Specialists at Penn Medicine answer questions about cancer care during COVID-19, vaccination of cancer patients, and current research surrounding cancer and coronavirus.
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thank you all for joining this afternoon. I'm going to spend a few minutes talking a little bit about ccn journey. All of you. I think you're familiar with the National Comprehensive Cancer Network or N C. C N. I'm gonna tell you a little bit about their activities around Covic on covert vaccination. The problem that we're going to talk about today, that we've all been confronted with is how best to use a limited vaccine supply the maximally benefit cancer patients. And we'll talk about that steps. Um, the CNN for a covert task force, which I've been part of in March last year in the spring, we met every week, met a little bit less frequently over the summer and then started to meet more frequently in the fall on that allowed the 30 SEC and centers to get together and talk a little bit about what they were doing in each of the centers because there was very little data out there to tell us what to do. I found this extremely helpful, and we all brought back to our institutions what we have learned that those sessions when Covic vaccines became available and it appeared that they would be available for cancer patients. We rapidly formed on NCC encoded 19 vaccination advisory committee, which I also had the privilege of serving on on January 11 on it was pulled together, literally with 24 hours notice we had to chair Steve Burgum and Lindsey Baden, both infectious disease specialists. Feed from the Hutch and Lindsay begin from Dana Farber Brigham Women's Cancer Center. And there was a broad membership on the advisory committee, including bioethicists, which turned out, I think they'd be very important. We worked pretty hard, and 11 days after we first met, we completed guidelines and NCC and vaccination, which I'll talk about and posted it on the N. C. C n website on January 22nd, we stated at the beginning that it was meant to be a living document that we would alter as new data became available and in fact, in the document had the quote do the limitation in perspective data. Relating the vaccination used in patients with active malignancy recommendations are based on the expert opinion of the committee, and that's just acknowledging the fact that we were making recommendations with unfortunately, very little data. What did we know about how to prioritize their patients with the national Academies had come out with a risk stratification for equitable allocation of vaccine. And they had four criteria. The risk of infection. So morbidity, these negative social impact and the risk of transmission to others. The N c C n modify those risk factors and said, In addition, the cancer specific factors the patient age, the patient, co morbidity, ease and social and demographic factors included poverty, limited access to health care and underrepresented minorities could all be taken into consideration. I will say that we spent ah, long time talking about a number of both practical and ethical considerations. And as I mentioned, we had bioethicists on the committee with us and we ask questions. And these are just two examples. You vaccinate high risk patients on the human logic malignancy. Patients are most high risk, though their chances for good response to the vaccine might not be great. Patients who had technologic malignancies or those who are receiving anti C 20 therapies such as retouched the math, do you vaccinate patients at highest risk even if their life expectancy is short, or do you vaccinate patients at lower risk with the higher likelihood of long term survival. You might have a patient with advanced lung cancer who projected survival might be measured in several months. Might be older, with co morbidity. Ease and is an extremely high risk to die from cove it if you were to become infected. But then you have a patient with testicular cancer. Young patient, 25 years old who is very low risk or moderately low risk to die of cove it but has an excellent all term prognosis. How do you best use limited vaccine? We acknowledge. As I mentioned that there was really no good vaccine data on cancer patients on active therapy on, we had an obligation to generate those data. We are trying to do that. We did say that there were no obvious safety concerns for cancer patients receiving the vaccine, and the efficacy of vaccination in different cancer populations was unknown. So we made the statement that patients with active cancer on active treatment or increased risk of complications and should be prioritized. We wanted a simple and rapid approach. The vaccination and Lin Lindsey. We're gonna talk about the pen approach on. It's important for it to be agile and fast, and we wanted to include racial and ethnic minorities and other high risk groups. We also made the statement that caregivers and household contacts should be considered for early vaccination, but they were not prioritized along with cancer patients. But obviously we didn't want people bringing Cove it into a Now you know, unlimited supply of vaccine. Everybody should be vaccinated tomorrow. I think we would all agree with that. But the degree of availability of vaccine will affect the prioritization specifics, and that was different for every medical center and every cancer center around the U. S. We all agree that vaccine should not be wasted. Um, if you had available vaccine, it has been thought it needs to be used that you have patients there. They should be vaccinated. The vaccine should make it into their arms. The sooner patients were vaccinated, the better. We also have an appreciation that for some centers like Penn, which is a matrix cancer center, we would need to share priorities with non cancer patients, patients who had undergone solid organ transplant or who had other immunological disorders. So this is the chart that the N C C n came up with and they didn't provided the patient's up into those with technologic malignancies and solid tumors, human logic, malignancies and acute myeloid leukemia induction. They said you should wait until a NC recovery, and the reason they said that was not because of fear of