The Best Cancer Care Through Partnership

When a patient arrives at Smilow Cancer Center they are assured of a team drawn from an experienced and deep bench, a multi-disciplinary group that can deliver state-of-the-art care and partner with the patient and their family. It includes highly trained cancer specialists, informed by breakthroughs from Yale’s diverse research programs and from centers around the world. The goal is delivery of cutting-edge care with understanding and compassion.

Briefly put, the partnership of Yale Cancer Center and Smilow Cancer Hospital is a nimble matrix with a multi-faceted focus on individuals with cancer.

“As we deliver the best care available today, the clinical team knows that we must do even better in the future. With that goal in mind, we are also conducting research in the laboratories and in the clinic to develop the next generation of cancer therapies. But we cannot do research in a vacuum.

"We need to listen to our patients about what is missing and what they need,” said Eric P. Winer, who leads the YCC/Smilow partnership as director of YCC and president and physician-in-chief of Smilow.

Nearly half of Connecticut residents with cancer are seen at one of the 16 Smilow sites, 15 of which are in the state and one in Rhode Island. The creation of so many points of care illustrate a concerted commitment to patients first, a recognition of the value in closer-to-home medicine.

Staffing and services at the many Smilow’s many cancer sites of care have expanded in recent years. Each site is increasingly staffed by oncologists who specialize in specific malignancies. For example, patients with breast cancer see breast cancer oncologists and those with colon cancer see oncologists who specialize in gastrointestinal malignancies. Clinical trials are also available at every site of care, so patients do not need to come to New Haven to participate in most research studies.

“The seamless partnership of Smilow and the Yale Cancer Center ultimately enables us to align and integrate all cancer specialties with a full complement of wrap-around services delivered through all cancer disciplines,” said Lori Pickens, senior vice president of cancer services and executive director of the Smilow Cancer Hospital. “[They] include, but are not limited to, doctors, researchers, educators, nurses, social workers, genetic counselors, pharmacists, all collectively engaged in patient care, clinical trials, survivorship and if needed, end of life comfort care.”

YCC/Smilow’s intentional expansion into 15 towns and cities outside of New Haven was influenced by input from patients and families, as well as community leaders.

Every individual with cancer faces a range of struggles. Programs or support services that lessen or eliminate some of the challenges may also address contributors to inequitable healthcare. Studies of disparities in cancer outcomes suggest that we can improve these outcomes through navigation that addresses issues such as transportation, insurance, work schedules, and childcare responsibilities.

The YCC multi-faceted approach to cancer includes substantial resources devoted to prevention and education. For example, hundreds of Connecticut residents and beyond have participated in YCC studies focused on nutrition, physical activity, and tobacco use—information that is important for cancer prevention and survivorship research. That data helps inform public-facing educational efforts designed to stop cancer before it starts, explained Melinda Irwin, PhD, MPH, Susan Dwight Bliss Professor of Epidemiology (chronic diseases) at Yale School of Public Health. She is also YCC deputy director, Population Sciences.

“And a new focus of our attention is on people diagnosed with cancer at younger ages, as well” said Dr. Irwin. She added that the breadth of YCC published research is essential to augmenting overall public and academic knowledge about cancer, possible causes, and what works as effective education to help prevent it.

“Working closely with Yale Cancer Center’s community outreach and engagement program and the community advisory board, we are tackling cancers common or rising in Connecticut,” Dr. Irwin said.

YCC’s Center for Community Engagement and Health Equity (CEHE) was created to bring a concerted focus to health equity and improving cancer patient outcomes, with an emphasis on historically underserved neighborhoods.

“Now, more than ever before, we need to reach out to our patients, the broad patient community, and the general public, to understand what we need to prioritize,” Dr. Winer said. “And we need to listen to their guidance.”

In operation for four years, CEHE already considers 140 community organizations to be partners in outreach and education, helping with initiatives including cancer screening events. Some $360,000 has been earmarked by YCC for community grantmaking through 2027. Last year, YCC made three $10,000 awards to community organizations to conduct their own research.

“It is essential to YCC that we involve our community members in the work we do. To expand this effort, we are thrilled to provide pilot grants to three, local community organizations doing important work related to cancer screening, research, and care,” Dr. Winer said in announcing the grants. They went to the Community Action Agency of New Haven, Inc., for informational campaigns, workshops, and community events to raise awareness about different types of cancer, risk factors, and ways to lead a healthier lifestyle; the Bridgeport-based Sister Girl Foundation that provides awareness, education, support, and advocacy to women with endometriosis, breast and ovarian cancers; and Sisters’ Journey, a support group for breast cancer survivors and their families and friends.

