December 8, 2020: We are Here for You: A Smilow Patient and Family Forum

December 09, 2020

Information

Hosted by Charles Fuchs, MD, MPH

Presentations by Drs. Christina Gomez, James Yu, Kevin Billingsley, and Kelsey Martin and Javier Alvarado, Paula Pike, and Kim Slusser

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03:40Hello.
03:43Good evening. Nice to see everybody.
03:48Let's see so. It's just about 6:30.
03:52Well, I think there are folks.
03:54Logging out will just give
03:55another minute before we start,
03:57but thank you all for making the
03:59time this evening to present.
04:01Share your thoughts. Baby here.
04:08I think we're waiting on Kevin.
04:13And Kim I think. Is that right, Renee?
04:21Yes, yeah. Well for the attendees,
04:24thank you. Bear with us,
04:26we're just we're just getting
04:27our group together and we're
04:29really looking forward to.
04:31Sharing our thoughts with you,
04:32getting your feedback and
04:34answering your questions.
04:34So give us another minute if.
05:25We know what it's it's 632.
05:29Why don't we get started?
05:31I know a couple of colleagues
05:34will be joining us as we speak.
05:36It looks like we have Kim joining us so well.
05:40Welcome to our patients and
05:42families in attendance and Ann.
05:44This is 1 now of several of our
05:47patient and family forums that we've
05:50been holding for Smilow Cancer
05:52Hospital and Yale Cancer Center.
05:54And really, it's an effort that we started.
05:57I believe in early April.
06:00To keep all of you informed about
06:03what's going on in the Cancer Center,
06:06how we're addressing this pandemic,
06:08how we're staying steadfast
06:10to the mission of discovery,
06:12compassionate,
06:13expert care and making sure that
06:16our patients and their families
06:18get nothing but the best possible
06:20cancer care imaginable.
06:22And I'm my name is Doctor Charles
06:25Fuchs and I'm the physician in
06:28chief of Smilow Cancer Hospital.
06:30And the director of the Yale
06:33Cancer Center and.
06:35Really appreciate your making
06:36the time to join us for our forum
06:39this evening and I'll I'll I'll
06:41I'll introduce people by name if
06:43you want to wave while everyone
06:45I call you so don't join this
06:47joining us today is Kim's lesser.
06:50Kim is the vice president
06:51for patient services.
06:52It's Milo and also our Chief nursing officer.
06:55We will will be joined by Kevin
06:58Billingsley who I think is is on route.
07:00Who's our Chief medical officer?
07:04Javier Alvarado,
07:05who is the system director for
07:07social work of Real New Haven Health.
07:10Nancy dear it Darienzo who's a nurse
07:13working in our Melanoma surgical unit.
07:17Doctor Christy Gomez,
07:18who's a member of our faculty,
07:20Assistant Professor of medicine,
07:22working at Torrington and an expert,
07:25among other things in
07:26gastrointestinal oncology.
07:27Doctor Kelsey Martin,
07:28who is also an assistant
07:30professor of medicine.
07:32Working in our Orange Care Center and
07:35with expertise in haematological ignis,
07:37delinquencies, and hematology.
07:38Paula Pike,
07:39who is clinical program manager
07:41for Smart for our Network,
07:43and finally, Doctor James you,
07:46who is a professor of therapeutic radiology.
07:49With expertise in a variety of things,
07:52including novel technologies
07:54and genitourinary and central
07:56nervous system cancers.
07:58And you know our agenda is we're going to.
08:01I was going to run through some items.
08:04I will say we got oh great.
08:07An finally doctor Kevin Billingsley,
08:09our Chief Medical Officer, just joined us.
08:11Do we have the full complement of experts?
08:14And I'm really,
08:15I'm so pleased that I'm joined with
08:18such a group of talent who span
08:21disciplines as part of our effort.
08:23It's Milo,
08:24so the agenda will be will have
08:26a few short presentations.
08:28We've got a number of questions
08:30already in advance,
08:31but we really encourage people
08:33to submit questions on the Q&A
08:35and and chat lines,
08:36and will get to as many as possible.
08:39So let me start with a little
08:41background and Renee if you want
08:43to bring up the first slide.
08:55Thank you honey.
08:56So if you want to just next slide,
08:59please. So is our agenda.
09:01Will be Kim and and Kevin will doctor
09:04Billingslea and will share with us some
09:07updates on our clinical operations and
09:10obviously be available for your questions.
09:12Javier will talk to us a little bit
09:15from the perspective of social work,
09:18about how we can care for each other and
09:21cope with what can be challenging times.
09:24And then our entire panel will
09:26be available for questions.
09:28So next slide, please Renee so.
09:31Just background that you want, you know,
09:33but I never want to take for granted,
09:36you know, we're really very fortunate
09:38to work at a place like the Yale Cancer
09:42Center and Smilow Cancer Hospital,
09:44which has really a century long,
09:46if not longer,
09:47history of leading research
09:49in cancer therapeutics.
09:50In fact, chemotherapy was essentially
09:52started in many respects in the early
09:561940s by investigators at Yale next slide.
09:59Um, one very important.
10:00Feature is the war on Cancer Act of the
10:04early 1970s designated across United States.
10:06These entities,
10:07which are at National Cancer Institute,
10:10designated comprehensive Cancer
10:11centers where basically you are the
10:14Center for your region and as part of
10:17that original designation in the 70s,
10:19Yale was the designated Center for
10:22for this region of of New England,
10:25and this the entire state of Connecticut
10:28and IT designation, which we continue to.
10:31Be privileged with today.
10:33Next slide.
10:36Landmark event was the opening of Smilow
10:40Cancer Hospital where I'm sitting at
10:42the moment a 15 story building dedicated
10:46to expert clinical care and research.
10:48Next, next step side in 2016,
10:51we opened the state of the Art
10:54Experimental Therapeutics unit next
10:56door to Smilow so that we have the
10:58ability for delivering to patients,
11:01really cutting edge new therapies
11:03that we think are moving the field.
11:05Today we have more than 450
11:08physicians and scientists.
11:09We now have care centers where our
11:12faculty and outstanding staff work
11:14across Connecticut and Rhode Island,
11:16where each of them is dedicated to
11:19being a destination expert center.
11:21Next slide.
11:23And by the way,
11:24we have to renew that designation.
11:26We have to compete for it.
11:29Every five years we've been successful.
11:31And frankly, in this last review in 2018,
11:33we were praised by the National
11:36Cancer Institute for being one of
11:38their truly outstanding centers.
11:40Next slide.
11:42And you know this is our network,
11:45as I say,
11:46beyond our center in New Haven,
11:48where I'm sitting moment at the moment
11:50we have centers really across the
11:52region and many of the folks on the
11:55call today represent those centers.
11:57And it really is our commitment
11:59to providing world class expert
12:00care to every community so that
12:03no patient ideally should have to
12:05travel more than 30 minutes to
12:06get access to world class care.
12:08Important access to novel therapies in
12:10clinical trials among other things.
12:12Next slide.
12:15You know the other key element of
12:17this is when you're when a patient
12:19and family are dealing with cancer,
12:22they want to see the expert,
12:24and that's one of the great things
12:26about our center we have expertise
12:28across this range of cancer types
12:30and we are continuing to expand our
12:33pool of talent beyond what we have.
12:35And I think many of our faculty
12:38here in our our staff nurses here
12:40today can speak to that expertise.
12:42Next slide.
12:45You know the other aspect is because
12:47we are National Cancer Institute
12:49Designated Center where we have labs
12:51that are focused on discovery of new targets,
12:54new therapies.
12:55We are committed to moving those discoveries
12:57in the lab to the clinic and next slide.
13:01We really had a very productive
13:03year this year, 2020,
13:05which is a cutting edge studies that
13:07define new treatments for colon cancer,
13:10head neck cancer, bladder cancer,
13:12genito, urinary cancer, prostate cancer,
13:14lung cancer among others, and next slide.
13:17What is really incredible is
13:19that an unprecedented feat.
13:21Which is this year?
13:22Studies by the Yale Cancer Center and
13:24Smilow Cancer Hospital will have led to
13:27four new drug approvals with the Food
13:29and Drug Administration in any any Goodyear.
13:31If you're lucky if you have one or
13:34zero for a Cancer Center to have
13:36four in a year is just reflective
13:38of the sheer talent we have here.
13:41Next slide.
13:42So we can overlook the fact that we're
13:45obviously dealing with the pandemic,
13:47and I'm so proud of the leaders
13:50on this call
13:51with me, who have taken charge of making sure
13:54that our patients got the care they needed,
13:57that it was safe that our staff are safe,
14:00that we always could expand the
14:02capacity to provide care to patients,
14:05and most importantly our researchers not
14:07only continued their work in Cancer Research
14:09and developing new cancer treatments.
14:11They actually led the charge on.
14:14As for Covid, which have been sort
14:16of landmark publications this year,
14:18that I think the field is is
14:21greatly benefiting from next slide.
14:24So it's been a tough haul and I'm not
14:26going to deny the fact for all of us living
14:28in these circumstances been challenged,
14:31including doing this event by zoom,
14:33but hope and vaccines are now on the way that
14:36the news is full of the stories of these,
14:38and I wanted to spend 'cause a lot of
14:41the questions related to the vaccine.
14:43I did want to share some some brief
14:45background on this, so next slide.
14:47So there are a number of vaccines
14:49that are under development.
14:50The two that are farthest along which
14:52are likely to be approved by the food
14:55and drink and Drug Administration.
14:57This week or next,
14:58or the ones by Pfizer and Moderna
15:01which are so called RNA vaccines.
15:03I had to RNA vaccines work so next slide.
15:08What RNA is a a piece of genetic
15:11code that encodes a protein,
15:13and So what these vaccines do is
15:15they take this little piece of code
15:18which codes a piece of the chobit
15:2019 virus called the spike protein
15:23and puts it in a lipid or not,
15:26or a fat particle and then that code is in
15:29packaged into the vaccine which next slide.
15:33Isn't next slide running is injected
15:37into your arm such that next slide?