vaccinated with a low, cute, uh, absolute new triple count. But the fact that they're lymphocytic immune system was also greatly suppressed during this time. Likewise, for transplants or Carty patients, they recommended waving at least three months post transplant for recovery of ideological function from marrow failure. States like on DS, they said vaccine available and for all others, including patients who are on drugs like tucks. A map vaccinate vaccine available for the solid tumor malignancies. Anybody receiving cited toxic chemotherapy should be prioritized. Those patients receiving targeted therapies should be prioritized patients receiving immunotherapy. Such a checkpoint inhibitors should be prioritized in those receiving radiation should also be prioritized now. There were a few considerations that we also spoke about. We felt that solid tumor patients should be vaccinated regardless of where in the chemotherapy cycle that they are. We didn't think that there was any data to say that made a difference that could be vaccinated in the treatment day during their nater. Even with homicide of tenia, we do bone marrow's and patients. We promise I'd up anywhere. You ought to be able to stick very small needle into somebody's arm. The patients is there. A vaccine is available, vaccinate and don't take into consideration. Well, they're gonna finish their chemotherapy another four weeks. Maybe we shouldn't wait. We recommended vaccinating. Assume this vaccine is available for they mentioned. For patients with human logic, malignancies, drugs like tucks, a map should not be a contra indication that we were not certain about what the responses would be and likewise with failure With marrow failure states, we also addressed clinical trials, and we felt like unless there was a very specific scientific reason that for not to vaccinate, the patients enrolled in political trial should be offered. Vaccination and vaccination should not be an eligibility disqualifier for enrollment in a trial. Now, clearly thes factors needed to be negotiated with sponsors of the trials, but we felt quite strongly about this and made a statement. So what's happened nationally? Well, vaccine supplies, as you know from reading the paper have very greatly by state, by county by city, and that's true in Pennsylvania as well. And rules are very greatly by state, county and city. When we talk to our colleagues in New York for Utah or California, government regulations have a lot to say about who could be vaccinated and when. We have to fit our priorities and our schedules around that the logistics are complicated and everyone's doing their best. Lynn and Lindsay, you're gonna talk about the logistics in vaccination rates and who is getting vaccinated has very greatly again from state to state and even within states from county to county. So with that, I'm gonna turn it over to Lin, who's gonna talk about, um, our experience of 10 on how we've sorted out the details and move forward. Then thanks, Larry, and thank you all for joining us today. Actually, I did. I haven't read the details, but I understand that there's been assessment of how states are doing it rolling out their vaccine programs, and the data on Pennsylvania is not so great. So I think we have a lot of work to dio about getting this vaccine out to our patients. Eso I really want to focus on the safety and the recommendation that our patients with cancer should be receiving the cove in 19 vaccine next slide. The goal is Aziz, Larry mentioned, is to vaccinate as many patients as quickly as we can. But we have to follow. Actually, really, you know pretty strict guidelines about where the vaccine is being distributed. Vaccine availability. As you know, there's different storage requirements. The Pfizer vaccine requires very specific freezer storage, and so not every site can handle the Pfizer vaccine. The modern A vaccine has different storage, and it makes it or available at community sites and other sites that don't, you know, not based at the hospital we have. Ah, uh, wayward vaccinating here at our site is with some staff but a lot of volunteers. And so this is logistically, as Lindsey will go through. I'm quite a challenge to get thousands of patients through the doors each day. Next slide. So in Pennsylvania and New Jersey, the guidelines say, for people over 65 they would qualify in general for the cove in 19 vaccine. But in addition, people with cancer are on that list and then patients who have an immuno compromised system because of prior treatment. No prior therapies that are on high dose steroids and then we've included and Philadelphia's included sickle cell disease, Azaz, um high risk group and sickle cell patients are high risk because their spleens don't function well, and so they are increased risk for infection. X slide Andi, These are next slide shows the guidelines in Philadelphia, which is a different age on. But then cancer is also listed. So the important work that NCC ended and then what we've looked here a pen is to try to say, Well, if you just said cancer patients, that denominator is quite large, and so then even within cancer is important to prioritize. Who are the patients at greatest risk here that we should prioritize vaccine because it is limited supply on DSO. How the prioritization works really is who are the patients, not that are increased risk for getting cove it, but really, there is now emerging data over this past year about which patients with cancer have the highest risk of complications from cove. It so complications meeting, needing for oxygen, requiring hospitalization and the increased mortality. So the CCN guidelines and our own guidelines that we've developed here at Abramson Cancer Center is really taken into account. Who's at greatest risk for complications of the virus? Eso the next slide. So we've looked at the data on DLA very, actually just spoke to this, but it is any patient with cancer over age 65 because older people now I mean, I'm almost in this group but are a greater risk for complications of Cove it, um, than anybody on active therapy. So that's regardless of stage. But if somebody is not active, treatment important. Thio offer vaccine to this group of patients before somebody say is a 10 year