September 1, 2021: A Smilow Patient and Family Forum
September 02, 2021Information
Hosted by Nita Ahuja, MD, MBA
Presentations by Drs. Kevin Billingsley, Maryam Lustberg, Scott Huntington, James Yu, Ohm Deshpande and Kim Slusser and Lisa Barbarotta.
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- 00:00Welcome to the Smilow
- 00:02patient and Family Forum.
- 00:04It's my pleasure to welcome you back.
- 00:06For those of you who may have been
- 00:08here the last time we were together.
- 00:10But for those of you joining or the
- 00:12first time my name is Doctor Nita
- 00:14Uja I'm the interim director for the
- 00:16Yale Cancer Center and position in
- 00:18Chief for the Smilow Cancer Hospitals.
- 00:20My other job is the chair of the
- 00:22Department of Surgery and it's
- 00:24a pleasure to see all of you,
- 00:26or at least have you join us this evening.
- 00:29So with that? Maybe next slide.
- 00:31I think many of you join us
- 00:33and are connected with us in.
- 00:34In over with you and and with your
- 00:37families and it's I want to take
- 00:39just a few minutes to acknowledge
- 00:41the upcoming cancer awareness funds.
- 00:42And September I'm going to just
- 00:44say is a busy month for us.
- 00:47So first up is.
- 00:50Our prostate Cancer Awareness month and.
- 00:56Prostate cancer, as some of you may know,
- 00:58is one of the most diagnosed and treated
- 01:00cancer in men at smilow Cancer hospital,
- 01:02accounting for 17% of all male cancers.
- 01:06BC here and our oncologist, urologist,
- 01:09radiation oncologists and other specialists
- 01:12partner together to provide specialty
- 01:14care to men diagnosed with this disease.
- 01:17So if you have please talk to the
- 01:19men in your life to talk to their
- 01:21health care provider about screening.
- 01:23This is it screen screen cancer Next up.
- 01:26Also, is gynecological
- 01:28Cancer awareness month?
- 01:29And similarly our team of gynecological
- 01:32oncologists and other specialty
- 01:33physicians provide excellent care
- 01:35to women diagnosed with ovarian,
- 01:37cervical, endometrial and other cancers.
- 01:41And for nearly twenty years
- 01:42or discovery to cancer,
- 01:43cure program has led research projects
- 01:46for earlier detection of ovarian
- 01:49cancer and supported clinical care
- 01:51for women at Yale and in Smilow.
- 01:54Enable you move to the next slide.
- 01:56I I mentioned it's it.
- 01:57There's a lot of cancer awareness.
- 01:59September, I think it's so.
- 02:00It's want to acknowledge all of the all
- 02:03of those in terms of raising awareness.
- 02:06Next up is blood Cancer Awareness
- 02:08Month and the Smilow Cancer
- 02:09Hospital hematology program,
- 02:11led by Doctor Stephanie Lee,
- 02:13has expanded over the last several years
- 02:16to provide expert care to patients through
- 02:18our multiple myeloma and gammopathy
- 02:21program classical hematology program.
- 02:24Leukemia,
- 02:24lymphoma,
- 02:25stem cell transplant and these
- 02:27newer therapies.
- 02:28The car T cell programs that are
- 02:30available are transplant program is
- 02:32also a member of the National Marrow
- 02:34Donor program and is accredited
- 02:36as a major transplant center under
- 02:38Dr Stuart Seropian's leadership.
- 02:42I also want to acknowledge thyroid
- 02:44cancer Awareness month and the
- 02:46incidence of thyroid cancers.
- 02:48Unfortunately,
- 02:48actually rising in for women in Connecticut.
- 02:51Dash,
- 02:51Jennifer Ogilvie joins Milo Cancer
- 02:53Hospital earlier this year as Chief
- 02:56of Endocrine Surgery and is leading
- 02:57a team including her endocrinologist
- 02:59and medical oncologist to care for
- 03:02patients diagnosed with thyroid cancers
- 03:04are cancer prevention and control
- 03:07research program is also actively
- 03:09receives researching this rising incidence.
- 03:12To determine the causes of this
- 03:14and find ways to prevent it Next
- 03:16up and then last but not least is
- 03:19childhood Cancer Awareness Month.
- 03:20We also celebrate our littlest
- 03:22patients and the tremendous care or
- 03:25pediatric hematologist and oncologist
- 03:26in child Life team provided smilow
- 03:29cancer hospital and in the Yale
- 03:31New Haven Children's Hospital.
- 03:32I'm also really excited to announce
- 03:35that next month we'll welcome Doctor
- 03:37Lakshman Krishnamurthi as our new
- 03:39Chief of Pediatric Hematology
- 03:41Oncology and bone marrow transplant.
- 03:44Questionable through more seasoned,
- 03:46accomplished pediatric hematologist
- 03:47oncologist and an international
- 03:49leader in bone marrow transplant.
- 03:52He's joining us from Atlanta Berries,
- 03:53a professor of Pediatrics at Emory
- 03:55University School of Medicine
- 03:57and director of the bone Marrow
- 03:59Transplantation program there.
- 04:00So that was a lot of raising awareness
- 04:02of all the cancers that are this month.
- 04:05Next up,
- 04:06it's the closer to free bike ride.
- 04:08I know that this is an event that
- 04:10has been important to Connecticut
- 04:11and all of our all of our
- 04:13patients. In our families, etc.
- 04:15It's on Saturday, September 11th.
- 04:17I know we were briefly hoping
- 04:19it would become an in person,
- 04:21but it has once again moved to
- 04:23a virtual event to protect and
- 04:24give safety to all our writers,
- 04:26volunteers and community.
- 04:27I'm could guarantee you the spirit will
- 04:30be strong in all of the participants,
- 04:32so even though it's virtual,
- 04:34I know many of you participated in
- 04:36this and I encourage you to register
- 04:38and join the event online or donate
- 04:40to support a rider or ride closer to
- 04:43free dot or you can log on and on the
- 04:46site on right closer to free.org.
- 04:48100% of the funds go to support patch
- 04:51patient carrots Milo Cancer Hospital in
- 04:53Cancer Research at our Cancer Center.
- 04:56I thought I would also talk very briefly
- 04:58about COVID data from our what we are seeing.
- 05:01So in terms of if you're wondering,
- 05:04the hospital Yale New Haven Health
- 05:06System has made vaccination mandatory
- 05:09and over 27,000 of our employees
- 05:11have been vaccinated and in terms of
- 05:13how many vaccines we have delivered,
- 05:15I think you can see that over 200,000.
- 05:17And if you see the care that continues
- 05:20to happen along with cancer care,
- 05:22we continue to provide care to our camp
- 05:24COVID patients over 12,000 patients
- 05:26have been discharged and released,
- 05:28and as health system has had the lowest
- 05:30mortality in the statement compared
- 05:32to the all the hospitals I know we all
- 05:34contribute and we're proud of that
- 05:36of the care we provide to our Community.
- 05:38So just wanted to take a minute to
- 05:40acknowledge that because I know this
- 05:42is something we're all living with.
- 05:44Next slide, Renee, please.
- 05:46Alright.
- 05:47So if you have suggestions or questions.
- 05:49About these forms,
- 05:50I do want you to take the time to reach
- 05:52out to us and all the ways Facebook,
- 05:54Twitter, etc.
- 05:55You can use old fashioned emails,
- 05:57cancer and answers at yale.edu
- 05:59and follow us on social media.
- 06:02I know Renee Gadets team since a
- 06:04lot of information on the various
- 06:06social media formats,
- 06:07so again we want to hear from you.