15:41That little coding particle is
15:43goes into into a cell in your arm,
15:46where it then produces that spike protein
15:48that protein that the virus normally makes,
15:51but you don't have the virus in,
15:54you just have that little protein and
15:57what that protein does next slide.
15:59Is it elicits an immune response,
16:02so antibodies and immune cells
16:03now recognize the protein,
16:05even though you never got infected
16:08with the virus such that next slide?
16:11When you actually are exposed to the virus,
16:14your immune system already recognizes it
16:17and destroys it so that you don't get sick.
16:21And I want to be clear that this
16:23little piece of RNA gets destroyed
16:25almost immediately in your cells,
16:27so there's no lingering effect of
16:29the genetic code in your body.
16:31It's perfectly safe.
16:32And what do we know about these
16:34two vaccines with studies of over
16:3770,000 individuals?
16:37Is there safe and they appear to
16:40be 95% effective?
16:41And this,
16:41I think is a game changer into
16:44what our lives will be the next
16:46of vaccine that you'll hear about
16:48is 1 by AstraZeneca knoxford,
16:50which essentially is.
16:51In this case.
16:53A modified virus that also
16:55contains this capsid protein
16:57and when given with the vaccine,
16:59the virus, the capsid protein
17:01from the modified virus,
17:03which is a inert virus,
17:05elicits an immune response and
17:06that too seems to be affective,
17:09although not quite as far along as the
17:12current vaccines from Pfizer and Majorna.
17:14What we suspect is that we will
17:17start to get shipments of this
17:20vaccine within the next week or two.
17:23The first phase of the vaccine will be
17:26administered to health care workers.
17:28Those people working on the frontline and
17:30what we anticipate happening after that
17:33is that it will be available to patients.
17:36How that will happen and when that
17:38happened and there's a lot of questions
17:41that came in about that is unclear.
17:43We think that as these systems or
17:46work through that cancer patients
17:47because of who they are,
17:49because the vulnerabilities will be
17:51a priority and we're optimistic.
17:53That in by the spring that cancer
17:56patients will start to get access to it.
17:58Alright evidence is that it's safe.
18:00The latest data as recently as today,
18:03is that matter.
18:04How old you are,
18:05no matter what the circumstances
18:07you are that two injections of
18:09the Pfizer or Moderna vaccine seem
18:10to be very safe and effective,
18:12and we have every reason to be that
18:15it would be effective for patients
18:17who have been treated for cancer.
18:19And we we certainly are going to
18:22encourage our staff to get this.
18:24And we're going to encourage
18:25our patients to do it,
18:27and we think it's going to obviously
18:29change all of our lives for the better.
18:32In 2021 will get to questions on this,
18:35but let me now turn it over to Kim
18:37and Kevin to share their updates
18:39on our cancer services.
18:46See can I have the next slide please?
18:50So. Charlie, thank you Ann.
18:54I really appreciate.
18:55The this you're sharing the vaccine
18:59information because I think that this
19:01is the the Ray of optimism that is so
19:05important for all of us during this time,
19:08which continues to be quite challenging. No,
19:11I think is is everyone can see in this slide.
19:17We dealt with the initial surge of this
19:20pandemic back in the spring when we had
19:24a significant number of hospitalizations.
19:26This data from the state of Connecticut,
19:29where we had about 1700 patients,
19:321800 patients in the
19:34hospital during late April.
19:36We had about 450 here in the
19:39hospital in New Haven,
19:41and much more across the system.
19:44We had kind of a brief RESP
19:46ITE over the summer months,
19:49but the tough reality is that we are back
19:52in the in the middle of a of a second wave.
19:57Another surge of the pandemic and.
20:00The difference now here at Smilow is
20:03that unlike the spring where we really
20:06suspended our clinical operations,
20:08we are continuing to provide ongoing
20:11access and treatment for cancer patients,
20:13both here in New Haven at the
20:16Smilow hospital,
20:17as well as all of our care
20:20delivery sites across our network.
20:23So all of our teams are manageing to
20:25care for covid patients in selected
20:28limited areas of the hospital as
20:30well as provide ongoing cancer care.
20:33And to do that in the safest possible way.
20:37Next slide, please.
20:40So I think these this volume data is
20:45really tells the tale of of what our teams
20:49have done over the past several months.
20:54The Orange Line is the year 2020.
20:56The blue line is the the previous year
20:59and you can tell during the midst of the
21:03original of the early phase of the pandemic
21:07we had a significant drop in visit,
21:10visit volume where patients were staying
21:13away from care for a period of time.
21:16But we have recovered to full capacity
21:19at all again at all of our care sites,
21:22and we are now continuing to operate
21:25at full capacity even through the
21:27midst of this second wave of pandemic.
21:30And I'm really pleased to say that that
21:33that full capacity operation is across
21:36all of our modalities of treatment,
21:39including our diagnostic services.
21:41Our evaluation services are in Fusion
21:45surgery and radiation therapy,
21:47and it is really a testament to the
21:50resilience in the flexibility of our
21:53teams who have adapted to providing
21:57clinical care in alternative spaces
21:59in a way that we're able to keep.
22:03Our patience is absolutely safe
22:05during this challenging time.
22:10Kim, I think I'll turn it over to you.
22:12I think for the next slide.
22:14Alright, thank you Kevin and I really
22:17appreciate the opportunity to talk to
22:20everyone this evening about the many
22:22actions our teams are taking to ensure
22:25we are able to continue that safe high
22:27quality care that Kevin mentioned
22:29and maintain the safest environment.
22:31So I wanted to make sure that all of
22:34our patients and community understood
22:36that we are still continuing with
22:39all of our covid operations,
22:41meaning that we are still
22:43performing pre screening.
22:45Phone calls prior to your
22:47visit and at and then.
22:48In addition,
22:49when you arrive at the front door
22:52so that we make sure that if you
22:55are having any symptoms that could.
22:58Warrant a covid test that we make
23:00sure that we make those appropriate
23:02arrangements and that the same happens
23:04when you arrive for your appointment.
23:07We also make sure that we have
23:09all the appropriate precautions,
23:10including our visitor restrictions.
23:12We I think for our patients and our teams,
23:15this is probably been one of the
23:17most one of the hardest things we've
23:19had to do is limit our visitors
23:21both on our inpatient units and
23:24in our ambulatory settings,
23:25so we do have exceptions when patients
23:28really need to have a loved one with them.
23:32For various reasons we we are allowing that,
23:35but we really do need a limit.
23:37Visitors as much as absolutely possible
23:40to ensure the safety of everyone.
23:42And we know that is very difficult.
23:45We are trying to use technology to
23:48stay connected and to make sure
23:50that our patients families and loved
23:52ones have the ability to participate
23:55in their care as much as possible.
23:58And so if those options are not
24:00being offered to you, I would.
24:03Encourage you to talk to your clinical
24:05teams about how we can use technology
24:07to bring your family members into your care,
24:10but we should also be offering
24:12that to to all of you.
24:15We do also for our cancer patients that
24:17are unfortunately experiencing covid.
24:19We do have a program where we are
24:22calling all of our kovid positive
24:24patients daily to do what we would
24:27call Wellness assessments on them and
24:30making sure that they are feeling OK,
24:32that they can stay at home and
24:35recover at home as much as possible,
24:38But then intervening if needed and
24:40making sure they get the access
24:43to the care they need.
24:45In a timely manner,
24:46so we are still performing that.
24:49In addition,
24:49we have we still have remained to
24:52have clinical workflows for cancer
24:54patients with covid if they need
24:57care or if they need to be tested
24:59and having symptoms.
25:00So we still have our rapid evaluation
25:03clinic here at the New Haven campus,
25:06and we also have regional designated
25:08sites where we can care for cancer
25:10patients who may be experiencing
25:12symptoms related to covid and
25:14get appropriate testing.
25:16And then also for our cancer
25:18patients who are covid positive.
25:21Who needs supportive care or may
25:23still be receiving cancer treatment?
25:26And we have actually in our
25:28rapid evaluation clinic since
25:30it opened in early April,
25:33we have had 971 appointments through
25:36that clinic and we're very proud of
25:40of of offering that to our patients.
25:43During this time, but as Kevin mentioned,
25:46in addition to doing all of
25:49those things to keep our patients
25:51and our staff safe, we are we.
25:54We really are continuing our cancer
25:56care and we have put together for
25:59transformation teams that really focus
26:02on everything we've learned through
26:04the pandemic on how we're going to
26:07leverage innovation to continue
26:08to provide excellent cancer care.
26:11So we have an inpatient team
26:13and ambulatory team.
26:15Port of Care team and a clinical
26:17research team and not only are these
26:20teams working on how we're delivering
26:23our Care now during the pandemic,
26:25but like I said,
26:27really innovating on how we're
26:29going to care in the future.
26:31Also, during this time,
26:32as Kevin mentioned,
26:33we are seeing our second wave of
26:36covid in the state of Connecticut
26:39and we are encouraging.
26:41That when we can use Tele health we
26:44are using Tele health for our patients.
26:47So in cancer care delivery.
26:48I know everyone on this forum knows
26:51that you need to physically be seen
26:53from at certain times in your journey
26:56and your treatments need to continue.
26:58But there are opportunities where we can
27:01provide Tele health services to you at home.
27:03We are even starting to do some
27:06nursing education televisit so that
27:08this used to be education that we
27:10had to provide to our patients.
27:13In the clinic that we are now piloting
27:15and trying through Tele Health
27:17as well as your provider visits,
27:19then go on to the next slide.
27:22I want to make sure that everyone on
27:25this forum knows that while we are
27:28limiting certain on-site activities,
27:30that we have continued to provide
27:33integrative medicine and supportive
27:34care virtually.
27:35You can go into the Yale Cancer Center
27:38website an you can find our weekly
27:41calendar and you can sign up for all
27:44of these virtual offerings we have.
27:47We still have meditation and yoga an our
27:50support groups led by our social work team.
27:54So I just want to make sure that our
27:56cancer patients and their families
27:58and loved ones know that we still are
28:01trying to ensure that you have access
28:04to all the supportive care that you
28:06would have had prior to the pandemic.