survivor from breast cancer, maybe on hormonal therapy. Patients with advanced cancer metastatic disease have also been shown in many studies that increased complications from COVITZ. So these air group of patients that are really high risking we were prioritized then, in general, patients with he malignancy, regardless of treatment, could be prioritized to receive the vaccine. This is again because patients with him malignancy patients with CLL, even who are not on active treatment, have B cell dysfunction and our greatest risk for complications, and then many studies have looked at patients with lung cancer. This could be related to underlying lung disease or prior radiation therapy. But patients in general with lung cancer seem to be, ah, higher risk. So these air, the group of patients that we've identified as highest, risk that as we're rolling out invitations for vaccine, we would prioritize this group and then, as I also mentioned, were also doing a lot of outreach to our patients with sickle cell and actually fallacy. Mia. It's the same issue next slide. So this is what you know. We all want to be speaking with the same voice. Which is to say that this Covic vaccine vaccine the two that are FDA approved thus far are safe now, of course, we are saying to patients as we're enrolling them, that this is approved through the emergency use authorization. So this is early access. It hasn't had the full FDA approval that takes many more months and longer follow up. Um, but it's through the EU a emergency use authorization that this vaccine is available on that we think this is safe and that were strongly recommending it to our patients who have cancer. And this is Aziz, Larry just showed, is supported by national guidelines. We're emphasizing patients on active therapy now. The question is, Is the vaccine going to be as effective as patients who, with patients who are on chemotherapy is certainly chemotherapy? Steroids suppress the immune system? Um, where we've studied this. We've actually had extensive studies in patients who are getting flu vaccine. We've evaluated patients getting flu vaccine who are on chemotherapy or immunotherapy, and their in their response to flu vaccine seems to be quite robust, so but it's possible that in patients who are, you know, severely, I'm compromised because of treatment that their immune response won't be as robust. But still, whatever response is occurs is predicted to be of benefit. And, as Larry said said, there's no issue about the timing of getting the vaccine and relationship to treatment. So there is no you should get it, not when you're getting the same day of treatment or trying Thio predict at a nadir. We have given flu vaccine and I'm sure you have too many patients who are getting treatment that day and get the flu vaccine and we have the experience already of giving this vaccine too many patients who are getting the vaccine same day as treatment. There are a few exclusion criteria. So in general there's a recommendation that individuals who have had a prior cove in 19 infection they should wait 90 days before receiving the vaccine. And that's CDC guidance. In part, this is that these patients who have had a cove in 19 infection really are protected and so don't need the vaccine right now. And so making the vaccine available to others and Keith Hamilton mentioned to us today who is an infectious disease. There may be some preliminary data that the response to the vaccine and people have had recent infection may not be as robust. So in general went possible. We've wait till 90 days after documented Kobe 19 infection. And then there are certain caveats around patients getting bone marrow transplanted car T cell in terms of waiting, you know, in general, for people have had an AL a transplant. We do wait a certain number of weeks or months before we give them their new vaccines because their immune systems are not capable. So there's specific guidance around. I mean of the vaccine and people who have had a bone marrow transplant or car T cell. And then there's general guidance again from the CDC that people who are having that have major surgery should wait two weeks after their surgery day to receive the vaccine next slide. No, many of you have received the vaccine, so you know, firsthand the side effects. But just to run through this because this is important as we're educating our patients, this vaccine is reacted genic. So when people get the vaccine, they can have side effects. But that is actually showing that their immune system is working. So there are local reactions, which is pain and tenderness at the injection site. But there are systemic reactions, and this is more than flu vaccine, So fever occurs and fever occurs commonly. After the second dose, this temperature could be 101 102. It does seem that younger people are having mawr of this febrile response, but fever, headache being Malays, muscle pain, and I do think this is important to mention lymph edn. Apathy is really being reported, and I had a patient text me last night. She had a second dose of vaccine on Friday. He had the vaccine, her left arms and enlarge lymph node under her left arm, and she was freaking out that it was recurrence of her cancer. Andi, we've had many of our nurses have experienced the same thing, so this can happen. It's the same arm where the vaccine generally is administered. Thes side effects will disappear within, you know, a day or two of getting the vaccine, and they can start roughly about 12 hours after the vaccine. We don't recommend that people get pre medicated, so we don't recommend that people get Tylenol or Motrin non steroidals prior to a vaccine. But if they do develop symptoms of from the vaccine, it's safe to take Alan are Motrin. If otherwise, it's safe for them to take it. It doesn't interfere with the success of the vaccine because I said, reactions occur most commonly after the second dose. And still Anna Phil Axis is really rare. Millions of doses have been administered at this point. They've been 31 cases at all. Those people have recovered next life, and this was just last week that there was a report of I t p so immune from beside a pina whether it followed a cove in 19 vaccine. So this question was raised. Could the vaccine