- 06:09You are part of our community and
- 06:11we feel very connected with you
- 06:12and we want to make sure we're
- 06:14supporting you and all your questions.
- 06:17With that I'm going to share
- 06:19the agenda for tonight.
- 06:20First up is our new chief for Breast
- 06:22medical Oncology and the director of
- 06:24the Breast Center at Smilow Cancer
- 06:26Hospital will be Dr Maryam Lustberg,
- 06:27who has joined us recently
- 06:29from the Ohio State,
- 06:30and she's going to be talking about the
- 06:33impact of COVID on cancer survivorship.
- 06:35I would like you know she will talk
- 06:37and then we'll have Q&A and after
- 06:39that we're going to talk about,
- 06:40I suspect,
- 06:41which there going to be a lot
- 06:42of questions and answers.
- 06:43It's immunocompromised patients
- 06:45and 3rd dose vaccinations.
- 06:47And doctor Om Deshpande,
- 06:49who's our executive director in
- 06:50charge of this program for Yale,
- 06:52New Haven Health,
- 06:53has joined us.
- 06:54Thank you Doctor Deshpande
- 06:56doctor Kevin Billingsley.
- 06:57Many of you know him.
- 06:58He's our chief medical officer
- 07:00for Smilow Cancer Hospital and
- 07:02will be giving us the updates.
- 07:03And he's joined by a team and we want to
- 07:05make sure we answer all the questions.
- 07:07Lisa Barber ODA,
- 07:09who's the program director and oncology
- 07:11education Dr Huntington who is in
- 07:14hematology and can answer those very
- 07:16specific questions for hematology,
- 07:18hematologic malignancies, patients.
- 07:20Miss Lester, who I know many of you.
- 07:23If you've joined us in the past,
- 07:24know her she's her chief nursing
- 07:26officer and vice president.
- 07:27Patient services for hospital
- 07:29and then Dr Euhus,
- 07:30their associate CMO for radiation oncology,
- 07:33is also joining.
- 07:34Still everybody give a big babe so you can.
- 07:36They can see your faces in your names are on,
- 07:39but with that I'm going to turn
- 07:40it over to our very own doctor
- 07:42Lustberg to give you an update
- 07:44on cancer survivorship.
- 07:46Doctor Losfer take it away please.
- 07:48Thank you Doctor Raja and
- 07:50thank you to all the.
- 07:51Participants tonight in this town hall.
- 07:55It's wonderful that you're here.
- 07:57So that we can all have a conversation
- 08:00about the impact of COVID,
- 08:02which has changed many things in healthcare.
- 08:06As many of you know,
- 08:07and I'm sure many of you have
- 08:10also been personally impacted.
- 08:12By many of the changes that we have
- 08:15all gone through since early 2020,
- 08:18so this schema here is a.
- 08:22It captures the work of many of
- 08:26the collaborate collaborations
- 08:28that I've had throughout the
- 08:30country where we were observing.
- 08:32Kind of what was happening to
- 08:35healthcare delivery as essentially the
- 08:37healthcare system for valid reasons
- 08:39had to come to a halt with with the
- 08:43mounting cases of COVID in early 2020,
- 08:46and as you can see we've had multiple waves.
- 08:50So this is, uh,
- 08:51this was an artistic depiction
- 08:54of how multiple cancer survivors
- 08:56were affected by multiple waves of
- 08:59COVID as they each came through,
- 09:01and we with each wave.
- 09:03We thought this might be the last one,
- 09:04and so as we're currently
- 09:07experiencing or fourth wave,
- 09:08I think it's it's.
- 09:09It's a telling schema and so with with
- 09:13many of the national survivorship experts,
- 09:15I think we we we really had multiple
- 09:18dialogues in terms of how we could
- 09:21better support cancer survivors as
- 09:23they were going through the pandemic.
- 09:25And to make sure we're all on
- 09:27the same page in terms of the
- 09:29definition of a cancer survivor,
- 09:31because I know that can
- 09:33be confusing sometimes.
- 09:34Uhm,
- 09:34really,
- 09:35the official National Cancer
- 09:37Center definition.
- 09:38Is anyone diagnosed with cancer
- 09:40from the day one of diagnosis
- 09:43throughout the rest of their lives.
- 09:46And obviously there are many
- 09:48different types of cancer survivors,
- 09:50and this will also be relevant in
- 09:52the next segment of this town hall.
- 09:55When we talk about.
- 09:57Patients on active treatment versus
- 09:59patients were not active treatment,
- 10:01but what we noticed kind as as as
- 10:04as a COVID-19 was mounting that
- 10:08there needed to be best practice
- 10:09is set in place in terms of how we
- 10:12better communicated with with the
- 10:14many different cancer survivors,
- 10:16how we shared information and
- 10:18how we try to make the best of
- 10:21things during resource lean times.
- 10:23When we were going through this crisis so.
- 10:27Many of these themes you have
- 10:29seen because the health system
- 10:31here has really done a terrific
- 10:34job of responding to this crisis.
- 10:36But on top of the wave you can
- 10:38see the the the the box,
- 10:40assess and anticipate the COVID-19 burden.
- 10:43And this is exactly what was done.
- 10:45What is being done?
- 10:46What will be done?
- 10:47Which is we are constantly looking at
- 10:50what our case numbers are doing and
- 10:53really making decisions in terms of.
- 10:55You know what?
- 10:57Whether we need to scale
- 10:59back from certain events,
- 11:02whether to keep things fresh.
- 11:04Also can constantly being in
- 11:06touch with you in terms of how how
- 11:10the COVID-19 burden is is doing.
- 11:13Another theme that emerged for
- 11:15cancer survivorship and other other
- 11:17types of cancer care delivery
- 11:19was other emergence of increased
- 11:21reliance on Tele health,
- 11:22which which has been a wonderful asset.
- 11:27However, we also want to make sure that
- 11:30cancer survivors also know that it's also
- 11:32safe to enter the health care system.
- 11:35There was a lot of fear,
- 11:37specially in the early months of
- 11:39the pandemic where certain signs
- 11:41and symptoms of disease progression,
- 11:44where perhaps being being ignored
- 11:46because patients didn't feel safe
- 11:48to enter the hospital system.
- 11:50So Tele health absolutely has a place it.
- 11:53It absolutely enhances care delivery,
- 11:56but they are there.
- 11:57Also, instances where a physical
- 11:59exam is also important.
- 12:00So really educating our survivors in
- 12:03terms of signs and symptoms to look for
- 12:07and to come into the health care system.
- 12:10If they are very worried or
- 12:13have a concerning system,
- 12:14the next piece that really emerged
- 12:17during the pandemic was the importance
- 12:19of the health care team that in
- 12:22order to this is something we've
- 12:24always known but but COVID really
- 12:26brought it to to center stage,
- 12:29which is that the different
- 12:31health care providers needed to
- 12:33really work together from primary
- 12:34care specialists to to oncology
- 12:36specialist continued collaboration
- 12:38with nurses and advanced practice.
- 12:41Providers another area that impacted
- 12:44are cancer survivors with access to
- 12:47diagnostic imaging and services and
- 12:49this is something that we can reassure
- 12:51you now that that things are back open.
- 12:54We want you to come in for your screenings.
- 12:57This is a central component of cancer
- 13:02survivorship and these services are
- 13:05available now and it's really important to.
- 13:08To follow a guideline,
- 13:11concordant care and what we unfortunately
- 13:15saw during the pandemic in in some of
- 13:17the earlier waves was that there was
- 13:20a sharp drop off of cancer screenings,
- 13:22and now we're seeing that starting
- 13:25cancers are actually presenting
- 13:27at more more more advanced stages.
- 13:30You'll hear a lot more about the next box,
- 13:33which is the concept of risk stratification.