28:09And with that I will turn it
28:11back over to Charlie.
28:13Or Kevin and Kim, thank you.
28:15Our next speaker is Harvey
28:17Alvarado who is the leader of
28:19social work for a health system.
28:21And you know, I think it was
28:24so pleased that hobby could
28:25make the time to to join us,
28:28because obviously we're all.
28:29I think all of us are dealing with some
28:32very challenging times and getting
28:34perspectives from somebody like hobbies.
28:36I think vitally important, so happy.
28:38Thank you for joining us.
28:41I thank you Doctor Fuchs and I'm so happy
28:44to be here with all of you tonight.
28:47But it's fair to say that we are living
28:50with a lot of fear and uncertainty,
28:53and many of us are sheltering in
28:56place to slow the spread of COVID-19.
28:59This can make it tough for any one person
29:02and family, and now we have a plan.
29:06As the holiday season which could add
29:09to the stress we are all experiencing.
29:12Doctor Fuchs mentioned a few reasons for
29:15optimism, vaccine and cancer treatments.
29:17And I'm going to talk a little bit about
29:21resilience and ways to be optimistic,
29:23optimistic to help us get through
29:26some of these challenges.
29:28So when we are first diagnosed
29:30with an illness,
29:31we may experience many emotional reactions.
29:34A wide range of feelings that we
29:36may not be used to dealing with.
29:40Feeling overwhelmed.
29:40Denial feelings of anger, fear,
29:43worry, sadness, depression.
29:44And sometimes we even feel like we have to.
29:48Be strong to protect our friends and
29:50families and all of this is normal.
29:53It's important to know, however,
29:55that there is a lot that we can control.
29:58Resilience is a skill.
30:00We can all learn resilience is the mental,
30:05physical, emotional,
30:06and behavioral ability to face and cope
30:10with adversity to be to be able to adapt,
30:15to change, to recover, and an learning,
30:18grow from from our setbacks.
30:22One of the most important
30:25resilience skills is our attitude,
30:27a positive attitude.
30:29It's important to our overall
30:31emotional health and it really
30:34attitude is really the way we think
30:37or feel about someone or something.
30:39You will find that in many behavioral
30:43health or therapy approaches there
30:45is a focus on our thoughts and
30:48how our thoughts lead to emotions
30:51and how those emotions.
30:53Often leads to our behaviors.
30:57Now it's it's easy to adopt A positive
31:00attitude when life circumstances are
31:02generally good and problems are few.
31:05But when circumstances drastically
31:06change in a negative way,
31:09it's not always easy to
31:11keep a positive outlook.
31:12I understand that especially when
31:14those changes in involve ill health.
31:17So what are some of the things
31:19that we can do so we all have
31:23these conversations in our head?
31:25I might be thinking.
31:26How am I going to do during
31:28this evening's presentation?
31:30I'm not going to do well,
31:32it's important to listen to those
31:34conversations that we have an
31:35when you have a negative thought,
31:37turn and try to turn it around and
31:39make it into a positive thought.
31:41We're really talking about is
31:43being practicing self compassion.
31:44Telling yourself you were doing well,
31:46you are doing the best you can.
31:48No one is perfect.
31:49Telling yourself that you are smart,
31:51but you're beautiful that
31:53you're funny that you're kind.
31:55Also,
31:55it's important I found it very important
31:58to interact with positive people.
32:00Now we all have negative friends
32:03or perhaps family members,
32:04and I'm not saying that we
32:07should disown them,
32:08but do your best to surround
32:10yourself with positivity and
32:12can mention some of the support
32:14groups that might be available.
32:16So some of these health related support
32:19groups would be an opportunity for us to
32:23share personal experiences and feelings, Ann.
32:26And coping strategies.
32:29Getting pleasure on the
32:30simple things in life.
32:32Whether it's a walk or time
32:34with family or friends.
32:36Now mostly virtual.
32:38Slowing down to enjoy these precious moments.
32:41Optimism seems to be the theme this evening,
32:45so hunting for the good stuff that
32:48gets us through each day is also important.
32:51It's a skill that helps us create positive
32:54emotion by noticing what's good in our lives.
32:58This is important because we
33:00often tend to focus on what isn't
33:03good in in behavioral science,
33:05this is called negative negativity bias.
33:09So praise yourself when you
33:11have done something well.
33:13Seeding praise makes people feel
33:15good practices every day and again
33:19really about self compassion.
33:24They are. Mindfulness if if you have ever
33:27if you've never heard of mindfulness before,
33:31it's the practice of being present
33:33in the moment. In my experience,
33:35present moment awareness helps
33:37reduce symptoms of anxiety.
33:39Depression when you focus on the
33:41present moment, your painting,
33:43you're paying attention to those
33:44things that are currently happening.
33:47We can take control of our day or each
33:50of our day in our outlook rather than
33:54focusing on the future in this way.
33:57Those who live in the moment
33:59tend to be happier, calmer,
34:00more relaxed and appreciative.
34:02Sometimes their mind will steal
34:04away these precious moments,
34:05so don't rush through it.
34:07Don't wish it away.
34:08Each day we could start
34:10positively when you wake up,
34:12decide what your day will look like.
34:14What can I do today to take care of myself?
34:18How will I practice self compassion?
34:20What can I do to feel more
34:22connected and fulfilled today?
34:24Now I I've taken meditation
34:26courses before and I remember my
34:28very first meditation course.
34:29I was told by the instructor that
34:31I was not breathing correctly which
34:34I found hard to believe because
34:36up to that point I was still alive
34:39and I thought I was breathing well.
34:41The purpose of mindful breathing is
34:44to anchor yourself in the present
34:46moment so that you can let go of worrying.
34:50Just taking those moments to focus
34:53on your breath becomes it involves
34:55becoming aware of your breath and
34:58focusing on it.
34:59Just the act again of focusing
35:01usually slows your breathing down,
35:03makes you feel more relaxed,
35:05so as you focus on how air moves in
35:09and out of your lungs, mouth, nose.
35:12It becomes a form of calming meditation.
35:16Uh, and while doing breathing,
35:18you can also do mine should be breathing,
35:21which is the technique of that helps
35:24you focus on your breath and mantra
35:26is just a phrase or a word that you
35:30repeat yourself to create focus.
35:32And as you repeat it,
35:34you become able to relax and meditate.
35:36Imantra such as I deserve happiness.
35:38I deserve peace,
35:40repeating that over and over again
35:42as you breathe again helps you focus.
35:46Connection is another important
35:48factor that affects us all,
35:50particularly when we are going
35:53through tough times.
35:55Actions are in our relationships with family,
35:58friends, other loved ones,
36:00even community connections.
36:02Seek them out,
36:04spend time around positive
36:06and supportive people.
36:08Um and so so, you know,
36:10these are some of the tips
36:13that help build resilience.
36:14And while we can't always be upbeat,
36:17and that's perfectly fine, it's it's.
36:20It's again about self compassion
36:22when you don't have good days,
36:24it's fine to accept that and
36:28have those moments.
36:30Another item I wanted to talk about
36:33was the Holidays and this all begins
36:36by acknowledging that the holiday
36:38season will be different this year,
36:40but that's different.
36:42That difference can have positive
36:44qualities I think as well.
36:46While many of our gatherings
36:48with family and friends will look
36:50very different this year,
36:52we may be able to create new
36:56traditions this holiday season.
36:58For many of us that will include,
37:02you know this technology
37:04and virtual gatherings.
37:05Others include things like making an
37:08online gift or shopping or very small
37:11events with your nuclear family,
37:14or maybe even thoughts about making digital
37:17photo Chronicles of previous Holidays.
37:21It allows for us to be creative this year.
37:24It forces us away from what we
37:27usually do this time of year,
37:29which is the the running around to all the
37:33stores and looking for the perfect gift.
37:36In many ways this is going to be a much more.
37:42Personal much more real holiday
37:44then that in the past so you know
37:47all of these changes are are in
37:50the name of preserving our health
37:53and our health of our loved ones.
37:56Let's not underestimate the value of
37:59old fashioned cards and letters that
38:01we used to send each other in the past.
38:05Remembering why we celebrate during
38:07this season with things we ought
38:10to be placing importance on like
38:13health and warmth and.
38:15Intimacy are all important all of
38:17very important and again focusing
38:19on our self care is important.
38:22Doing things that we enjoy,
38:24whether it's taking a walk,
38:26virtual exercise class,
38:27cooking a meal,
38:28spending time with our family for those
38:31of our our patients and families that
38:34are burdened by illness this season
38:37we are encouraging you to accept the
38:40help and support that is extended
38:42both from your loved ones as well as from.
38:46Other sources can mentioned
38:48the integrative Medicine,
38:50an off the that you can
38:53find on the SMILE website.
38:57There are a number of videos
39:00is can mention that.
39:05The Library of videos that talk
39:07about a lot of things that
39:09I just talked about today.
39:11So thank you again and again.
39:13Practice a lot of self compassion and.
39:17The resilience that we've shown
39:18over the last many months.
39:20We can continue to show in the
39:22many months to come, so thank you.
39:27Well hobby, thank you there was
39:30there was a great discussion
39:31and I think incredibly helpful for all of us,
39:34most notably our patients. Let me now.
39:37I think we're going to turn that a question.
39:40And as I say, we've gotten many.
39:42Please continue to submit your
39:44questions on the Q&A or chat line,
39:47and then I'll start,
39:48you know and and and I'll start with a few.
39:51So let me actually open first
39:53and then turn to Nancy and Nancy.
39:56You know somebody?
39:58Who's you're obviously working with?
40:00Lot of patients in your capacity
40:02as a nurse in the Melanoma unit.
40:04I wondered if you could share with
40:07us your perspectives from you know,
40:08as you know from nursing really
40:10in the care of patients during
40:12these challenging times.
40:13What you have encountered some of the
40:15things you would like to share with the,
40:18you know,
40:18the several 100 people who are
40:20on the line now.
40:22I think it's most important for me to
40:24tell everyone how much we care about
40:26each and everyone of our patients.