cause I T. P you know, there was that sentinel event that occurred there was a physician in Florida who received the vaccine and several days later had a drop in his platelet count. So this is what we know. And this is information from Adam Suker, who runs are benign team section that as of January 31st, there were 36 cases of I. T. P reported into this US Vaccine Adverse event reporting system following Pfizer and moderate a vaccine. And Adam points out that I tip is common and there are the incidents is six cases per 100,000 and doing a back of the envelope type calculation. About 33 million people have already received one dose of the vaccine. We would expect in this time frame to receive at least 2000. Excuse me to have seen at least 2000 cases of I tip, so it's not clear that this vaccine is causing ITP. Some of these reports of ITV happened within days of getting the vaccine and That's not what the biology is of I. T. P. When ITV follows a drug or a vaccine, it's typically takes weeks to develop anti platelet I G antibodies. So I would say there's more work to Dio and Adam Suker's recommendations, and we agree with him Is that in the meantime, we can say yes. Um, I t P if Kobe vaccine causes I tp, it's extremely rare, but it's certainly not clear that there's a causal relationship at this point. And clearly the risk benefit is in favor of receiving vaccine and risk of dying from co vid. Infection far outweighs this potential risk of I. T. P Next life. Just a couple of other things about education for our patients. So in particular this issue of fever and chills. So we have seen a lot of fever and our staff and in our colleagues. So this is particularly an issue in our patients on chemotherapy who might develop a fever related to baby, a low white blood cell count and from their chemotherapy. So we certainly want people to report in fever if they could be at risk for getting an infection related to the treatment that they're on, and we just need to counsel those patients. So in a patient who could be neutral Penick, who received the vaccine and develops a fever, we may need to bring them in for evaluation. Even though it could be very likely that that federal event was related to the vaccine, some patients would still require evaluation, check their like blood cell count, make sure there's no action. So we certainly did not say that everybody, all of our cancer patients develop a fever should call us. But certainly if there is any concern or they're on chemotherapy and concern about a potential infection, they should give us a call. What about patients with low platelet count? We're not screening patients for platelets pounds before they get the vaccine on DSO. The volume of the injection is quite low, so we're not checking that, and we think it's safe. You know, if someone's gonna have a brief period of Toronto side of Penny and you want to wait a week, that's certainly fine. Just that we don't know when these invitations come available, either at the county level, you know, at a drug store or at the, um, you know health system. So you know, better to say yes and grab that. There may be specific concerns in patients with sickle cell. There were reports in some of our staff who have sickle cell who received the vaccine that may precipitate a pain crisis. It may need additional blood transfusion. So if you have additional questions about sickle cell patients that may be in your community, have included Farzana Siamese email. Here she directs Our sickle cell program is just happy to walk through this with you, but she's really recommending vaccine for our patients with sickle cell Unveil, See me next slide. So the most important point this is my final slide is to say that this is showing you the efficacy data of the vaccine and highlighted in yellow. The purpose of people getting this vaccine is that it is protecting people from needs for hospitalizations and death, and you compare the placebo or treatment arms. And these vaccines are incredibly effective in preventing serious complications of cove it. So I think they're very similar between Madonna and Pfizer. You know, after the Pfizer vaccine, you have about 50 to 60% protection after the first dose about 98% percent protection after the second dose. But the important thing and why were strongly recommending covert vaccine is that it really is protecting from hospitalizations and death and important that we also mentioned that for our patients when they get the vaccine, it's still important for them to maintain precautions. They still need to wear a mask. They still need to maintain social distancing. And so this is really important. We're going to get emerging data about which vaccine might be more effective against different variants. But that's an important part of the education Is that even if vaccinated, patients still need to wear a mask? So I'm gonna end there and I'm going to turn it over to my colleague Lindsey Z. Thanks, Lynne. So Hi, everyone. I'm gonna be talking thio about how we actually implemented oncology patient vaccinations at Penn s. Oh, really? During the end of January, we began 10 day soft pilot for oncology patients to be able to receive their covert vaccination at the Perlman Center for Advanced Medicine. And that's our outpatient facility that's really located across the street from the Hospital of the University of Pennsylvania. Where are Cancer Center location at the Perlman Center is located. And so the purpose of the pilot was really to be able to test our 15th floor of the Perlman Center, which is really a non clinical location that has been being utilized for employees vaccination since December. The purpose of the pilot was to test that location as a potential site for mass patient vaccination at Penn, Um, just to paint the picture of the backdrop for the pilot. It was quite the burning platform due to concerns about maintaining our supply from the city. We have less than 24 hours to plan and implement the pilot. From the time we were notified of the ability to vaccinate patients to the time that we actually administered our first dose of vaccine to a cancer patient at 10, all in, it was probably closer to 12 12 hours to prepare. So we had to really assemble a very large multi disciplinary team too