- 13:36We we we want to be really giving
- 13:40personalized care to all of you,
- 13:42which means your vaccine recommendations
- 13:44and a lot of your care.
- 13:47Recommendations and cautions are
- 13:48dictated by your level of risk,
- 13:51which is in many ways determined
- 13:54by the type of cancer you have and
- 13:56the type of cancer treatments that
- 13:58you are receiving.
- 14:00So a lot more information will come
- 14:02up in the next segment of the town
- 14:04hall and also in the panel discussion.
- 14:07And uhm.
- 14:08The next box focusing on outreach
- 14:11and education.
- 14:12This is something that we feel very
- 14:15passionately about and inspire low,
- 14:16and we this is one of the many reasons
- 14:19we're having town halls like this
- 14:22is that we're one community and we
- 14:24want to share with you information
- 14:27as it becomes available and to really
- 14:30focus on state of the art patient
- 14:33education through our websites,
- 14:35social media as well as these types
- 14:37of live events.
- 14:39And then most importantly,
- 14:41I think it's important to take a pause.
- 14:43All of us and really acknowledge what,
- 14:46what, what, what, these past year,
- 14:49year and a half has done to us
- 14:51and in our workforce and our
- 14:54families in our relationships.
- 14:55I think it's up there.
- 14:58There has been a significant like the
- 15:02social impact of COVID-19 It's important
- 15:05to to take a moment and realize that,
- 15:08and also know that there are
- 15:11many resources available to.
- 15:13To address these psychosocial needs and to
- 15:16be able to ask for help to to know that.
- 15:20Social distancing does not necessarily
- 15:22have to mean social isolation and
- 15:24that there are different ways
- 15:25that we can all reach out to each
- 15:28other and support one another.
- 15:29And you're part of our community,
- 15:32and so I just want to encourage
- 15:34you to continue to to reach out.
- 15:37So this was the schema was initially created
- 15:40by my colleagues early on in the pandemic,
- 15:43and the next figure reiterates the similar
- 15:47themes that I'm not going to go over,
- 15:50but it highlights how we
- 15:52thought that the pandemic.
- 15:53Was over and then into 2021 we realized.
- 15:56Gosh we needed to reassess.
- 15:58What are survivor needs were and
- 16:00you can see a lot of the same
- 16:02themes that I already covered,
- 16:04including you know do not delay
- 16:07needed and in person visits.
- 16:09Uhm,
- 16:10really it would continue to focus on
- 16:13healthy habits and healthy behaviors.
- 16:17And additional themes emerged,
- 16:19including the financial impact of
- 16:22COVID-19 because it was impacting
- 16:25survivors in terms of.
- 16:27Many different issues in terms
- 16:29of changes and work patterns,
- 16:31and this may have impacted their ability,
- 16:35ability to access health insurance,
- 16:38or be able to pay for certain services so.
- 16:43Or I think it just highlighted that
- 16:46these needs continued even into
- 16:49the into the third and 4th wave.
- 16:53And that the main upshot was to really
- 16:58be open to using the health care facilities,
- 17:01acknowledge the impact of COVID,
- 17:03and know that you know many
- 17:05cancer services cannot wait that
- 17:08that that that cancer itself is.
- 17:10Is not an elective procedure that
- 17:12was one of the other myths that that
- 17:14sometimes emerges like Oh well,
- 17:16cancer surgery can be can be postponed
- 17:18or a bit, but we we we really,
- 17:21I think,
- 17:22have a better understanding that all
- 17:25our patients and cancer survivors
- 17:27need ongoing care and we are.
- 17:30We are committed to providing that
- 17:33with you and in the subsequent segments
- 17:35of this town hall you'll hear more
- 17:38about how we can help optimize your health.
- 17:41As we continue to go through this 4th wave,
- 17:44so I'll stop there to make sure we have
- 17:46time for other segments and for questions.
- 17:49Thank
- 17:49you doctor. Lustberg I think
- 17:50will save the questions.
- 17:51There are some questions
- 17:53around protecting survivors.
- 17:54I'm going to leave it at the end
- 17:55because I think a lot of the next
- 17:57discussion will also address this.
- 17:58I think the points that I heard
- 18:00which I loved, social distancing,
- 18:02doesn't mean social isolation.
- 18:04We need to remember this part of her
- 18:06can taking care of our community,
- 18:08and I think if everyone didn't
- 18:10get this then make sure you get.
- 18:12While you're screening done because
- 18:13I think last year we did see a
- 18:16lot of gaps as things shut down,
- 18:17so thank you so much I I suspect there
- 18:20will be more and more questions,
- 18:21but I want to sort of come I
- 18:24someone saying they cannot hear me.
- 18:27Uhm? Or others hearing me,
- 18:29just give me a thumbs up if you can hear me.
- 18:31OK doctor Deshpande.
- 18:32Others OK miss our fee I'm hoping
- 18:35that we can get you connected or
- 18:37enable reach out to you offline
- 18:39but I'm going to move on to the
- 18:41next segment because I suspect
- 18:43there are lots and lots and lots of
- 18:45questions around the booster shots.
- 18:46So with that Doctor Deshpande,
- 18:48I think you're starting this segment.
- 18:51Or Doctor Billingslea or Miss
- 18:52Barbarito I I am actually I'm going
- 18:54to pass it on to the panel so.
- 18:57OK, I think we could probably tag team and,
- 19:00uh, but uh, thank you Doctor Who
- 19:02and thank you for having me so.
- 19:05You know, as was mentioned earlier,
- 19:08the health system has actually
- 19:10done over 450,000 vaccinations and
- 19:13has vaccinated approximately 200
- 19:15and 15,000 people individually.
- 19:17You know on the point that Doctor
- 19:20Who brought up that are about
- 19:22our health care workers.
- 19:23We jointly with our other
- 19:26hospitals in in the state,
- 19:29had really committed to a vaccine
- 19:32mandate and we were at 81% of
- 19:35our of our full workforce.
- 19:37Which includes our medical staff
- 19:39prior to the mandate and we are
- 19:41making significant progress.
- 19:43Our deadline for the first dose
- 19:44was actually yesterday and we're
- 19:45still waiting on the final data,
- 19:47but we're we are making a lot of
- 19:49progress and we anticipate that we
- 19:51will get to our goal by the end of September,
- 19:54which is, you know,
- 19:55part of our ongoing commitment to providing,
- 19:57you know, the really safest care
- 19:58to all of our patients.
- 20:00And of course,
- 20:02most importantly are those who
- 20:04are had increased vulnerability.
- 20:06With regards to the immunocompromised
- 20:09population there,
- 20:10I'm sure most of you are aware
- 20:13of the fact that a third dose was
- 20:17approved sometime ago and thus
- 20:19far in the state of Connecticut,
- 20:20about 10,000 of these doses have
- 20:22been administered and around
- 20:248:00 or 900 of these doses have
- 20:26been administered at Yale,
- 20:27New Haven Health,
- 20:28so the process really has not changed
- 20:31from our first from our first wave,
- 20:34the first two doses it's very easy to.
- 20:37To go through the process and get scheduled,
- 20:40uh,
- 20:40the the website is is on the
- 20:42bottom of this slide.
- 20:43You can also call our call center at 833.
- 20:46Ask why NHH and they can also
- 20:49telephonically schedule you.
- 20:51The process is fairly seamless
- 20:54and straightforward.
- 20:55You really have to attest to the fact
- 20:58that you you meet the definition of
- 21:00them in a compromise and as a part of
- 21:03that workflow we really do highlight
- 21:05the different things that that.