40:28We have gone to great lengths to.
40:30Make sure the environment is clean and
40:33is safe during the height of the kovid
40:36pandemic we were out of the Smile Cancer
40:39hospital and relocated to Guilford.
40:41We had a young man who parents
40:43did not want him to come into
40:46the building and Doctor Cloonan.
40:48I went out and took stitches out of his
40:51person in the back of his mother's car.
40:54We are here to do anything we need to.
40:58Our team wants to meet every patient.
41:01At the space they need us to,
41:03we're willing to to do anything to
41:07make everyone comfortable and safe.
41:09Um, I think that it's also something that
41:13we pride ourselves in here in the cancer
41:15hospital that we put patients first.
41:19Or dance you thank you.
41:21And that's a great story and it
41:23really speaks to your commitment
41:25and those of your colleagues.
41:27Paula, as somebody who leads
41:30administratively the operations
41:31for a number of our care centers
41:33that is outside of New Haven.
41:35One question that's come in is
41:37are we applying the same rules of
41:40safety in those centers that we are
41:43in the main campus in New Haven,
41:45and you know how is that going and you know,
41:49tell us about that approach.
41:53Thank
41:53you, Charlie. Absolutely,
41:54we are employing the same standard for
41:57covid precautions and all our smile
42:00locate Smiler locations as well as
42:02throughout the entire hospital system.
42:04We work very hard.
42:06We prescreen all our patients 24 to 48
42:09hours in advance of their appointment.
42:12We also have the unfortunate job
42:15of telling our patients about our
42:18visitor restrictions because our
42:20staff totally miss our visitors.
42:23It's not just the patients who sits in
42:26our infusion share or in the exam room
42:28that we have developed relationships with,
42:30but it certainly is that caregiver that has
42:33providing the care outside of our walls to
42:36that patient that we miss just as much.
42:38We also are using the
42:41standard protective equipment,
42:42so we are masking gowning hand hygiene.
42:44We talk about this every single
42:46day in our huddles.
42:48Every single one of our locations,
42:50whether we are at main campus at
42:5220 York Street at North Pavilion,
42:55or in one of the network sites,
42:57has a daily morning huddle that we are
43:00discussing any of the new things that
43:03we are doing to protect our patients.
43:06Our patients arrive at any of our
43:08locations are against screened at
43:10the door and we apologize that we are
43:12asking the same questions about your
43:14cough and sneezing and runny noses.
43:16But we do want to go through every
43:18single one of those symptoms because
43:20we want to make sure that we are
43:23identifying anyone that might have
43:24a covid symptom and rest assured
43:26your treatment will not be suspended
43:28if you do have a covid system,
43:30a symptom that is what I rapid
43:32evaluation clinic is all about and
43:34just this week we had a patient
43:36to present it to the clinic.
43:38We had one of the covid symptoms and
43:41didn't think that it had anything
43:42to do with Kovid,
43:44but were able to get a ride over
43:45to the rapid evaluation clinical
43:47Lisa Barbara to help us make sure
43:49that that happened very quickly.
43:51And in fact she did not have covid at
43:54all and continued on with their treatment.
43:56We just want to make sure
43:58the safe environment.
43:59We've also stepped up our environmental
44:01services so we have a team walking
44:03around with the cleaning supplies
44:04that we need our cleaning extra
44:06every single door nob,
44:07an elevator button that you might
44:09press so we are doing everything
44:11we can to keep everyone safe.
44:14And Paul, thank you and I actually
44:16when when you've given me the privilege
44:19of a tour, I I have to tell you,
44:22I I walk through with you and I don't
44:25think there's a safer place to be.
44:27And on the planet so and I know the
44:31patients feel the same when they're there.
44:33So thank you. Thank you, Charlie.
44:35So Doctor Kelsey Martin,
44:37who works in Orange Kelsey, you know.
44:39Obviously two questions.
44:40One given your expertise,
44:41and hematology and hematologic legacies,
44:43we actually have a number of patients.
44:46Who have the gamut of of Lincoln
44:49season hematology, lymphoma,
44:50chronic myelogenous leukemia,
44:51myeloma, all of whom were asking
44:53when the vaccine becomes available
44:55for covid should they do it?
44:57Is it safe?
44:59Will they respond?
45:00You know and then wanted to ask you that
45:03and then also any thoughts you have from
45:06your experience from your vantage point,
45:09your practice.
45:11Alright,
45:11thanks, Charlie.
45:12Thank you to everyone that's
45:13really interesting to hear
45:15everyone's thoughts tonight.
45:16I think that's a really,
45:18really important question and I
45:20think we all have the same question.
45:22And Doctor Anthony found she actually
45:25just spoke a couple of days ago
45:27at our ash meeting at our American
45:29Society of Hematology meeting.
45:31And you know, he he was promoting the use of,
45:34you know, the chobit 19 vaccines
45:37for our patients with blood cancers.
45:39That being said, I'm not familiar with.
45:41And I don't think that you know they
45:44included any patients who had, you know,
45:47compromised immune systems in those studies.
45:49So I think it's probably an area that's
45:52evolving for our knowledge base and
45:54one of the concerns that we sometimes
45:56had for patients with blood cancers
45:58is have any of the treatments they've
46:01received is not going to impact their
46:03ability to respond to the vaccine,
46:06and I think that's an important question
46:08that were that were still there.
46:10We're still learning information about.
46:13But I.
46:13I hope that we it's not a live vaccine.
46:16The ones we have available so far,
46:18so I hope that they will be
46:20available to all our patients safely.
46:23Great thank you and then sort of
46:25from your perspective from you
46:26know you're working in Orange.
46:27Any thoughts that things that you've
46:29come across that you wanted to share?
46:32Oh yeah, so this has been a fascinating
46:35right, and I think that one of the
46:37things that I just wanted to say
46:40thank you to all of our patients for
46:42their flexibility because every day
46:45I sometimes feels like a new email
46:47comes across or a new rule or new
46:51visitor restriction and we have to tell
46:54patients things at the last minute and.
46:57Ann are patient and have handled
46:59it with such stride an as as the
47:02speakers before may have mentioned.
47:03We're here for you whether we're
47:06making a phone call from you know,
47:08or a video visit, or you know,
47:11coming up with some creative alternative of,
47:13you know, including patients and family
47:15members you know we have not stopped,
47:18and but I really do appreciate
47:20everyone's flexibility because
47:21there's lot of pivots and changes
47:23that have happened along the way.
47:28Kelsey, thank you Doctor Christy Gomez,
47:30who works in Torrance and Christy
47:32a number of questions that I could
47:35offer and obviously we want to hear.
47:37I also get your perspective from Torrington,
47:40but let me just start couple of
47:42questions that patients are asking both
47:44for themselves and for their family
47:46about during this challenging time.
47:48Christy, what should we recommending
47:50about people going for standard
47:52screening like colonoscopy and
47:53mammography and things like that?
47:55What advice giving is that something we
47:58should be recommending or not recommending?
48:00What do you?
48:01What do you think we should suggest
48:02to patients and families about this?
48:06Charlie, thank you with this kind
48:08of is a beautiful segue into
48:10what I wanted to comment on.
48:13I want to highlight or
48:15recognize or honor for a second.
48:17The fatigue that comes with
48:19a new way of life.
48:21Now months into this,
48:22my oldest niece is in her senior
48:25year of high school and I am trying
48:28to challenge her to see that life
48:31goes on that senior year looks
48:34different than we are called.
48:3622 newness or creativity like hobby
48:39mentioned and so in the same light,
48:42life goes on an or health remains.
48:47Pivotal.
48:47Um and must be optimized in
48:51order number one to continue to.
48:54Be healthy in light of a potential risk
48:57of a virus and infection, but more that.
49:02Our body, our aging process.
49:05Our screening anniversary's
49:06need to be met and that safety
49:10has been our utmost commitment.
49:14I am working closely with the GI.
49:19Team locally and have they
49:22have guaranteed the safety of,
49:24for instance,
49:25endoscopies annual colonoscopies
49:26at our center in Torrington.
49:28We have a local imaging center right
49:31next door and our patients are so
49:34appreciative that their breasts,
49:36exams,
49:37their mammograms and ultrasounds are done.
49:39I'm seeing a patient.
49:41She goes next door and gets the study.
49:45Um, life goes on and we are asked to too.
49:52Our called to continue to show
49:54up to all that life is calling
49:57us to in utmost safety an eye.
50:00Everyone is pulling through with that.
50:03Our colleagues in GI in radiology.
50:05To me it's been the utmost important
50:08recommendation to my patients.
50:10In some instances when the world
50:12stood still in the spring,
50:14things were delayed,
50:15and unfortunately we've seen some
50:17manifestations of her later presentations,
50:19so I encourage everyone.
50:21I invite you.
50:22I hold your hand in saying it is
50:25safe to do so, and you are important.
50:29Your health is important.
50:30So that you meet the challenges of of
50:33your health and any challenge that
50:35you have in these times of sheltering and.
50:40Christy, thank you. That's very helpful.
50:42Doctor James you from therapeutic
50:44radiology radiation oncology.
50:45We actually have some questions about
50:47a number of questions that relate
50:49to various radiation approaches.
50:50In fact, one question specifically about
50:52the role of IMRT for prostate cancer,
50:55but in which I think would
50:57be great for you to dress.
50:59But you also maybe if you,
51:01if you wouldn't mind.
51:02James also is sharing some of your
51:05thoughts about some of the newer
51:07technologies that you and your team are
51:09beginning to avail patients as as were.
51:12Moving forward. Sure,
51:14so most of the innovations in
51:16radiation over the past couple years
51:19have mainly been in technique and
51:21trying to reduce the side effects
51:24associated with radiation treatment.
51:25The area that I mainly treat,
51:28prostate cancer we've been.
51:31Pioneering the use of something
51:33called space or hydrogel,
51:34which is to space the prostate
51:36away from the rectum to reduce
51:38side effects to the rectum.
51:40We put markers into the prostate to
51:42track the motion and really shrink
51:45the margins around the prostate.