quickly, engage in super rapid implementation planning. Obviously, as you could imagine, much of this was on the fly. We had a really ah, lot of need for quick turnaround from a data perspective as well as an education perspective on day. All the while, we were sort of approaching this pilot trying to plan for longer term sustainability and turnover of the operations to a more centralized management system are infusion. Nursing leadership was really critical in this process, and there was a team of nurses that were helping toe lead the rapid planning and patient education and coordination as well as the implementation efforts even go to the next line, please. On the next one, eso We essentially started the soft pilot process with a manual invitation process to invite patients to receive the vaccine, and this was because our Elektronik scheduling and R E M R department builds actually weren't weren't live in the system for this type of scheduling. And so we began on the first day really engaging in targeted patient outreach with the patients that we thought would be most likely to come in on such short notice, which was really just starting with verbal invitations in the infusions we with treatment patients that were already here for a treatment visit. And I think this worked well because obviously we were targeting some of our highest risk most vulnerable patients that were on active treatment, and they were also already here. But we very quickly realized that we were not going to be able to fill all of our vaccine slots with that approach. So we quickly progressed Thio phone call outreach for a broader group of high risk cancer patients that are living in Philadelphia. And so this manual invitation process was really a collaborative effort between leadership, the providers and their care teams on. Basically, what we did is we would have providers identify lists of their patients who lived in Philadelphia and met the criteria. And then they or someone on their care team either their A. P P or their administrative assistant or there are n would call the patient to determine whether or not they would be interested in receiving the vaccine on Ben. From there, we actually centralize the pilot scheduling to a core group of individuals who would contact the patient to be able to facilitate getting their their first vaccine here attend, should they be able to come in and meet the specific criteria in terms of our eligibility criteria for the soft pilot. Unfortunately, due to restrictions from the city related to our supply from the city. Patients did have to be residents of Philadelphia to participate in the pilot s o. The criteria that we established established collaboratively for the pilot was that patients had to number one be. Residents of Philadelphia also have cancer or sickle cell, plus anyone off the following, and you could see them listed. There was either age over 65 metastatic solid tumor, lung cancer patients, key malignancy or any treatment, systemic therapy or radiation treatment. Within 90 days, I could go to the next slide, please. So just to provide a little context of our vaccination site at the Roman Center, as I mentioned previously, our 15th floor is a non clinical area, and so this largely consists of administrative offices and conference space. But it's been being effectively utilized every day since early December as a as a mass employees vaccination site were able to vaccinate. About 800 employees per day at this particular location are projected daily patient capacity, which is part of what we were trying to test during the pilot was about 400 patients per day. Eso you're roughly able to do about half of many patients as you are employees at this vaccination site due to all the things you would imagine. There's just additional time related Thio, you know, increased amount of co morbidity is and other health conditions with patients compared to employees as well as transportation needs. Monitoring needs. Etcetera on git is staffed by a variety of roles across all levels, so there is entity leadership there every day. There's a variety of care team members that staff the site physicians, advanced practice providers, nurses, front desk staff and medical assistance. We have repurposed a lot of nurses that air in non direct care roles. They've been pulled from their home units in order to staff this space on Dwyer, also relying heavily on pharmacy staff as well as nursing students and college volunteers to staff the space in terms of the types of roles in the clinic. Um, there are a variety of roles, so there is obviously a check in and check out area immediately for when you arrive into the into the unit. From there, you're taking to a consenting station where patients or employees are then consented and have an opportunity to have their questions answered. From there, you progress to the next sort of phase of the layout, and that's where you're actually vaccinated by a nurse or by a pharmacist on Ben. From there you go into a monitoring room, and there are clinical monitors who circulate the room on DMA Monitor for reactions as well. A schedule, your follow up appointment for your second vaccination. Then we also have this critically important role of the flow monitor there. And so those individuals are typically tend to be leadership. Volunteers who are helping monitor the flow through the entire space. Go to the next slide, please. So in terms of our results, we vaccinated about 280 patients during the 10 day pilot. Other areas, just to give a little context that participated in the pilot, were patients from renal solid organ transplant as well as primary care. And we found that about 70% of our cancer patients accepted a vaccine appointment, and we were really impressed with that. It seemed to be number one much higher than we anticipated, and also much higher than the acceptance rate that we were observing in the other specialty areas that were participating in the pilot. We did include treatment. Patients for both medical oncology as well as radiation oncology on DWI also included patients from our other downtown hospitals, such as Penn Presbyterian and Pennsylvania Hospital. E think overall, the soft pilot was very successful. Our biggest wins. I think we're that