- 21:07Are there constituting any compromise
- 21:09per the CDC's recommendation,
- 21:11and the language has changed a fair
- 21:13amount over the last few weeks of thing
- 21:15as things have gotten better and better,
- 21:17so I think that our language as you
- 21:20actually schedule through the website,
- 21:22it has been updated.
- 21:23I don't know.
- 21:24There are website where it talks about LVK
- 21:27seen eligibility has been fully updated,
- 21:29so just stay tuned.
- 21:30That will also be updated
- 21:32by tomorrow morning.
- 21:33Kevin Lisa, if you do,
- 21:35do you want us to go through the specific?
- 21:37I can't.
- 21:38OK there we go.
- 21:39Thank you doctor. Just pandi.
- 21:41You know, I I'd like to just
- 21:43build on a couple of the comments
- 21:46made by my colleagues. First off,
- 21:49to echo Dr Lustberg we fully understand.
- 21:53On behalf of our patients and their
- 21:57families that navigating a cancer
- 21:59diagnosis and cancer care and
- 22:01getting through the cancer journey
- 22:04is difficult and trying at best.
- 22:07But when our patients and families
- 22:09confront the challenges of a global
- 22:12pandemic layered on top of their diagnosis,
- 22:15it truly creates a difficult mix.
- 22:19Our goal is your cancer care team is to make.
- 22:23Navigating that difficult mix as easy
- 22:26as possible and as safe as possible.
- 22:30And as Doctor Deshpande indicated.
- 22:34Part of that is that we,
- 22:36as health care providers,
- 22:38are committed to getting vaccinated
- 22:40ourselves so that when you come
- 22:42into our facilities or offices,
- 22:44you know you're safe.
- 22:45Our health care system has been in
- 22:48the lead in the state of Connecticut
- 22:50and vaccinating people over 250.
- 22:52Fifteen thousand people vaccinated,
- 22:55and we're still rolling.
- 22:57Now with this third dose.
- 23:00And the question is, you know,
- 23:02as Doctor Despond indicated,
- 23:03this has been a moving target and we
- 23:07have just updated our recommendations.
- 23:09The original description was for
- 23:12immuno compromised patients to be
- 23:14immediately eligible for a third dose
- 23:17vaccination to boost their immunity
- 23:20and the truth is that the vast
- 23:23majority of our patients are actually
- 23:26within this eligibility criteria.
- 23:28So just to go through this in a
- 23:30little bit more detail and you can
- 23:32certainly read along with me if you
- 23:34are this is and this is part of our
- 23:37attestation language on our website.
- 23:39If you are an individual who has
- 23:41a diagnosis of cancer and you've
- 23:43met at least one of these criteria,
- 23:45you are eligible for an immediate
- 23:48vaccination either within our system
- 23:50or within one of the commercial
- 23:52sites around the state.
- 23:54Meaning that you have received
- 23:56some cancer therapy,
- 23:57including really the entire
- 23:58spectrum of treatment for cancer.
- 24:01For a solid tumor within one year of your
- 24:04initial COVID-19 vaccination series.
- 24:06Or you or someone who may not
- 24:09have started your treatment,
- 24:10but you've been diagnosed with
- 24:12cancer or recurrent cancer and you
- 24:15have a treatment plan in place that
- 24:17will be moving forward that will
- 24:19include chemotherapy, immunotherapy,
- 24:21radiation therapy.
- 24:22And we are even including surgery in that.
- 24:26Or you were one of these?
- 24:27One of our patients who were
- 24:30facing a hematologic disease or
- 24:33blood cancer diagnosis.
- 24:34For example, leukemia,
- 24:35lymphoma, myeloma, or Milo,
- 24:38dysplastic syndrome,
- 24:39or other chronic myeloproliferative
- 24:41conditions.
- 24:42You are also eligible and that
- 24:46eligibility is broadly spanning in time.
- 24:50Or you were a patient who's received
- 24:52a stem cell transplant or car T
- 24:55therapy at virtually any time here
- 24:57at the Smilow cancer hospital.
- 24:59So.
- 25:00We're really creating a broad
- 25:03eligibility structure for patients
- 25:06to derive the additional protective
- 25:08effect of that third dose vaccine,
- 25:12and we are in alliance in alignment
- 25:16with our peer institutions through the
- 25:19National Comprehensive Cancer Network,
- 25:22as well as the updated CDC guidelines.
- 25:28Next slide.
- 25:33That actually may be the end
- 25:35of our slides. Renee, UM.
- 25:40Yeah, I think we want to
- 25:42leave time for questions.
- 25:43Doctor Billingslea,
- 25:43so I think there's a lot of questions.
- 25:45The first one is from Miss Monaghan.
- 25:47Asking for advice for caregivers,
- 25:49spouses, Visa V protecting cancer
- 25:52survivors from COVID would be appreciated.
- 25:58And I also want to make sure
- 26:01that we introduce our panelists.
- 26:04Uh, I see my colleague Doctor Huntington
- 26:08who's also available to answer
- 26:10questions in the heme malignancy space.
- 26:12Uhm, we introduce these folks earlier,
- 26:14but Kim Slusser at least brought
- 26:16us so all can help with answering
- 26:18the answering our question.
- 26:20Would you like to take that one for
- 26:22sure? I know it's a.
- 26:23It's a great question on highlighting.
- 26:26The importance of caregivers. First of all,
- 26:29thank you for all that you do come.
- 26:32It's a way we are only the thing stages are
- 26:36truly recognizing what impact caregivers
- 26:39actually have during the cancer continuum.
- 26:43But to specifically answer your question,
- 26:46the the biggest thing you can do is to be
- 26:49normally vaccinated for standard of care
- 26:52as well as continuing to practice masking.
- 26:56In high risk situations,
- 26:59good hygiene, and if there are any,
- 27:02any symptoms that that,
- 27:04that that that raises the question in
- 27:06your head is could this be covered?
- 27:08Could this happy Kovit getting tested?
- 27:11Because testing it is is available
- 27:14and so those are those are the
- 27:18precautions that you can take as
- 27:21caregivers to to protect higher risk
- 27:23individuals at this point in time.
- 27:27Thank you, Mary. Come next question.
- 27:30I think this may be doctor
- 27:32Deshpande your alley.
- 27:33Should there be a delay between the
- 27:35flu shot and the third COVID dose?
- 27:37If So what is the suggested time frame?
- 27:39I know you've answered it,
- 27:41but maybe just give some more details.
- 27:43Thank you.
- 27:46So the Advisory Committee
- 27:48on Immunization Practices,
- 27:49which is sort of the the Group of
- 27:52expert who helps us create the
- 27:54guidelines for administration here,
- 27:55have reviewed the data across the
- 27:57board and have determined that it's.
- 27:59It seems it appears to be completely safe to
- 28:02get multiple vaccinations at the same time,
- 28:04so there's really no reason to could
- 28:06be concerned that you know either the
- 28:08flu or the code vaccine would be less
- 28:11effective by getting them at the same time.
- 28:13Again, the only thing is that you
- 28:14know if you get both of them.
- 28:16The COVID vaccine is likely to result
- 28:18in some transient side effects.
- 28:20The usual muscle aches a little bit of fever,
- 28:23headaches, things of that nature which
- 28:26all resolved within two to three days.
- 28:28So you you are going to you.
- 28:31You can easily experience those things,
- 28:33but again, those are.
- 28:34Those would be experienced regardless,
- 28:35so it is completely safe to
- 28:36get them both at the same time.
- 28:38And actually as we are planning
- 28:40forward for our health care workers,
- 28:42we are,
- 28:43we're figuring out the workflow to
- 28:44do that exactly that so it there's no
- 28:47reason to be concerned in that regard.