51:47When we deliver radiation treatment.
51:48But one of the things that's been beneficial.
51:52Based on what we've done at Yale
51:55is to shorten radiation treatments
51:57and that is actually because of
52:00the kovid pandemic really shone a
52:02light on how we focused on trying
52:05to make the patients is trying to
52:07make the treatments as convenient
52:09for patients as possible,
52:11and reducing the number of times that
52:14they come in for radiation treatment
52:16has been one of the things that is
52:19recommended for how to deal with
52:22both treating patients properly.
52:23And minimizing their their virus risk.
52:26I can speak more about radiation
52:28technologies for hours,
52:30but I think I'll leave it there.
52:32Thank you, James.
52:36Kevin Billingsley, um?
52:37You know, as you may have heard,
52:40the state of Massachusetts,
52:42the governor just announced that
52:44they're they're putting a stop.
52:46If not a slowdown to elective surgeries.
52:50Any thoughts about what will happen
52:52in this latest surge with regard
52:55to surgeries that are at smilow?
52:58Charlie, I really
52:59appreciate that question because I
53:02having lived through the spring.
53:04When we had to delay so much surgery, it was.
53:09I think such a source of.
53:13I think it was a source of great stress
53:16and anxiety for many patients and families.
53:19And as a surgeon myself,
53:23I really have great reticence.
53:27Two to postpone a patient's operation in
53:30the setting of a of a cancer procedure.
53:34I think the good news is that with the
53:39tiered approach and the size of our
53:43hospital facilities across our network,
53:46it gives us incredible flexibility
53:49to move patients across inpatient
53:53units and and separate surgical
53:56patients from from covid patients or
54:00even patients under investigation.
54:02And at this point we are continuing
54:05to do our full operative schedule
54:08and we have no no plans to curtail
54:12surgical procedures.
54:14Now that being said,
54:16you know we are monitoring infection rates,
54:19hospitalization rates,
54:20Edie utilization rates on a really
54:23on daily basis, and you know the the.
54:27This pandemic can certainly throw
54:30us a curveball, but it.
54:32Our really our aim is to continue
54:36unrestricted access to surgical services.
54:40True, thank you Kevin Harvey. I really.
54:43I think it's a really good question that
54:46one of our patients is sharing that I.
54:49I'm really pleased that
54:50they're willing to share this.
54:52A patient talks about her spouse who doesn't
54:54like to talk about the patients cancer,
54:57and I think sounds like by the
55:00story wants to sort of be a brave
55:03soul and reassure the spouse.
55:04But doesn't you know,
55:06it doesn't really want to talk about it and.
55:10I think it's it as she says,
55:12he's not in denial,
55:14but uncomfortable talking about it.
55:15And you know what?
55:17Would you advise a couple like that?
55:20Yeah,
55:21thank you for that that question.
55:25I think it's important to remember
55:27that many people have little experience
55:30with life threatening illnesses.
55:32They may not know what to
55:35say to you or how to act.
55:39For some people, it may be frightening
55:42to learn that their partner has cancer,
55:46others may have lost loved ones.
55:49Cancer and the diagnosis may
55:51may bring up painful memories.
55:54Um, For these reasons,
55:56some of some of your friends and
56:00family members may not be able to
56:03offer you support that you expect,
56:06and although that may be painful to
56:09remember again at these reactions
56:12may reflect.
56:13Past experiences and losses
56:15and not their feelings for you.
56:18Some some friends and family
56:21members make this in themselves.
56:24There's a.
56:26Surprise you with with with emotional
56:29and physical support throughout your.
56:31Your illness is important to
56:33have these conversations to let
56:36your husband or your wife know
56:39on going communications.
56:40Sometimes we try to protect our loved
56:43ones by withholding information,
56:45thinking that that's going to help them.
56:51Also with your children. Over 4.
56:56You did with the children should be
56:58able to cope with your cancer diagnosis.
57:01It's important to share information.
57:04So it it it you know at the end of the day,
57:09the more that we communicate
57:10and share an even express,
57:12I would express to my husband or
57:14my wife that they may be having
57:17difficulty expressing themselves
57:18that you understand that it's OK,
57:21and when they're ready to talk that
57:23you're you're there to listen.
57:27Thank you, that's very helpful.
57:29Nancy, a couple of questions that
57:31I think would be relevant to your
57:33son is your area of expertise.
57:35One is for patients who are,
57:37you know, who are potentially going
57:39undergoing surgery for, you know,
57:41Melanoma or any other cancer.
57:42Is there any greater risk in
57:44terms of what's going on with the
57:46pandemic and should other things
57:48they need to be doing differently?
57:50Should they delay their surgery and then
57:52also related to your work in Melanoma?
57:55A common tale is, you know,
57:57somebody notices something on their skin.
57:59But you know,
58:00do you want to go to the doctor
58:02and get it checked out?
58:04And but at the same time you're concerned
58:07about it? So what do you do?
58:09So two questions for you sure
58:11definitely have it checked out.
58:13Dermatology is a big portion
58:15of of how we operate.
58:16If someone goes to their
58:18dermatologist and a biopsy is done,
58:20they are referred to the Melanoma team.
58:22It's important to keep track of the moles
58:25and discolorations that you may have,
58:27especially as one matures.
58:30Most of the sun damage that
58:32was done in our youth develops,
58:35as you know, as we become adults.
58:38So I encourage people to please
58:40go to the dermatologist.
58:42Don't delay that as far
58:44as our surgical setting,
58:46because we saw such a dip in March and
58:50people did delay treatment and care
58:53the we've noticed that some of the.
58:57Areas are larger, deeper and bigger,
58:59so I would hope that people would
59:01realize that we are offering a
59:04service in a safe environment.
59:06And please do not delay care
59:08because the area can change or
59:10grow and present other issues that
59:12we could head off at an earlier
59:15stage if caught earlier.
59:18Thank you, Nancy Kim.
59:20Let me ask you you.
59:21Obviously I think we've talked a
59:23little bit about the Visitation
59:25policies and on the inpatient side.
59:27So what kind of things can we do for patients
59:30and their families who are hospitalized?
59:32Given the fact that we we need to take
59:35these policy's keep these policies
59:36in place to keep everyone safe.
59:39So what kind of things we can we
59:41do to help families through that?
59:44Entirely
59:45thank you for that question, and again,
59:47we're really trying to make sure that we
59:50are engaging and providing that support
59:53for patients and their loved ones.
59:56So we really are trying
59:58to leverage technology.
59:59So if our family We have the
01:00:02ability to FaceTime and we can
01:00:04also set up much similar to this.
01:00:07A zoom you know where even when
01:00:09our providers when our physicians
01:00:11are rounding and and the family
01:00:13Member wants to have their loved
01:00:16one involved in that discussion,
01:00:18we can zoom them in.
01:00:19We end the patient doesn't have to have
01:00:22their own smartphone or their own tablet.
01:00:25We have the ability to provide that
01:00:28at certain points in the day for.
01:00:31For patients who do not have those devices,
01:00:34so we really try very hard to make
01:00:37sure that that we have that ability.
01:00:40We can do the good old fashioned
01:00:42phone call if people don't have the
01:00:45ability to do the video interaction,
01:00:47so we also have that availability and again,
01:00:51is Javier had mentioned, you know we do have.
01:00:55Are social workers available and
01:00:57our social workers are not just
01:00:59available to our patients but there
01:01:01they are available to our patients
01:01:03and their families and loved ones.
01:01:06So I want to make sure that
01:01:08you know that that.
01:01:10That patients and families know
01:01:12that we're here to support them,
01:01:14so we just try really hard to
01:01:16engage in any way possible.
01:01:18A lot of times.
01:01:19What's helpful if a patient
01:01:21is going to be admitted.
01:01:22I know sometimes our teams are asking,
01:01:25you know what? What would you like?
01:01:27I think setting up that plan ahead of time.
01:01:30Is there someone in particular you
01:01:32wants to give updates to every day?
01:01:34Is there someone that you want to make
01:01:37sure that I'm here when you call them too?
01:01:40To provide any answers to any of
01:01:43their questions that they have
01:01:44while you're talking to them on
01:01:46the phone or face timing them.
01:01:48So I think there's lots of ways
01:01:51that we are trying to engage.
01:01:53It is hard of it. Paula talked about this.
01:01:56Nancy talked about this.
01:01:57Our physicians on the line here,
01:01:59talked about it. It is.
01:02:01It is something that is just very
01:02:03difficult for all of us because
01:02:05it's something that we find so
01:02:07meaningful in our work and we
01:02:09want our families involved.
01:02:11In the Keran we get a lot of joy out
01:02:13of interacting with our patients,
01:02:15families and loved ones.
01:02:16So this is this is very difficult
01:02:18for us as well and we just want
01:02:20to connect anyway we can,
01:02:22so I would also say for any of the
01:02:24patients or family members on the line here,
01:02:27if there are any other suggestions
01:02:29for us on how we can interact with
01:02:31you and how we can engage with you,
01:02:33we would love to hear those as well.
01:02:36So please don't be shy about giving
01:02:38us your thoughts and ideas.
01:02:40Jim, thank you Apala.
01:02:42I think a very fair question.
01:02:44How are we screening our
01:02:46employees who are coming to work
01:02:49to make sure that everything is
01:02:51safe in our in our facilities?
01:02:55Absolutely, so all our employees
01:02:57are required to self check
01:02:59their temperatures twice daily.
01:03:01One prior to arriving to
01:03:03work and one after work.
01:03:06We also provided thermometers
01:03:08to those employees who were not
01:03:11able to afford a thermometer.
01:03:14We also had employed during the height
01:03:16of the pandemic a temperature check.
01:03:18Stations throughout all the
01:03:20network care center sites.
01:03:22Anytime an employee during their
01:03:24shift feels the least bit sick.
01:03:27Doesn't matter how insignificant
01:03:28it was a sneeze or cough or I'm
01:03:32just starting to get a headache.
01:03:35There immediately reported to the
01:03:37onsite leader and they are sent
01:03:39home and then they called our
01:03:42covid hotline for instructions.
