changing gears, I,
51:02you referred a couple minutes ago
51:05to the AI revolution that's coming.
51:09And I've been hearing a little bit
51:12about bridge and this technology of,
51:15you know, forming our notes
51:16while we're in the room.
51:18I wondered if you could speak to that
51:20and what we know might be coming there.
51:23But should we anticipate
51:25there's a pilot coming?
51:26I've seen a demonstration of it.
51:28It's really quite remarkable,
51:30at least based on the demonstration.
51:33I, I, I saw and I think it'll be great.
51:37And you know, there is,
51:38I have been to three retreats in
51:40the past three months that focused
51:43entirely on AI and how AI is going
51:45to affect everything that we do,
51:48I think is still an unknown.
51:50I think from an administrative standpoint,
51:53like with notes,
51:54it can be very, very helpful.
51:56I think there are a lot of people who
52:00have many concerns by patients calling
52:02up and interacting with a, you know,
52:05chat box and not even realizing that
52:09that's what they're interacting with.
52:12And I think there are feelings
52:14that in those situations,
52:15patients need to be informed
52:17what they're dealing with.
52:20You know, the other of course,
52:21big areas are how can,
52:24how can AI help us with decision making?
52:27You know, in my mind,
52:29really good clinicians,
52:31you know,
52:32can bring together lots of different
52:36data from many different sources
52:38to make a decision with a patient.
52:40But the truth is there's so
52:42much information out there that
52:44none of us can do it as well as
52:46we can with some assistance.
52:51OK who? Amar? OK,
52:54Yeah, yeah. Thanks, Eric.
52:55Sorry I couldn't be in, in person.
52:57And so great vision.
52:59I I think I would.
53:00I was wondering whether you could
53:02speak more to your thoughts about how
53:04the efforts in clinical research with
53:06the new model will be incorporated
53:09without transactional components.
53:11I'm particularly worried about the
53:13junior faculty who are hoping to be
53:15clinical trialists and all the like
53:17huge amount of work that goes into
53:20Iits and early phase clinical trials.
53:22And as you know,
53:23getting grant funding for this
53:26generally has not been easy.
53:28So how,
53:28how do we maintain that academic
53:31interest in clinical trials without
53:33having these junior faculty shift
53:36to RVU generation and without
53:38compromising the academic mission?
53:40I
53:41think it's a great question, Amir.
53:43So in much the same way that
53:45for somebody in who's going
53:47to have a laboratory career,
53:50you can't say, well,
53:52initially you're supposed to see,
53:55you know, three days,
53:56three days a week you're in clinic
53:59and then if you get a grant,
54:01you can have protected time in the
54:03laboratory that doesn't work on the
54:05clinical research and either and
54:07particularly early in people's careers,
54:10they need protected time.
54:11I mean, we recognize that
54:14for laboratory investigators,
54:15it is true for clinical
54:18investigators as well.
54:19And through a variety of
54:21mechanisms and funds flow,
54:23we have the flexibility to do that.
54:27That doesn't mean that people
54:29can work one day a week and
54:31spend the rest of the time,
54:32you know,
54:33doing whatever they want to be doing.
54:35And they have to ultimately
54:37demonstrate productivity because
54:39we all have to be accountable.
54:41But we will be able to protect people's time.
54:44And if we can't,
54:46we will lose a generation of people.
54:50So I'm certainly committed to that.
54:53You're going to be part of the
54:55conversation about how exactly
54:56we're going to implement that.
55:00Last question, Adriana,
55:11Hi. I just wanted to ask a question going on
55:13that, but not related to the clinician,
55:15but more related to the timing
55:17from when you have an IIT presented
55:19to the time it indeed opens.
55:21It takes about a year
55:22or so or more sometimes.
55:23So and also for activation of clinical
55:26trials, you have seen that that's
55:27also something that takes a while.
55:29So how are we going to think ahead
55:30to try to make that a little shorter?
55:32So it's not that like lengthy.
55:34Well, thankfully I have two great
55:37colleagues in Ian and Alyssa,
55:39and I let them think about that
55:42whole activation piece because I
55:43know that they're thinking about
55:45it far better than I ever could.
55:47And they have, they have really
55:50made significant strides there.
55:52There's more work to be done,
55:55and some of it has to do with
55:57working in a large matrix system and
56:00not having full control over this,
56:02but they're slowly chiseling away at that.
56:06In terms of the IIT, you know,
56:09a lot of the time is really
56:11spent perfecting the idea.
56:13And I think with the right mentorship,
56:17I think we can, you know, for junior people,
56:20we can do that more quickly.
56:22You know, a year seems sort of OK to me.
56:27Six months would be better.
56:29And I think 6 months is about as good as
56:32you can get in terms of having an idea,
56:34putting it all together and
56:36then getting it through.
56:37But I think that's ultimately the goal.
56:40So I want to thank everyone.
56:43I will try to do this again
56:46in about another year.
56:48I, I just want to say that, you know,
56:51we really want to make this place great.
56:54It's it is great,
56:55but we want to make it greater.
56:58And, and I think that we're
57:00sort of on the cusp of,
57:03of really a very different way of,
57:10of working together.
57:12And I think that we are going to be
57:15far more productive both research wise
57:18and clinically than we ever have been.
57:21And that's sort of an arrogant thing to say
57:23for somebody who's been here for two years.
57:25But I, I,
57:26I really do believe there's just such
57:29unbelievable potential here that and,
57:32and, and such a spirit of wanting it to
57:35be better and working together that I,
57:39you know, just gonna keep our,
57:42keep our, our, our eyes focused on,
57:46on what's really important.
57:47So come talk anytime.