- 28:49OK,
- 28:50thanks, start responding.
- 28:51I think the next one,
- 28:52which is also important and I suspect
- 28:55front and center on following the
- 28:57question that doctor lost forgot.
- 28:59When will the caregivers of cancer
- 29:01patients be eligible for the booster?
- 29:04I know this is an area that's up and sort
- 29:06of there's a lot of data I don't know.
- 29:08Doctor Billingslea,
- 29:08are you taking this one?
- 29:12I'd be happy to you know.
- 29:15What I think we all would like to
- 29:18share is that this is. One of these.
- 29:23Areas that is evolving very quickly
- 29:26and I think that if you follow the
- 29:30CDC commentary and the advice of
- 29:33governing bodies around the country,
- 29:36there is accelerating movement
- 29:38towards opening accessibility for the
- 29:41general population for a third dose of
- 29:44vaccination in the very near term. Now,
- 29:47like the original rollout of the vaccine,
- 29:50I suspect that there will be a staged.
- 29:54Approach to this with the most high
- 29:57risk individuals being encouraged
- 29:59to seek that third dose the soonest
- 30:02particularly paid folks in in
- 30:05long term care facilities,
- 30:06the elderly,
- 30:07and probably health care personnel.
- 30:10But I think that that very,
- 30:12very quickly you will be seeing
- 30:16broad eligibility for a third dose.
- 30:19Doctor
- 30:20Deshpande, anything else you'd
- 30:21like to point out 'cause you manage
- 30:23this for the entire health system?
- 30:24Anything else we should point?
- 30:26I know this is a we'll be seeing
- 30:28more information. I suspect. Pretty
- 30:29short. Yeah, yeah we will
- 30:31be seeing more information.
- 30:32I I think that you know and I believe
- 30:34in the some of the documents that
- 30:35were some of the questions that
- 30:37had been submitted previously.
- 30:39Someone had asked to comment on a
- 30:40New York Times article that speaks
- 30:42to the sort of the controversies
- 30:44around waning immunity.
- 30:45And it gets a little complicated,
- 30:49so I'll try not to get too deep.
- 30:50Into the weeds,
- 30:51but I think the key thing here is
- 30:53that there are individuals who are
- 30:55clearly immunosuppressed or for
- 30:57some reason immunity does truly win.
- 30:59And you know the cancer patients and
- 31:02you know everyone who's receiving the
- 31:04therapy is that doctor Billingsley just
- 31:07outlined clearly fall into that category.
- 31:09Other people who are also probably
- 31:11in that category of people over
- 31:13the age of 65 and have you know,
- 31:15even if they have no other
- 31:17comorbid conditions.
- 31:18It is a little less clear about
- 31:21younger people and who may
- 31:23not have these comorbidities,
- 31:25so I think that is some of the
- 31:27data that has to be parsed.
- 31:29I do think you know,
- 31:30based on the the signaling
- 31:31from the White House,
- 31:32there was a desire to make this,
- 31:34you know available across the board
- 31:36and we were planning frankly for that
- 31:39eventuality towards the end of September.
- 31:41But I think we're also hoping that
- 31:42there's a little more clarity
- 31:44about who will actually benefit
- 31:45'cause the New York Times article,
- 31:47that that was sort of that
- 31:48was in the questions.
- 31:49Highlighted the fact that you
- 31:51know four people who are otherwise
- 31:53healthy and of our it's it's really.
- 31:55There are certain groups that clearly
- 31:57will benefit and then there are.
- 31:58There may be others who don't.
- 31:59So I think that we just need a
- 32:01little more information and with
- 32:02regards to the original question is
- 32:04to when caregivers will be eligible.
- 32:07It really depends on the national
- 32:09guidelines that are that are
- 32:11released in the meantime.
- 32:12Of course you know the key
- 32:14things that you know.
- 32:16Mask wearing,
- 32:16universal mask wearing hand hygiene
- 32:18and being particularly careful about.
- 32:20All the other infection prevention
- 32:23behaviours are or absolutely
- 32:24obviously continue to be critical.
- 32:28Thank you and I think you know
- 32:29the New York Times articles.
- 32:30For those of you may not have read it,
- 32:32I think talks about you know the
- 32:34risk benefit, and I think this
- 32:35is an area we continue to learn.
- 32:36I think 18 months later we know
- 32:38a lot more of this disease,
- 32:40but it also changes,
- 32:41so I think it's it gets into
- 32:43a lot of details around this.
- 32:44I think. Certainly there are clear
- 32:46categories with immuno suppression.
- 32:47Bear it's beneficial but you
- 32:49know if you're young and healthy.
- 32:51Do you benefit from a booster?
- 32:52I think it's something will bill figure out,
- 32:54but I think we're all learning a lot
- 32:57with this disease also and collectively.
- 32:59Uhm, dealing with this, uh,
- 33:02there's a question around
- 33:03getting the Moderna.
- 33:04If you got your last two doses of Moderna
- 33:06and now you're trying to get your booster,
- 33:09someone saying I can't get
- 33:10an appointment at Yale.
- 33:12They're waiting on a shipment Lisa,
- 33:13would you like to take this
- 33:15one or doctor Deshpande?
- 33:16I don't know who wants to take this one.
- 33:18It looks like it's gonna
- 33:19say that responded probably.
- 33:21I know it is.
- 33:22I figured that I would just give him a break.
- 33:24It's OK, no problem.
- 33:26So yeah, we so the good thing is
- 33:29that there really is enough vaccine.
- 33:31That's available so we can
- 33:33absolutely are ordering a.
- 33:35We are certainly ordering enough and
- 33:36we will have it available. You know,
- 33:39the number of for this initial group.
- 33:41We've only we've opened a
- 33:43limited number of of sites,
- 33:45mostly in RMG sites,
- 33:46and we're working to create some
- 33:48popups for smilow clinics as well.
- 33:51But there there is absolutely availability
- 33:53and we will make sure that Moderna
- 33:55will be an option that will that
- 33:57will that we will certainly offer.
- 33:59I think when when all is.
- 34:02Told the split between Moderna and Pfizer.
- 34:05I think we actually administered
- 34:06more Pfizer than Moderna were.
- 34:07Actually I'm sorry.
- 34:08More Moderna than Pfizer so
- 34:10we will absolutely have those
- 34:12available as we go forward.
- 34:14That responded don't go away I.
- 34:16I think there's another
- 34:17question following this.
- 34:18If you got Pfizer initially should you?
- 34:21Can you get the Moderner Moderna initially?
- 34:23Can you switch to Pfizer?
- 34:24So can you sort of share
- 34:27the combinations? Yeah,
- 34:28it's a. It's a great question and you know
- 34:30the the bottom line is that we really have.
- 34:33We are following the CDC's guidelines,
- 34:35which are really saying that you
- 34:36have to get the same version of the
- 34:39vaccine that you got originally.
- 34:41There's a lot of interest.
- 34:42There's a lot of research.
- 34:44That's actively going on here.
- 34:47There's a theoretically a lot of
- 34:49people have sort of had played
- 34:51out the value of vaccine mixing,
- 34:53but it really needs to be fully
- 34:54studied in a rigorous fashion,
- 34:56and we don't have those data to say
- 34:58that it's safe and truly efficacious,
- 34:59so we're waiting for those trials.
- 35:01At present, the the the.
- 35:05The guideline,
- 35:06the recommendation that we are following,
- 35:07is that you you get the same kind of
- 35:10vaccine that you got the first time.
- 35:11The first two times and
- 35:13we did get some questions on
- 35:15email prior to this event,
- 35:16as people register the last
- 35:17one on this and there were two
- 35:19questions which seem similar.