01:03:44We have very detailed instructions
01:03:46as management team that is,
01:03:48but from our infection prevention
01:03:51experts at Yale.
01:03:52Related to exposure guidelines
01:03:53and we follow those to the T.
01:03:57Thank you Doctor Gomez question how?
01:04:01How does one access genetic testing,
01:04:04genetic counseling, and should all
01:04:07patients undergo genetic testing?
01:04:12So one of my my loves in in
01:04:14oncology is that we're really a
01:04:17team and something like tonight is
01:04:19the way we approach cancer care.
01:04:22And here at Yale, we have a strong
01:04:25genetics counseling team for me.
01:04:27There a click away and part of my
01:04:30assessment of patients is to obtain
01:04:32a very detailed family history
01:04:34that can give clues as to whether
01:04:37there is a familial syndrome.
01:04:39That this cancer may have elicited from
01:04:42or protein or risk to next generation.
01:04:45Once children or grandchildren or
01:04:47siblings as well. So that's number one.
01:04:50We've got a strong genetics team.
01:04:52To me it's a click away.
01:04:55It's part of my initial and
01:04:58subsequent evaluations of patient.
01:05:00Secondly,
01:05:01the next question is who gets tested or
01:05:04when does that conversation come up?
01:05:07I have a particular.
01:05:10Affinity,
01:05:10as you mentioned or or love
01:05:13and interest in GI cancers.
01:05:15And as you are all likely familiar
01:05:17'cause it was all over the newspaper.
01:05:20New York Times headlines over two years ago.
01:05:24Colon cancers are manifesting themselves
01:05:26in younger and younger patients.
01:05:28Patients who have not yet had
01:05:30their first colonoscopy as
01:05:31initially prescribed at age 50.
01:05:34So when we see younger breast
01:05:36cancers when we see colon
01:05:38cancer in younger individuals.
01:05:40When we see families where there's multiple
01:05:43members with similar or linked tumor types,
01:05:46all of that signals to us these flags
01:05:49and we begin the discussion of a
01:05:52deeper family history and a referral.
01:05:55Sometimes just to genetics,
01:05:57even if it's not the classic syndromes.
01:06:00But there's just some key members
01:06:03that should be further looked at
01:06:05and tested in addition to have
01:06:08patients who've had multiple cancers.
01:06:10Throughout their life and again,
01:06:12they're not syndromes that fall
01:06:14in link or textbook cases of
01:06:17pancreas or breast and ovarian.
01:06:19But that's just the fact that there's
01:06:21multiple cancers in an individual.
01:06:23I think that to warrant a consultation
01:06:25with our genetics team, once again,
01:06:27a team approach to cancer care.
01:06:30Great, thank you. Um?
01:06:32Doctor Martin, a question of if
01:06:34someone has been diagnosed with cancer
01:06:36and actually been treated for it.
01:06:38Are they at higher risk of getting
01:06:41covid and whether they are?
01:06:43They're not?
01:06:43What sort of things should they be
01:06:46doing to ensure that their risk
01:06:48of getting is as low as possible?
01:06:52Sure, thank you was the
01:06:54question that they are
01:06:55on treatment is.
01:06:56The question is specifically a patient
01:06:58I guess is completed treatment,
01:07:00but are they at higher risk of getting it?
01:07:03And I guess you could also speak to
01:07:05people even on treatment and what
01:07:07kind of things can they do to minimize
01:07:10their risk of getting it? Sure, sure.
01:07:12Yeah, that's a great question so you
01:07:15know for our patients with cancer who
01:07:17are actively undergoing treatment,
01:07:18such as chemotherapy,
01:07:19you know we do want to take extra
01:07:23precaution for those patients.
01:07:25You know, I think there's a number of
01:07:27things so that we are also aware of.
01:07:30You know that that increase the
01:07:32risk of of the severity of covid.
01:07:35I should also say things like
01:07:38more common health conditions,
01:07:39blood pressure and diabetes and obesity.
01:07:42So some you know,
01:07:43we often are looking at the total package,
01:07:47so to speak.
01:07:48You know we would continue to
01:07:50emphasize wearing masks and hand
01:07:53washing and practicing social
01:07:56distancing until you know we have.
01:07:58You know,
01:07:59and I think I think we just also
01:08:01want to address and see how
01:08:03some of the questions Doctor Fix
01:08:05in the in the chat about.
01:08:07You know the safety of the vaccine in
01:08:09patients with different types of cancers.
01:08:11And you know,
01:08:12I think just to clarify something
01:08:14I might have said before is,
01:08:16you know these are not the
01:08:17so far the vaccines that you
01:08:19mentioned previously or not.
01:08:21You know what we call live vaccines
01:08:22and so if we compare that to other
01:08:25non live vaccines that we use
01:08:27for you know previously I mean.
01:08:29We do.
01:08:29We do use those in patients with cancer,
01:08:32and so I'm optimistic that
01:08:33that's going to be our plan.
01:08:37Great, thank you.
01:08:41Thank you James. Two questions one.
01:08:43A very specific question, which is if
01:08:46you had radiation after a resection
01:08:48of your prostate for prostate cancer.
01:08:50Can you get radiation out areas and
01:08:53then another question that's come in is,
01:08:55you know there's been in the news notion
01:08:59of proton beam center and proton centers.
01:09:02You know what is that?
01:09:03Who should get it?
01:09:04Is it a good thing?
01:09:07So thanks for that question.
01:09:09So the first part you can you
01:09:11should not get re radiated to
01:09:13where the prostate used to be.
01:09:16If you got what's called salvage or adj
01:09:19event radiation to the prostate bed
01:09:21because we push the dose up to pretty
01:09:24much the maximum tolerated dose for an
01:09:26area that's been surgically reconnected.
01:09:28But you can get other spots radiated if
01:09:31cancer pops up in another spot, there's a.
01:09:35Entity called Oligo metastatic,
01:09:37which is increasingly talked about
01:09:39but basically means only a few
01:09:42sites of metastatic disease that's
01:09:44I would say relative.
01:09:45So knew that you should really have
01:09:48a conversation with your oncologist
01:09:50in your radiation oncologist about
01:09:52whether you qualify for radiation
01:09:54of those oligo metastatic sites.
01:09:56If you are having pain in a site.
01:10:01Oh, and then certainly we can
01:10:03radiate in the traditional manner.
01:10:04But sometimes the treatment of oligo
01:10:06metastases is a little more aggressive and
01:10:09using a little bit more radiation dose.
01:10:11But it's a conversation you should
01:10:13personalize with your provider now.
01:10:15The second question that you ask,
01:10:17Doctor Fuchs about proton beam.
01:10:19Proton beam is actually a technology
01:10:23that's been around since the 60s
01:10:26and mass general was using a huge
01:10:29cyclotron to treat in a kind of a.
01:10:32Unflexible way,
01:10:33I guess because of the technology
01:10:35at the time.
01:10:36Since then,
01:10:37the technology has been miniaturized,
01:10:39shaped, and an now there's second, 3rd,
01:10:42and 4th generation proton machines.
01:10:44Here in the state of Connecticut.
01:10:46I think we're actively.
01:10:47I mean,
01:10:48it's public record we're actively seeking
01:10:51to partner and build one of those machines.
01:10:54Simply because we think it's
01:10:56the right thing to do.
01:10:58I think the benefit of that technology
01:11:01is largely in kids with who you
01:11:04don't want to radiate any tiny
01:11:06amount of tissue unnecessarily,
01:11:09and there may be other benefits
01:11:12for adults as well.
01:11:14Folks with head neck cancers who require
01:11:17reradiation oesophageal cancers.
01:11:19Certain types of lung cancers.
01:11:21And maybe breast and prostate cancer,
01:11:24but those are a little bit more tricky
01:11:27because we do such a good job already.
01:11:30And so I think Yale is going to
01:11:33approach it in the right way,
01:11:36making it available to our patients
01:11:38while at the same time building up
01:11:41evidence to support its proper use
01:11:43so that we can be good stewards of
01:11:46everybody's health care dollars.
01:11:49Thank you.
01:11:51Nancy a patient asks who I guess had
01:11:55his who had a non localized Melanoma,
01:11:58removed surgically, who's getting exams,
01:12:01lymph node, checks blood work xrays
01:12:03but wants to know what is the latest
01:12:07research concerning getting an early
01:12:10diagnosis of recurrence of Melanoma.
01:12:13Well, we recommend that if you've had
01:12:16a Melanoma that you're followed by a
01:12:18dermatologist every three or six months,
01:12:20so that would be the first step
01:12:23in catching anything that changed
01:12:25on the surface of the skin.
01:12:27People have actually told us
01:12:29that they see a spot change and
01:12:31they call the dermatologist.
01:12:32So self examination is most important.
01:12:35Being away are now.
01:12:36If it's on your back and you have
01:12:39to have your partner or significant
01:12:41other participate in this of
01:12:43that's important so that there's.
01:12:45Over lines of communication
01:12:46within the family that keeps
01:12:48an eye on everyone's body.
01:12:50Surface area.
01:12:52But I think that to go back to what I'm
01:12:56driving at in a very long train here.
01:13:00The sooner we can get this,
01:13:02the sooner we can get it in and.
01:13:04Biopsied or resected the better off
01:13:06we all are Melanoma as you know is
01:13:08this is a sneaky little devil and it
01:13:11can pop up again in other places,
01:13:13so the more we can see it and keep
01:13:15track of it the better off we are.
01:13:19Thank you. Harvey,
01:13:20a question about access to support groups.
01:13:23You know what's this?
01:13:24You know you alluded to it,
01:13:26but it came in actually a couple of
01:13:28folks asked about the availability.
01:13:30How do they access it?
01:13:32How does it work in the current scenario?
01:13:35The pandemic?
01:13:36And could you elaborate a little bit on that?
01:13:40Here so so thank you for the question.
01:13:45The support groups.
01:13:48Really important for a lot of us
01:13:50when we're going through a crisis
01:13:52and it allows us the opportunity to.
01:13:55Share similar experiences and and
01:13:57talk about the ways that we cope.