we were able to prove that this employee vaccination site was actually very effective location for patients. It really has been incredible, Um, in terms of the flow and the efficiency of the operations on our patients and providers were just thrilled to be having the opportunity to vaccinate patients so much earlier than we had anticipated. Given that this was all occurring at the end of January, Um, it was also a really great chance to start to evaluate some of the really complex clinical questions that were arising. Um, and I'll sort of outline those next. So in terms of the challenges that we identified or sort of the lessons learned during the pilot patient navigation was and continues to be someone of a challenge, a zai mentioned. Our 15th floor is non clinical, and so it is not easy to find. Many patients do need escorts to make their way up to this location. It's quite far from our cancer center location, even though it's still in the building s. So we had to work a lot on patient, we finding both from a volunteer perspective as well as a signage perspective. Um, there's also a lot of complex scheduling coordination for cancer patients. So for cancer patient, in terms of their vaccination, you know the ideal time to schedule would be after their clinic visit. That way they would have the opportunity to talk to their provider first about vaccination. And then, ideally, we try not to send them in between clinic and infusion just because of the concern that if they are to be delayed in the vaccination area, they could theoretically missed their infusion. Um, but then the downside to that is sometimes, you know, as we all know, patients do get delayed in the infusion area. And then we were bumping up against the vaccine area, closing at the end of the day. So there was a lot of complex scheduling coordination for cancer patients, um, that we uncovered during the pilot and also a lot of clinical nuance. We had a lot of really good questions arise. And obviously there weren't always easy or straightforward answers due to the lack of available data. And both Dr Shulman and Doctor Shocker already touched on a lot of this, so I won't review it in detail. But the most common questions were about platelet counts. Anti coagulation. What happens if you're patient actually gets cove it in between the first and the the second dose, Um, lots about allergy history, in particular. Previous tax all real actions, which, of course, we see in our cancer patients a swell as concerns about pre meds and the timing of pre meds. And so those are the biggest questions that arose during during the pilot period. From from sort of a clinical management perspective, you could go to the next slide, please. So after the 10 day period, we transition to a centralized management system for vaccine invitations for the health system, and I asked, essentially implemented essentially managed algorithm to identify the highest risk patients across all specialties, so that included patients with kidney disease, diabetes, cardiac indications, etcetera, and this really became a health system effort again. This was still for Philadelphia residents on Lee at this time, although we do have applications pending for our regional locations that both Cherry Hill in Radnor. We are trying to beam or inclusive of non Philadelphia residents, but those are not yet approved at this time. Eso then from there are cancer center leadership was ableto work with, I asked, in order to incorporate our highest risk cancer criteria into this pre existing central prioritization algorithm. So here is sort of a summary of what we formalized for our highest risk criteria. It was at least one visit to human Craddock, Organon for cancer diagnosis or sickle cell in the past year, any one of the following so aged over 65 equal to or greater to 65 key malignancy, metastatic solid tumor, lung cancer and systemic or radiation therapy in the last 90 days, and then for our exclusion criteria, we were able to incorporate three elements so BMT within the last 90 days, Carty within the last 90 days, as well as covert infection within the last 90 days and filter those out so that those patients were not given invitations during during the centralized management system. Um, even go to the next slide, please. So, with the transition to this system. Essentially, the current seat now is that patients are sent scheduling tickets via our patient portal, which is called my pen medicine. And so to back that up, the primary mechanism of communicating with patients when it's their turn to schedule is a scheduling ticket via the patient portal. But to be able to back that up, we have outbound calls that are being completed for outreach to those patients that aren't enrolled in my pen medicine or those that are enrolled but have gotten a ticket to schedule but haven't yet actually engaged in the scheduling of the ticket. We do not have an inbound call line established for vaccinations at this time, and that's really to align and reinforced with our previous messaging to patients, which is essentially been, you know, don't call us. We'll call you when it's time to schedule your vaccine. Um, generally speaking, with the transition to the new system, they are not accepting decentralized referrals for oncology patients, with the exception of some special exceptions. So, for example, if we have a frail elderly patient here with transportation issues, they meet the criteria. We try and work to vaccinate them while they're here. And that, and that's really consistent with some of the NCC and guidance that that Larry shared earlier. We also are working on a system for the end of the day to help prevent vaccine waste, which is also consistent with some of the N. C. C N recommendations that Larry she shared earlier. And the reason is, you know, once that vaccine is completely thought, it can't go back in the fridge on DSO. That is one scenario where the city will allow us to administer the vaccine to a non Philadelphia resident. Aziz. We happen to have patients that are still here at that hour receiving their infusion treatments. Um, in terms of the current issues that we're still working through with the centralized system, you know, we're really relying heavily on my friend medicine