- 35:20People who had the J&J vaccine,
- 35:23should they be getting a
- 35:24booster from Pfizer Moderna
- 35:25or wait to see what J&J does?
- 35:28Yeah, so this is all we have to wait.
- 35:30At present we are not able to provide
- 35:32an M RNA vaccine for them at President.
- 35:34Did JJ has concluded a trial.
- 35:37Of the a second booster, because you'll
- 35:40recall that the J&J is a one shot,
- 35:42was was a one shot vaccine and we
- 35:45are still waiting for the actual
- 35:48trial data to understand what benefit
- 35:50and how how great the benefit is.
- 35:52So they they've issued a press release
- 35:54but we can't go by press releases.
- 35:56We have to wait until we have.
- 35:57We really have full transparency
- 35:59to the outcomes data.
- 36:00Thank you.
- 36:03I think the next one is for you Doctor
- 36:06Huntington neutropenia with with.
- 36:08Angus, I probably said it wrong,
- 36:10but no treatment yet qualify
- 36:12for third vaccine. Yeah,
- 36:14I. I think you know our
- 36:16guidance has evolved over time.
- 36:17So I think initially the CDC really
- 36:20was focused on active treatment.
- 36:22But for him malignancies oftentimes
- 36:25we won't actually vaccinate before we
- 36:27start the most oppressive therapy.
- 36:28And so I think our current guidance
- 36:30would be that some of that has engulfed
- 36:33neutropenia foramina suppressed and they
- 36:34would fall under the new category of
- 36:36of being allowed to have a third dose.
- 36:38Just want to.
- 36:39Had one UM, kind of feature about
- 36:41think about third dose versus booster.
- 36:43Many of my patients didn't respond to
- 36:45the first 22 doses and so our goal of
- 36:47the third dose is really to get those
- 36:49folks that didn't have any antibody
- 36:51response to having a response a little
- 36:53bit different when we think about the
- 36:55Community about people that you know,
- 36:5795% of the people on those Moderna
- 36:59and Pfizer vaccines made antibodies.
- 37:01Many of our patients were
- 37:03not those of those folks.
- 37:05They don't have antibodies,
- 37:05and so the third dose for them
- 37:07is a little bit different,
- 37:08so that's why I think the timing is.
- 37:09Also a little bit more nuanced in
- 37:11terms of not waiting eight months,
- 37:12but really within 28 days or
- 37:14more after a second dose,
- 37:16you can get a third
- 37:16dose. Thank you Doctor Huntington.
- 37:18You answered the question that came
- 37:20through our chat earlier and you
- 37:23answered that that immunosuppressed
- 37:24people do not mount a response,
- 37:26so they need their third dose a little
- 37:29sooner versus those of us who mounted and
- 37:32gaining immunity are waiting the time.
- 37:34I think this has been answered,
- 37:35but doctor Lustberg would you
- 37:37like to just add more detail?
- 37:38Those taking anastrozole?
- 37:39Daily basis count as amino suppression
- 37:42and can you get a boost right?
- 37:43Think the answer is yes,
- 37:45but anything else you want to add for
- 37:47other types of hormonal therapies etc.
- 37:49Yes, so no. I completely agree as my
- 37:52colleague hasn't happened have answered
- 37:53and that we want to be as broad as
- 37:56possible and be as inclusive as possible.
- 37:58It's absolutely true that you know
- 38:00compared to a patient on immunotherapy
- 38:03or chemotherapy the the level of
- 38:05immunosuppression from anastrozole is
- 38:07is not equivalent, but we we want to.
- 38:10Protect all our cancer survivors
- 38:12at various levels of training.
- 38:14So this is this is this is to be as
- 38:16inclusive as possible and protect
- 38:18as many patients as possible.
- 38:20So yes, any type of hormonal therapy and
- 38:22I also saw a question on other types of
- 38:26oral therapy such as PARP inhibitors.
- 38:28So that applies to that as well,
- 38:31which is that if you're on any
- 38:32type of treatment,
- 38:33go ahead and know that you
- 38:35are eligible for the booster.
- 38:38Thank you doctor you,
- 38:39you've been quiet, you know.
- 38:41Is there a benefit?
- 38:41Should you do it after that?
- 38:43Your booster after six months or eight
- 38:45months you know people want to know.
- 38:47Would you wait six months or eight months?
- 38:49Well, so as a
- 38:50radiation oncologist it's very
- 38:52question for me to answer, but I would say
- 38:55if you the NCCN is trying to be
- 38:57as broad as possible, and so if
- 38:59you fit the category of of getting
- 39:02a booster right away.
- 39:04You know, I don't think there's a downside to
- 39:06going ahead and getting
- 39:07it now. Is there a rush?
- 39:09I mean there was.
- 39:09I think there was a question
- 39:11in there about a patient would
- 39:12just finish radiation treatment.
- 39:14Just finished chemo.
- 39:15I would assume if they had had their
- 39:17immunization within a couple months,
- 39:19it's OK to kind of recover from that.
- 39:20And and there's no extreme rush
- 39:23to get the the third booster,
- 39:25so I would say fit it in your schedule
- 39:27and your lifestyle and know that the
- 39:29NCCN is being broadened recommending
- 39:31the booster as soon as it it fits.
- 39:36Thank you, I'm going to switch to
- 39:38the question answers, let's see.
- 39:39Uhm, perhaps I don't know Kim,
- 39:41do you want answer this?
- 39:43When are we going to have
- 39:45psychosocial services?
- 39:46I have nerd not heard
- 39:47of any or offered any.
- 39:50Oh OK, thank you.
- 39:51I'm so I'm so sorry that you
- 39:53haven't been offered psychosocial
- 39:55services due to the pandemic we
- 39:58have had to alter the way we
- 40:00offer a lot of those services,
- 40:02but we do have a lot of our social
- 40:05work team back in our clinic areas in
- 40:08some capacity to meet with patients.
- 40:11And then they also have the ability
- 40:13to meet virtually with our patients.
- 40:15So if you have not I, I really apologize.
- 40:19We're happy to follow up specifically.
- 40:21And then also on our Yale Cancer Center site,
- 40:25we have all of our listings of
- 40:27our integrative medicine offerings
- 40:29that are all done virtually now.
- 40:31And we actually saw that patients
- 40:33liked to do a lot of these things
- 40:36like meditation and yoga,
- 40:37right from the comfort of their home.
- 40:39So we still have those.
- 40:41And along with our support groups,
- 40:42so we have a, uh,
- 40:44a series of many different support groups
- 40:46and those are being provided virtually now.
- 40:49I know that some people.
- 40:51May not have all the technology
- 40:52they need and we are very sensitive
- 40:54to that and we are trying to bring
- 40:57those services back,
- 40:58but we're also trying to make sure
- 41:00we still maintain safe distancing.
- 41:02Social distancing in our clinical areas,
- 41:05and so it is a balance and we
- 41:08appreciate our patients flexibility
- 41:09through this and but please know that
- 41:12we want to provide these services.
- 41:15We have our our entire multidisciplinary
- 41:18multi departmental team here
- 41:20to take care of you.
- 41:21And we apologize if those
- 41:23services have not been offered,
- 41:24and again,
- 41:25happy to follow up individually
- 41:26and and make sure you're connected
- 41:28with the resources that you need.
- 41:31Thank you and our Renee.
- 41:34God has already put a couple
- 41:35of links on the integrative
- 41:36Medicine Office offerings
- 41:37and support group structure.
- 41:39Less for do you wanna add
- 41:41any more information?
- 41:41I thought it was pretty comprehensive,
- 41:43but if there's something
- 41:44else you'd like to add
- 41:45right now, can get such an amazing job.