01:14:00We have been offering my win
01:14:02smile as social workers have been
01:14:04offering virtual support groups.
01:14:06Those are available and probably the
01:14:09best way to access it is when is just to
01:14:12to be able to call the hospital and
01:14:16ask for the social work Department and we
01:14:19can connect in some of those support groups.
01:14:22I'm leaving just one second I'm going to.
01:14:25Pull up the phone number that will get
01:14:28the folks to the Social Department.
01:14:31So number is 203.
01:14:33688 2195 the number again is 203-688-2195.
01:14:37That's the social work Department and would
01:14:40be happy to connect it to a support group.
01:14:43Whether it's in the hospital,
01:14:45outside of the community.
01:14:48Great, thank you. To see Doctor Martin,
01:14:53you actually mentioned the fact
01:14:55that as we I guess, the meeting of
01:14:58the American Society of Hematology,
01:15:00where a lot of the latest
01:15:03advancements in the treatment of of.
01:15:05Blood cancers is being discussed as we speak.
01:15:08Anything you want to share in
01:15:10terms of some exciting things that
01:15:12you're seeing from that meeting?
01:15:15Sure, so so firstly we had so
01:15:17many of our own physicians at
01:15:19presenting really up-to-date,
01:15:21amazing research at the meeting.
01:15:24And we've got such a strong team here,
01:15:27so I was very proud to see that.
01:15:29I think some of the things that
01:15:32are happening are, you know,
01:15:33expanding use of of immunotherapy
01:15:35drugs into our blood cancers
01:15:36is a very exciting area.
01:15:40You know, I think there was a
01:15:43really interesting sessions talking
01:15:44about the role of what we call our
01:15:47microbiome and the role of you
01:15:48know that our our own bacteria.
01:15:50And are you know how that
01:15:52impacts our health overall and.
01:15:54Um our blood cancers and and you know,
01:15:58knew new combinations of dizzying numbers
01:16:00of combinations of drugs available.
01:16:02So I think the future is really bright,
01:16:05and I think I'm very proud to
01:16:08see that our own, you know,
01:16:11professors and doctors were a
01:16:13big part of the conference.
01:16:16Thank you.
01:16:19Doctor billingslea for
01:16:22patients who aren't having any
01:16:24symptoms that relate to Covid,
01:16:26but believe that they may have come in
01:16:30contact with somebody who is positive.
01:16:33What should they do?
01:16:39If I'm understanding the
01:16:41question correctly, you're asking about
01:16:43patients who have a known exposure who are
01:16:47undergoing treatment or undergoing treatment,
01:16:50but so at patient's follow patient
01:16:53who's who's who recognizes they've
01:16:55been near somebody who's positive,
01:16:58but they're not necessarily
01:16:59having symptoms themselves.
01:17:05For that group of patients.
01:17:09One of the things it is is.
01:17:13Particularly critical is the level
01:17:15of exposure and if it is where
01:17:19it is particularly difficult,
01:17:21is is for folks who have an
01:17:23exposure to a family member or a
01:17:27close relative where they have
01:17:29close and sustained exposure,
01:17:32and in those situations we are
01:17:34dealing with a greater likelihood
01:17:37of transmission and it's
01:17:39absolutely critical that in those
01:17:41situations people self quarantine.
01:17:44For a sustained period of time and
01:17:47we're still saying a full 14 days now.
01:17:51What I want people to be mindful of though,
01:17:54is that even if there is a risk,
01:17:58we still want you to be cared for,
01:18:01and that's where you need to be
01:18:04in contact with the your oncology
01:18:06providers offices and if necessary,
01:18:09we will see you in the SREC.
01:18:12The Smilow Rapid Evaluation Clinic
01:18:14where we can evaluate you or care for
01:18:18you in a very safe environment and not.
01:18:21Risk exposure to other patients.
01:18:25Thank you, well, I this isn't a question,
01:18:27but Nancy if you didn't see it,
01:18:30someone actually wrote not a
01:18:32question but a shout out to the
01:18:34amazing Nancy who is a wonderful,
01:18:36compassionate person in life saver so.
01:18:40High praise and well thank you.
01:18:43So um hobby, a question.
01:18:45I mean some folks you know.
01:18:47Obviously there are folks
01:18:49who who live with others,
01:18:50but there are patients we have who
01:18:53actually are single live alone.
01:18:55And this is a tough time.
01:18:57You know whether you're having dealing
01:18:59with cancer or not to be living alone.
01:19:02And what advice do you have for those?
01:19:07Thank you, so yeah,
01:19:09it's it's a tough situation.
01:19:11I think it's important to know that
01:19:14none of us are are alone that the
01:19:17folks on this panel Smilow hospital,
01:19:19social workers, and there are so
01:19:22many other resources that are
01:19:24available to all of us and at times
01:19:27I understand that we may feel.
01:19:29Overall, we're not.
01:19:31There's an opportunity for us to reach
01:19:34out and to be able to connect to these.
01:19:37Which is and so I encourage folks that
01:19:40are feeling that way to make the call
01:19:43into each out another risk for nothing.
01:19:49Thank you, let me just say
01:19:50that and we're going to.
01:19:52We're going to try to get to
01:19:54as many questions as possible,
01:19:55but there are a number of questions
01:19:57that a number of our panel so
01:20:00they tried to answer with.
01:20:01A variety of folks who have
01:20:04been diagnosed with him,
01:20:05a logically concedes colon
01:20:07cancer of variety of cancers.
01:20:09Asking, is it safe to get the vaccine?
01:20:12Will the vaccine work?
01:20:15Let me just say that this
01:20:17is an evolving field.
01:20:18First, the VAC vaccine is safe.
01:20:21As Doctor Martin alluded to,
01:20:23it's not an active virus,
01:20:25it's it's actually in some
01:20:28respects an RNA or or something
01:20:30like that that simply expresses
01:20:32the capsid protein is a protein,
01:20:35so you can't.
01:20:36You can't get Covid from the Covid vaccine,
01:20:40and there's reason to believe that
01:20:43the majority of people who get the
01:20:46vaccine will will benefit from it.
01:20:49To Doctor Martin's point earlier,
01:20:51the sort of sub studies the details on
01:20:53individuals with certain malignancies.
01:20:55Wonder when a bomber transplant,
01:20:57you know?
01:20:58I think that the level effectiveness
01:21:00still probably needs to be sorted out,
01:21:03but there's every reason to believe
01:21:05that people would benefit from it.
01:21:07You know when and how much remains
01:21:10to be determined,
01:21:11but my guess is when it
01:21:13becomes available in 2021,
01:21:15we're going to recommend that people
01:21:18get it because there's no risk to you.
01:21:21In terms of getting covid,
01:21:23one question that came up is,
01:21:25well, if you had covid.
01:21:28Should you get the vaccine
01:21:30and the answer is yes,
01:21:31because apparently the data that
01:21:33came out today from the Pfizer
01:21:35vaccine was there actually a
01:21:37number of people who had covid that
01:21:39still got in trial and they didn't
01:21:41appreciate they've been exposed to
01:21:43covid and there was no increased
01:21:45harm to getting the vaccine.
01:21:47Even if you had Coke so and we
01:21:49don't know how long immunity lasts,
01:21:52so there's no reason you can't
01:21:54get the vaccine.
01:21:56Another question came up, which is.
01:21:58I think this is an optimistic point of view.
01:22:01Is that if you get the vaccine,
01:22:03does that mean you don't have to
01:22:05wear a mask and that's a really
01:22:07interesting question and believe it or not,
01:22:09it's actually the title of a New
01:22:12York Times article today that I saw.
01:22:14So maybe that person saw the
01:22:16article and the New York Times.
01:22:18Not that they're necessarily the
01:22:19arbiters on this recommend that yes,
01:22:21you do have to wear a mask
01:22:23if you get the vaccine.
01:22:25Why?
01:22:25Because what we know is that
01:22:27it is protective.
01:22:28For you,
01:22:29but we don't know whether that
01:22:31stops you from even if you're
01:22:35asymptomatic from transmitting.
01:22:36So for now,
01:22:37when you and we're all hopefully going
01:22:39to get this vaccine when you get it
01:22:42until further instructions come,
01:22:44we're still going to have to wear a
01:22:46mask until everyone says it's safe.
01:22:49So and I know, you know,
01:22:51I can let me just tell you there's a lot
01:22:53of great questions about the vaccine
01:22:56when it's going to be available,
01:22:58and I think what we know is it's safe.
01:23:02Yeah, 95% effective and people
01:23:03ask what does that mean?
01:23:05It means that compared to the
01:23:07people who got the placebo,
01:23:09there was a 95% reduction in their risk of
01:23:11getting covid and Moreover the data says
01:23:13that even for the rare individual got it,
01:23:16their case was far less severe.
01:23:18This is really exciting and
01:23:20it's really encouraging.
01:23:21So I I think that you know it.
01:23:23It offers a lot of hope.
01:23:27You know, I think there's probably as much.
01:23:29I mean our colleague.
01:23:31Any of my colleagues can
01:23:32comment on the vaccine war,
01:23:34'cause I know so many questions have come in.
01:23:37We're going to learn more,
01:23:39but so far all the news,
01:23:41including today's is good.
01:23:42And you know, you can ask,
01:23:44you know, ask your doctor,
01:23:45your nurse, your providers.
01:23:47We will continue to have these forms and
01:23:49keep you informed about the vaccine.
01:23:51And just as soon as we can,
01:23:54we're going to make it available to you so.
01:23:57Stay tuned,
01:23:57you know the cavalry is on his way,
01:24:00but I just I just wanted to
01:24:03interrupt the flow just because so
01:24:05many good questions are coming up.
01:24:08And obviously, we're we're.
01:24:10We're committed to making sure
01:24:13that you get access to that.
01:24:18Nancy, you know, actually,
01:24:19maybe because you're on the line.
01:24:21Alot of questions about Melanoma too.
01:24:23Probably see coming through some of
01:24:25which we relate to immunotherapy.
01:24:27And and I, you know,
01:24:29I suppose there's there's several of them.