CEHE coordinates with YCC’s Diversity, Equity, and Inclusion (DEI) effort and Cancer Research Training & Education Coordination (CRTEC). Leaders of the three programs work closely to maintain the pipeline of future cancer researchers, scientists and clinicians through educational outreach that extends from area high schools to post-doctoral programs with a goal of fostering a diverse new generation to be at patient bedsides and in the research labs.

“Our goal is to expand our pathway programs in collaboration with CRTEC to reach students throughout their academic journey,” said Faye Rogers, PhD, associate director for DEI at the cancer center and associate professor of Therapeutic Radiology at Yale School of Medicine. “For example, we recently received funding to support the creation of an American Cancer Society (ACS) Diversity in Cancer Research Postbac Fellows Program. In collaboration with CRTEC the students will participate in the Cancer Biology Training Program.”

Cancer Treatments of Today and Tomorrow

Medicine and research have enjoyed a collaborative relationship since New Haven became home to Yale School of Medicine as well as a state hospital in the early 1800s. Since the 1840s, Yale School of Medicine students have written a thesis based on original research, reinforcing the message of its importance institution wide.

Research could easily get lost in the immediate concerns and urgency of the day-to-day at Smilow. But research, and its tremendous promise, remain a crucial priority for virtually all of the oncology clinicians. Research is how cancer treatment will be better in 2030 than it is in 2023. Within YCC, researchers are divided into distinct programs and at any time there are hundreds of research projects underway, including clinical trials, laboratory experiments, and studies that look at large populations.

“The basic science laboratories at the Yale Cancer Center continue to make important discoveries that shed important new light into the underlying causes of cancer,” said Daniel DiMaio, MD, PhD, who is deputy director, Laboratory Science at YCC and Waldemar Von Zedtwitz Professor of Genetics, professor of molecular biophysics and biochemistry, and of therapeutic radiology at Yale School of Medicine (YSM).

Dr. DiMaio specifically noted work related to the role some chromosomal abnormalities play in cancer growth and another study of mechanisms that tissues use to limit the growth of mutated cells, which could form cancer cells. The chromosomal study was published in Science magazine by a team led Jason Sheltzer, PhD, assistant professor of Surgery (oncology) and of Genetics, YSM. The paper on tissue mechanisms was published in Nature, by the YCC lab of Valentina Greco, PhD, who is Carolyn Walch Slayman Professor of Genetics at YSM.

“These sorts of basic science findings are required for us to understand the fundamental mechanisms that lead to cancer, and they point the way toward novel approaches to prevent or treat this disease,” Dr. DiMaio said.

Scientists in the research programs—Cancer Immunology, Cancer Prevention & Control, Developmental Therapeutics, Cancer Signaling Networks, Radiobiology & Genome Integrity and Genomics, Genetics and Epigenetics—seek partners and collaborators throughout Yale and beyond, including other public, and private, research institutions in the US and around the world.

Advancing Toward Critical Last Steps in Treatment Development

Of the many steps in research, approval for clinical trials follows extensive preclinical work. Treatments that are most promising after those initial tests are developed into clinical trials. All of today’s most advanced cancer treatments followed similar paths to final approval from the US Food & Drug Administration.

The clinical trial portion of the journey from idea to useful treatment can be the most personnel- and time-intensive, given the primary goal of safety for participants as well as data collection. Treatment on a clinical trial requires attention to detail because we are simultaneously trying to provide the best patient care and learn how to improve care in the future. Ultimately, new drugs can only become a standard approach after FDA approval.

The National Cancer Institute has, for some years, promoted efforts to diversify clinical trial participants in terms of race, ethnicity, gender, age, and individuals from historically under-represented regions of the US. More diversity is linked to greater confidence in results, allaying fears that a treatment might not be effective, or safe, for a group of patients and that could further widen disparities in cancer treatment outcomes.

A national study presented in September at the Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved—sponsored by the American Association of Cancer Researchers—found that trial diversity had grown from the period 2000-2003 to 2020-2022.

YCC’s clinical trial office is supporting the Early Phase Clinical Trial Hybrid Decentralization Project, identifying, and removing barriers to participation in first-phase clinical trials. This project, spearheaded by Drs. Patricia LoRusso and Marcella Nunez-Smith, is well funded from both industry partners and foundations. It will allow Yale to recruit early-phase trial participants from across the state, and one of the specific goals is to increase the diversity of the trial participants.

“Today’s clinical trials are tomorrow’s standard of care,” said Roy S. Herbst, MD, PhD, Ensign Professor of Medicine (medical oncology) and professor of pharmacology at YSM; deputy director, YCC; and chief of medical oncology, YCC and Smilow Cancer Hospital. “By ensuring all patients have access to the most scientifically driven studies we ensure a patient gets the best possible standard of care with the opportunity to reach even farther to raise the bar with new science from Yale and elsewhere.”