- 41:48Yeah, I was just speaking to one of
- 41:50our social workers and she echoed.
- 41:51Exactly what this cluster referred to,
- 41:55and this psychosocial gaps are a common
- 41:59theme and cancer survivorship throughout
- 42:02the country not making excuses,
- 42:06but simply sharing that this is an evolving
- 42:09area that we're continuing to to to work on,
- 42:13and it it it really necessitates using
- 42:17both university and academic resources.
- 42:20In addition to also liaisoning with our
- 42:23community of mental health resources so,
- 42:25so you're going to see that that that
- 42:28theme continued to be discussed and
- 42:29we would love to partner with you to
- 42:32additionally understand the gaps that you
- 42:34have experienced so that we can make it
- 42:36better for you as well as other patients.
- 42:39Thank you, I'm also looking at questions
- 42:41that we've received beforehand.
- 42:42There was a question on I am a patient at
- 42:45Smilow Cancer Hospital in Waterford and
- 42:47there are eligible for the third dose,
- 42:50but I think the vaccine appointments
- 42:52are not available in New London.
- 42:55When will they be available?
- 42:56They could only find an option in Trumbull,
- 42:58so these are Kim or Kevin.
- 43:00Would you like to take that one?
- 43:03Sorry, it's quite specific.
- 43:04I know this might always keep
- 43:07saying yeah, I might.
- 43:08Maybe I can take that. Thank you
- 43:10Doctor Deshpande. We are. We're
- 43:12administering vaccines at a Northeast
- 43:15Medical Group site in New London.
- 43:18It is available periodically so
- 43:20I I think maybe please do check
- 43:23back on the website but I as of.
- 43:26As of yesterday, I believe we were.
- 43:27We were vaccinating there and it's
- 43:29been available for for about a week
- 43:31so I just please do check back.
- 43:33It is available.
- 43:34OK. Thank you so much. There are a
- 43:37lot of questions around antibodies.
- 43:39Should you be checking on antibodies?
- 43:41When should you do the third dose?
- 43:43So maybe someone who's a very
- 43:45good immunologist can take this.
- 43:47One is for this. Who's going to be
- 43:50brave enough to answer this one?
- 43:51I think we know the answer is no,
- 43:53you shouldn't,
- 43:53but I want someone to answer the question.
- 43:55I'm happy to you know,
- 43:57should you be doing routine antibody
- 43:59tests after your second dose,
- 44:02patients with multiple myeloma?
- 44:04Should they take their response
- 44:06to the vaccine so not everybody
- 44:08raise their hand all at once.
- 44:10I think this is,
- 44:11I think this is a doctor Huntington
- 44:13and Lisa Barbara question first.
- 44:18I could do the broad
- 44:19strokes cotton you could fill in through
- 44:21details so you know the CDC and our.
- 44:24You know our oncology national groups do
- 44:27not recommend routine antibody testing as a
- 44:30means of measuring response to vaccination
- 44:33or kind of advising on timing of third dose.
- 44:37There's a variety of currently available
- 44:40antibody tests and there's not a real
- 44:43standardization in those tests which make
- 44:46it difficult to implement one standard.
- 44:48So outside of the context
- 44:50of a research setting,
- 44:52we're not recommending antibody
- 44:54testing for our patients today,
- 44:57and so I think one of the questions was,
- 44:59well, how do we, you know,
- 45:00have this information that advises
- 45:02these third doses and the answer to
- 45:06that is that antibody testing was done
- 45:08in the context of big research studies
- 45:11in labs that are doing good antibody
- 45:14testing and have given us this data.
- 45:17And we're hoping to learn more.
- 45:19This is obviously a very hot topic,
- 45:21and I think one that will continue
- 45:23to learn more about and ultimately
- 45:25hopefully have some standardized
- 45:27testing in the near future.
- 45:30But Scott,
- 45:30I don't know if you want to fill
- 45:32in any other because we just don't
- 45:35know how to interpret with the
- 45:37antibiotics mean in terms of whether
- 45:38that's clinically relevant and
- 45:40whether we should be tailoring a,
- 45:41you know,
- 45:42not giving a third dose to
- 45:43someone that has antibodies,
- 45:44and so the antibodies weren't really part of.
- 45:48Now giving a third dose and broad
- 45:50booster regiments if you think
- 45:52about other nations like Israel,
- 45:54and so I think the data that supports
- 45:57what we're doing is not really
- 45:59requiring the antibody levels.
- 46:01We do have ongoing clinical
- 46:02trial or not clinical trials,
- 46:04but observational prospective studies
- 46:06available for patients with blood cancer.
- 46:09So certainly folks that are interested
- 46:11in kind of contributing to science,
- 46:13and we have that available
- 46:16to get antibody test.
- 46:17But after the second dose.
- 46:20And also after the third dose
- 46:21in that month thereafter.
- 46:23So try and take them while you're
- 46:24answering all the immunotherapy.
- 46:26How long should I wait after receiving
- 46:28immunotherapy to receive the booster?
- 46:30Yeah, so you know, I think these are
- 46:32broad strokes in the sense that we
- 46:33do think that most of our patients
- 46:35should be having a third dose.
- 46:36The actual nuances about when the
- 46:38best timing is is really I think the
- 46:40discussion that many folks should
- 46:42have with their treating provider,
- 46:44particularly those unactive cancer therapy,
- 46:46including immunotherapy.
- 46:47There's some medications,
- 46:50and I use where I would typically
- 46:51try to wait three months,
- 46:53perhaps even six months after,
- 46:55because that blunt antibody response,
- 46:57but for other therapies it may be
- 46:58best to give it right, you know,
- 47:00during treatment.
- 47:01So I think those sort of questions
- 47:03you're seeing your provider regularly
- 47:04on treatment definitely ask them
- 47:06about the timing of the third dose.
- 47:08Thank you Lisa. Thank you, Scott.
- 47:11Anyone else? Anything else?
- 47:12We want to add Doctor Deshpande, anyone else?
- 47:15OK, Doctor Lustberg,
- 47:17there's a question here or whoever
- 47:18wants else wants to answer.
- 47:20This was received prior on a prescription
- 47:23drug for psoriatic arthritis tremfya.
- 47:26Their primary care has
- 47:27recommended an additional dose.
- 47:29Can they schedule an appointment for an
- 47:31additional dose of the Moderna vaccine?
- 47:33I'm going to hazard, yes,
- 47:34'cause it's a immunosuppressive,
- 47:36but I'd like someone else to just.
- 47:38Confirm yes, that's that's correct.
- 47:41Alright, good thanks Yep.
- 47:44Thank you,
- 47:45can I just add on the scheduling website?
- 47:48There is a list of immunosuppressive drugs.
- 47:51It's not a comprehensive list,
- 47:52but it does provide some guidance
- 47:54if patients are wondering if the
- 47:56drugs they're on meet criteria,
- 47:57and if you're unsure,
- 47:59I think Renee included
- 48:00the call center number on the list
- 48:02and you can also consult with your
- 48:05provider that prescribes that
- 48:07medication to get guidance,
- 48:09right? Yeah, I did actually check that list.
- 48:12Trump fire is not on it. So again,
- 48:13to this point it's not comprehensive.
- 48:15But it is a interleukin 23 inhibitor
- 48:17I think, so it it it it buys.
- 48:19I mean it's it suppresses your
- 48:22immune system so absolutely.
- 48:24There's a question also on.
- 48:26I've received my third Pfizer
- 48:28shot outside of the system.
- 48:29How do I mark that on my chart?