01:24:31And so maybe as opposed to covering
01:24:33each one and specifically,
01:24:35maybe you can just give us a
01:24:37thumbnail on, you, know,
01:24:39the state of immunotherapy for for
01:24:41Melanoma and where you see that going. I
01:24:44see it as a very promising future for us.
01:24:48The anti PD one zanan and all of
01:24:51the newest treatments are amazing.
01:24:54Doctor Olino is using T back which
01:24:57is an injection into the tumors
01:25:00themselves which has been very
01:25:02promising little off label but she's
01:25:05had great results with it so there's
01:25:08a lot of new things on the horizon
01:25:12and I think when Doctor Arian.
01:25:15Started the Department.
01:25:16There wasn't as much to offer people today.
01:25:19There is a lot to offer.
01:25:22Someone who has a Melanoma.
01:25:26I I can't give you specifics or
01:25:28not the top of my head I get so
01:25:31excited that I get overwhelmed,
01:25:33but there's there's always knew an positive
01:25:35things happening within the Department.
01:25:38Yeah, no idea. I think it's it's so true.
01:25:41I mean, we've you all have done
01:25:43a really exciting work and it's
01:25:45obviously changed the landscape
01:25:46and given a lot of patients.
01:25:48Hope so. Thank you.
01:25:52James I I store question fly by I don't
01:25:54know if you saw it about sort of an
01:25:57ultrasound approach for prostate and
01:25:59you know maybe you saw the question.
01:26:02I'm sorry I'm digging through,
01:26:03but maybe you know
01:26:05I I answered it.
01:26:08I I'm not aware of HIFU being used,
01:26:11but I do know Doctor Preston Sprenkle and
01:26:14the folks in urology are looking into
01:26:17what's called focal partial gland therapy.
01:26:19I know he's used cryotherapy in the past
01:26:22and there's they're working on potentially
01:26:25other techniques we I think as a group,
01:26:28largely think of it as in the
01:26:30experimental range and not really a
01:26:33whole gland there a curatives treatment,
01:26:35but it's something under
01:26:37investigation and I would encourage.
01:26:39Reaching out to one of the urologists here,
01:26:42Doctor Preston Sprinkle comes to
01:26:44mind as somebody who could comment
01:26:46about vocal therapy.
01:26:47Partial gland treatment,
01:26:49including HIFU for prostate cancer.
01:26:51Thank you,
01:26:51Kim. There was a question about you,
01:26:54know whether we're all we're back,
01:26:56practicing and swallowing,
01:26:57and maybe you can answer that
01:27:00question directly, but also,
01:27:01you know, given the fact that when
01:27:04there was a surgeon April we had
01:27:07to move off some floors and your.
01:27:09Thoughts about where we're going now?
01:27:13Sure, Charlie, thank you. So we
01:27:16have most of our care back
01:27:19in their original locations,
01:27:21but there are still some clinics and
01:27:23some of our infusion services that are
01:27:26still in our satellite locations that
01:27:29were originally in the Smilow Cancer
01:27:32Hospital and that is really due to the
01:27:36number of patients that are the non
01:27:39cancer patient population at Yale,
01:27:41New Haven Hospital.
01:27:43So we are staying.
01:27:45We are continuing having
01:27:46some of those clinics,
01:27:48and some of those infusion services
01:27:50off of the main campus to accommodate
01:27:53the care that we need to provide
01:27:56not only to covid patients,
01:27:58but because of the increase in covid.
01:28:00With this second surge,
01:28:02it's other patients requiring
01:28:04hospital care that we're needing
01:28:06to make sure that we have room
01:28:08for on York Street campus, so.
01:28:11So that is something that we watch daily.
01:28:16We hope that we have a good plan in place.
01:28:19The hospital has really then the
01:28:22entire health system has really
01:28:24done a great job and trying to make
01:28:26sure that we are not disrupting
01:28:29services unless absolutely needed.
01:28:30So we do have a strong plan in place as
01:28:34the covid as the second wave continues.
01:28:37We have been doing a lot of
01:28:39predictive modeling and we're really
01:28:41hopeful that that we won't have to
01:28:44do a whole lot of more movement.
01:28:47Again,
01:28:47we're living through something that
01:28:49none of us have ever lived through
01:28:52before so we never can say never.
01:28:54But we are hopeful that we can continue
01:28:57the way we're delivering our care right now,
01:29:00and that at some point we will return
01:29:03those other services back to the York
01:29:06Street campus and continue with our
01:29:08robust network sites as well so you know,
01:29:11we have our eye on the future while we're
01:29:14continuing to manage through this, but.
01:29:16We have really an eye.
01:29:19I think somebody mentioned this before that
01:29:20we really do appreciate the flexibility.
01:29:23I think it was Doctor Gomez
01:29:25that mentioned this.
01:29:26The flexibility of our patients,
01:29:27they really have gone through a
01:29:29lot with us through this and there
01:29:32are times where we have to notify
01:29:34patients quickly that things are
01:29:35going to change a little.
01:29:37We are really trying to minimize that
01:29:39as much as possible and feel like
01:29:41we're going in a pretty good place right now,
01:29:44but we do always have to have a cautious I.
01:29:48Great thank you Paula. Sort of.
01:29:51On a related note, given the
01:29:54numbers creeping up again in covid,
01:29:56any changes you anticipate
01:29:58across the Care center network.
01:30:01Well, certainly we
01:30:02want to make sure that the right visit
01:30:05type is given to the right patient with
01:30:07the right physician at the right time.
01:30:10So we do look at our schedules ahead
01:30:12of time and there likely will be some
01:30:15patients that will be asked to do a Tele
01:30:18health visit either by phone or video.
01:30:21That is about to change to
01:30:22a new platform zoom.
01:30:24So we're hoping that some of the
01:30:26technology glitches that we experienced
01:30:28with the current platform will be
01:30:30illuminated with the zoom platform
01:30:32because we know it's disappointing
01:30:33when you can't see your physician
01:30:35and he or she cannot see you,
01:30:38but again, those will be selected on.
01:30:40Patients that it's the right type of
01:30:42visit for them right now and all the
01:30:45network sites and at the 20 York Street
01:30:47North Pavilion were all following very
01:30:50strict social distancing guidelines.
01:30:51So we're flexing our staff in and out of our
01:30:54locations that includes our support team.
01:30:56So when we have high volumes of
01:30:59social work needs or making sure
01:31:01that we're moving someone out in a
01:31:03staff around to move that social
01:31:05worker in so that we can provide
01:31:07our patients everything they need.
01:31:09Data site but I don't anticipate many.
01:31:11More changes to our patients other
01:31:13than we're just continue to ask for
01:31:16that patience on our pre screening
01:31:17and at the door screening and that
01:31:20we continue to monitor our visitors.
01:31:22'cause we do work in very enclosed spaces
01:31:24and we just want to keep everybody safe.
01:31:28Thank you Paula Kevin.
01:31:29I I I I may have created this confusion
01:31:31when I asked you the question
01:31:33about the Governor of Massachusetts
01:31:36slowing down elective surgeries,
01:31:38a question a couple of questions came
01:31:40up as his cancer surgery elective.
01:31:42I mean is is that the is that
01:31:45fall in that bailiwicks?
01:31:47Maybe you could clarify
01:31:48that for the audience.
01:31:54I it's not a straightforward
01:31:57question to answer.
01:31:59By strict criteria.
01:32:05Much of cancer surgery we would.
01:32:09Neroly define is elective,
01:32:12meaning that it is not an acute surgical
01:32:17emergency caused by something such as.
01:32:22Bleeding or intestinal obstruction.
01:32:26However, is any of us recognize?
01:32:32When you are a patient or family,
01:32:34there is nothing about.
01:32:37Cancer care or cancer surgery that.
01:32:41Feels or can be considered elective.
01:32:45So. Although.
01:32:49That terminology may be applied.
01:32:54I would not say that we.
01:32:57On our surgical teams here,
01:32:59consider any procedure for
01:33:01cancer truly elective.
01:33:02We would say that.
01:33:05That that is.
01:33:07At least urgent.
01:33:10Thank
01:33:10you, well, you know it's it's just about
01:33:138:00 o'clock and I think everyone will
01:33:15will probably call it a quick call.
01:33:18It quits at this time,
01:33:20but let me just first and foremost thank
01:33:23our extraordinary panel of experts for
01:33:25taking the time to answer questions and
01:33:28share your insights with with our audience.
01:33:30We really pleased we had a extraordinary
01:33:33turn out this evening and and Renee.
01:33:35Correct me if I'm wrong.
01:33:37'cause the questions came up.
01:33:39This is being recorded. Correct?
01:33:42Yes, will post it on line tomorrow.
01:33:44Yeah, so it will be available for folks
01:33:46who weren't able to watch tonight.
01:33:48If you want to let people know,
01:33:50but let me just thank everyone.
01:33:52Patients and families who took the
01:33:54time to join us. This has been.
01:33:57To say the least.
01:33:59Extraordinary times this year,
01:34:00it's hard enough
01:34:01having cancer. Or caring
01:34:03for somebody you care about this cancer.
01:34:06And doing that in the midst
01:34:08of what is one of the greatest
01:34:10public health crises and century.
01:34:12It's pretty tough. But you know,
01:34:14know for sure that we're all here for you.
01:34:18This forum will continue to keep you
01:34:20informed were always available as a
01:34:23resource and let me just say that.
01:34:26Your courage is patients and
01:34:28families dealing with this.
01:34:29You inspires, and it's what gives us joy
01:34:33in our work is to work with all of you.
01:34:36So on that note as we now,
01:34:39this will probably our last
01:34:41patient family form for the for
01:34:43the year before the Holidays.
01:34:45So to our panelists,
01:34:47to our patients and families wish you a safe,
01:34:50healthy holiday season.
01:34:52Really exciting things coming.
01:34:53I think 2021 with the vaccine and.
01:34:56At hopefully life back to normal,
01:34:58so a lot to look forward for
01:35:00the two and four, so thank you.
01:35:03Thank you everyone and have a good night.