enrollment as the key communication strategy here. We're very fortunate in oncology that are utilization of that patient portal is much higher than the rest of the health system and other types of patient populations that we're in a good starting point. But we are working on strategies as a health system to try and continue to push utilization of the patient portal as the primary mechanism for communicating with patients about vaccination. We're also trying to make our communication with patients more transparent when it is their turn to schedule. ESO, for example, Providers and care teams are now able to see in our EMR when an attempt is need to contact the patient for scheduling the vaccine so they can see that they received a scheduling ticket. Or they can see that an outbound call was made to try and contact their patient to schedule their vaccine. We have noticed quite a few patient requested address changes to Philadelphia residency that have happened since our health system communication that were only able to vaccine e Philadelphia residents. And so it's been interesting to observe how many patients seem to have newly moved to Philadelphia. We did have one patient even call to change their address, and the address given is actually the location of one of our facilities. So we've been sort of working through that. We've also seen challenges with patients receiving their first dose in the community at sort of the first place that offered them the vaccine on. Then they go back for their second dose in that location no longer has adequate supply to give them their second dose. So then they come here for their dose, and we find out that in fact, there do for Madonna. But we're only offering Pfizer right now. And so we've been trying to work on facilitation for those cases and getting those patients to a location within Penn that is offering the type of vaccine that they need to complete their sequence. We're also piloting some new phone menus at our regional sites on this is really to try and decrease the amount of inbound calls that our teams are working through related to vaccination questions. So essentially at these sites, when a patient now calls, they're able Thio, listen to a message that says, If you're calling about vaccines, press one, then they're taken to a new message that essentially reiterates our current vaccination system three invitation process as well as where they can go for more information. So the next slide, please. So the next slide is just an overview of where we are in terms of the locations that were able to vaccinate patients. Right now, you can see we're still in Phase one, and we're getting ready to transition to phase two. Hopefully soon. Um, essentially, right now, we're offering vaccinations to patients at all of our downtown hospitals. Chester County Hospital. Lancaster General is well, is Princeton on Ben? We hope to have the approval to vaccinate patients soon at our Cherry Hill and Radner facilities. And then phase three would be, ultimately the ability to try and vaccinate patients. Um, in our primary care practices, go to the next slide, please. So the last two slides, or just a little bit about what our communications strategy to patients has been through through all of this. And so you can see that in mid December we had the EU ways go through for the cove, it vaccines. And at that time we began employees vaccination. Our communication to patients initially was, we don't have any plans to vaccinate patients at Penn Medicine at this time. Um, in late December, we continue to see a really incredibly high volume of calls and messages, um, from cancer patients regarding Covic vaccines. Um, but we still had minimal cancer specific guidance from the n c c N N c D. C. At that time. Um, in the first week of January, we began our first communication mass communication to oncology patients at Penn VR Patient Portal and essentially just gave some very general high level information about the vaccine. On on the 21st of January was the first day of our oncology patients pilot for Cancer Center Patients that were Philadelphia residents on DWI continued to see a really high volume of enquiries. During the pilot period, our clinic staff began to do outreach to patients regarding Covic vaccination. Andare pilot really continued through the first week of February. And then, um, in the first week of February, we worked on mass distribution of a Covic vaccination F A Q document, and we've tried Thio in conjunction with our marketing partners. Get that out to patients via a variety of ways. And so we've been able to push communication about that document via our patient portal. We have uploaded that document to our Abramson Cancer Center Web page on. We've also worked on and continuing to work on this week, making sure that message is distributed across all of our cancer care locations. Through my head medicine, go to the next line please s Oh, this is just a little overview of what is actually in that patient communication regarding vaccination, and so it's really essentially divided into two parts. The first part is cancer specific information about vaccination. And so during that portion of the document we're really talking about, you know, Koven vaccination is safe for all patients receiving immunotherapy, chemotherapy, targeted therapy. Ondas, Lynne and Larry talked about. We're really trying to drive home the message that regardless of your treatment type, vaccination is still recommended on. We talk a little bit about how the you know the vaccine is safe, but the effectiveness might be different depending on your disease specific disease. In the specific treatment that you're receiving, Um, it talks about, you know, cancer patients. As a high priority population on goes into some of Penn medicines, limited ability to vaccinate patients beyond Philadelphia at this time on really reinforces the message that we will contact you when when we're able to schedule you. And so trying Thio to reinforce that message as much as we can. And Lin talked about this a little bit, but really trying to reinforce the message about cancer patients on active therapy. Those patients have to call the care team so that we know if they get a fever after they've received the