- 48:32I think that's a good question,
- 48:33and if someone can sure
- 48:35yes. I mean the nice thing about as long as
- 48:38you receive that in the state of Connecticut,
- 48:40there's a there's a statewide database
- 48:43that every vaccine provider sends data to.
- 48:46And as of about two months ago,
- 48:49I believe our Yale New Haven
- 48:52Health version of EPIC downloads.
- 48:54All the data, so it doesn't really matter
- 48:57whether or not you got it through us or or
- 49:00someone else in the state of Connecticut,
- 49:02those data are automatically
- 49:04populated and will show up in epic.
- 49:06Now if you did get it out of state.
- 49:10I believe we have a process through my chart
- 49:12that we're working on putting together.
- 49:14I don't know that it's it's fully baked,
- 49:17but if you if you did receive it somewhere
- 49:19anywhere in the state of Connecticut,
- 49:21that data will automatically
- 49:22show up in an epic.
- 49:24That's wonderful, I think this is,
- 49:27you know, I'm still grappling my
- 49:28and I think many of us are still
- 49:30understanding about the third dose.
- 49:31But someone asked when will
- 49:33you need another booster?
- 49:34How many months after Will
- 49:364th doses be recommended so?
- 49:38Really insightful questions.
- 49:40I'm from Doctor Deshpande.
- 49:42You're going to take that one again. Also,
- 49:44I I can get. I can hazard a guess.
- 49:45I mean, I, you know, I think the the key
- 49:48thing is these vaccines are are great,
- 49:51but I think one of what we are
- 49:53seeing is that as the virus changes,
- 49:56the vaccines that currently that
- 49:58were initially programmed may be less
- 50:00effective against the the changing
- 50:02physical nature of these viruses.
- 50:04So I think the question about when are we
- 50:06in need another dose depends on how the.
- 50:09Pandemic looks globally if another type of
- 50:13variant of of of COVID-19 evolves at that.
- 50:17Against which our current vaccines
- 50:18are current or less affected.
- 50:20You know, on the positive side,
- 50:21these companies have the ability
- 50:23to so called, you know,
- 50:25essentially reprogram the vaccine
- 50:27fairly quickly and trot out new
- 50:29versions as the as the virus evolves.
- 50:32We haven't seen that the second
- 50:33that you know,
- 50:34the 2.0 version of these vaccines yet,
- 50:37but just the nature of especially
- 50:38the M RNA technology,
- 50:40is such that the time to develop a
- 50:42a the next version is very rapid,
- 50:44so it it really depends on when as the.
- 50:47How the pandemic goes,
- 50:48but it might be a year from now.
- 50:50It really depends on what vaccines
- 50:51were there variants excuse me,
- 50:53arise
- 50:53yeah and I think part of it of
- 50:55course depends not only on what
- 50:56the variants arise of course,
- 50:57and also how in Connecticut has done
- 51:00a fabulous job on things like social
- 51:03distancing and respiratory's and all
- 51:04the protection and hand hygiene.
- 51:05So again, I think good questions.
- 51:08Things will will keep these forms going
- 51:10to just keep all of you informed.
- 51:13Thank you Renee for putting
- 51:14the phone number 833.
- 51:16Ask why NHH for vaccine information and.
- 51:18To schedule the website information is there,
- 51:22I think the last there's another
- 51:23question about I've had two Pfizer
- 51:25shots and the booster and they
- 51:27never got a physical reaction.
- 51:29And I think a lot of us, you know,
- 51:31think that we get a physical reaction.
- 51:33I'm forming antibody.
- 51:34How true is that?
- 51:37Doctor Deshpande, I think you're it. OK,
- 51:40yeah, it it. Actually you know,
- 51:43I think the the physical reactions,
- 51:45the side effects that
- 51:46that you may experience.
- 51:48Our confirmatory,
- 51:49but they are not required,
- 51:50so the the it's it was very well
- 51:53characterized that there were
- 51:55individuals who really, you know,
- 51:57went through the the two dose series
- 51:59without any issues with really feeling.
- 52:01Just great not having anything and
- 52:03they absolutely had equivalent or
- 52:05the same sort of protection in terms
- 52:08of getting symptomatic COVID-19.
- 52:09And certainly you know,
- 52:11being hospitalized from COVID-19
- 52:12so the vaccines can protect you.
- 52:14The fact that you don't have these
- 52:16reactions doesn't really mean anything.
- 52:18Doctor Huntington, Dr Billingsly
- 52:20anything else you'd like to add for
- 52:22our cancer patients in regards to that?
- 52:28No, I I do want to make sure.
- 52:31Have we touched on any questions
- 52:33about the Johnson and Johnson vaccine
- 52:35we did be talking. There were a couple
- 52:37longsword addressing that
- 52:39a little bit because I.
- 52:42I have gotten some questions
- 52:43from my own patients about that,
- 52:45and it's a small number and I I just
- 52:48do want to underscore to our patients
- 52:50and families that there will we that
- 52:53if you've had J&J you've not been
- 52:55forgotten and there will be more
- 52:57information coming very quickly.
- 53:01I think I'd just like to add
- 53:04that even with a third dose,
- 53:05there may be patients out there
- 53:06that they don't have a response
- 53:08to the antibody treatment,
- 53:08and I think we're really fortunate
- 53:10enough to have a backup,
- 53:12which is the monoclonal code
- 53:14antibody therapy that I think
- 53:15Gail's done a really good job.
- 53:17Integrating into the care of patients
- 53:19with cancer and without cancer.
- 53:20And so if there's any concern of COVID
- 53:23when they've been vaccine or not,
- 53:25vaccinate getting tested
- 53:26and if it's positive,
- 53:28calling your provider kind of immediately
- 53:29to get the monoclonal antibodies.
- 53:31I really think reduces hospitalizations
- 53:33and likely saves lives in
- 53:35particularly these vulnerable
- 53:36patients that they may not respond
- 53:38even through the three vaccines.
- 53:40So I think that that's important.
- 53:43Any closing words from doctor
- 53:45you came slosser others any other
- 53:47closing words from all of you eye
- 53:49on things we haven't covered?
- 53:51I covered a lot.
- 53:52I have to tell you there
- 53:53were a lot of good questions.
- 53:55I would just say that that for those
- 53:57of you at home who are wondering,
- 53:58you know, do I delay care because
- 54:00I haven't gotten the booster
- 54:01or this or that.
- 54:02Please know that the hospital
- 54:03is a very safe place to be.
- 54:04Do not delay your care if you
- 54:07have any uncertainty, talk
- 54:09to your care provider.
- 54:11But cancer is. Is a very
- 54:13important thing to get treated even
- 54:15when there's a COVID virus floating
- 54:17around, so do not delay your care
- 54:19and we're here for you.
- 54:20Thank you, doctor you.
- 54:21I think doctor Lustberg.
- 54:22I think you commented earlier in
- 54:24the the hour about how we saw delays
- 54:27last year and that we're seeing on.
- 54:29So please, please, please do your cancer
- 54:32screenings if your or your surveillance.
- 54:34Those are important.
- 54:36And then Mr. Armstrong.
- 54:38I think we did it. You know,
- 54:39if if it isn't clear enable reach out.
- 54:41But no, we're not testing for.
- 54:43Antibodies after the vaccine
- 54:44to see how we responded.
- 54:47Once again thank you to
- 54:48all of you for joining in.
- 54:49We will keep these as as repeating
- 54:52sessions as we learn more as hopefully we
- 54:55understand more about the booster for J&J,
- 54:57or as we hear more about cancer,
- 55:00people who care givers and
- 55:01then they would be eligible.
- 55:02'cause I sensed a lot of
- 55:05questions around that.
- 55:06As always,
- 55:07please reach out to us as
- 55:09cancer answers at yale.edu.