vaccine. Because if they're on active treatment, we might need to figure out you know what else might be going on. Even though it, you know, it seems likely that that would be vaccine related rather than something else. We still have to sort of work through that differential diagnosis. And so the document also includes just some general covert vaccine information. So reinforcing again how it works, the importance of following up and actually getting that second dose of the vaccine, regardless of side effects experience what the common side effects experience are the fact that you cannot get co vid from the vaccine. That tends to be a big question both among patients and staff, as well as providing them additional resource is, should they want more information? So that's just a summary of what our communications strategy has been, um, to patients so far. And I think that concludes, um, my presentation and the whole presentation. And so I think we'll move to questions right now. Thank you, Lindsey. Thank you. So there was a question that just came up. And it comes from Trish, who asked, What was the percentage of employees who agreed to be vaccinated when offered the opportunity? Yeah, no, that's a great question. So I haven't I haven't seen the data on that in about two weeks. But I did see the data about two weeks ago broken down by by race. And there were a Z expected, some pretty significant disparities that we've been working through. But in terms of our white employees attended, the rate was about 75% our Asian employees. It was about 80% acceptance in our Hispanic employees. It was about mid forties from a percentage standpoint and then about 30 to 35% acceptance amongst our African American employees. And so we've been working on a lot of strategies as a health system in terms of working on, um, some of the racial disparities that were observed and expects and acceptance rates on Guy. I believe our intent is to try and apply those learnings a swell to our to our patients in terms of acceptance rates. Have any other questions for speakers, It looks like we dio if a patient from the outside, Philly gets a dose of extra vaccine. Are they able to get a second dose? We, we are following through on our commitment in terms off if they for a patient that is non Philadelphia and they happen to be one of the fortunate ones who there's there happens to be unused dose that night, and they are able to receive the vaccine. We are then scheduling them for their second does. Even though they're non Philadelphia resident. We have any other questions for any of our speakers. Let me jump in here. I know we have some people from all of the sites, and I was wondering if anyone from our cancer network sites would like to share what your experience is being and because I know our senators have started to roll out the availability, Um, anybody from Bay Health or Virtua um, or Saint Mary's on the line that wants Thio. Talk about this. Don't be shy. Um, Cindy, we also have another question coming in from one of the speak way. Go into that one. So three question is asking, Can you review recommendations for patients scheduled for recovering from surgery? I'll take that. So the recommendation is Thio, Um, if you're If someone's having major surgery to wait two weeks post surgery to get the first dose of vaccine now, that's not always going to be possible. And I think the main issue there is this concern of fever. So somebody had to surgery and that a post op fever I was doing consenting yesterday here. And there was a patient who a week ago had hydro valve surgery and his cardiologists and surgeons. I don't know if they knew that guidance, but they wanted him to get the vaccine because there was a slot and he was very frail. And so we vaccinated him. So I think it's sort of a soft thing is there's nothing about efficacy. Uh, I think it's more about confusion of a post operative period, and I just want to say I can't like living through what Lindsey said about the pilot, like, it's like it looks so organized and so thoughtful what we were doing. So I really appreciate you, Um, putting that together and go ahead. Lab. Go ahead, Larry. No, I was just gonna echo that. I mean, I think it was amazing. As Lindsey said, You know, we had about 12 hours, uh, to figure this all out the first day on way got people vaccinated on that was the bottom line because many people vaccinated as possible on, you know, Lindsay and Lynn and so many others really just in incredible job maximizing the benefit to our patients. But to Peggy's question and this is, you know, one of the I think the important reasons why we're having this, um webinar is that I do I discuss vaccine with every patient that comes into clinic, and I'm asking them thio, go to their county website, or I mean, virtual has done an amazing job of staffing large vaccine centers in New Jersey. But we have been asking our patients to go on every website and to do their best to get an appointment and then see what see what happens. But I do think that providers should be having this conversation with their patients about the strong recommendation and wherever they get it and whichever vaccine I think as the J and J becomes available, you know the efficacy of the J and J vaccine. So I'm showing you also really effective at preventing hospitalizations and death. So I just want is a community that were being very proactive about encouraging the vaccine and using yes, every county hospital system resource and now drugstores, which I think is going to be helpful. A swell. I think we're coming to the end of our our and I just I make one more point. I just wanted to mention Sorry that the monoclonal antibody and monoclonal antibodies for patients with Cove it and cancer is I mean, the data are getting, um, no more impressive about the value of getting the monoclonal antibody, the lily product or the Regeneron product for patients who have cove it, who have symptoms Onda criteria. Once you add cancer in there, you are cancer patients meet the criteria for the model antibody. So it's also to know in your region who's giving it. Like for us. We're giving it a P. Campbell. We're not giving it all of our sites. So I think also important to know where can you send your patients for the monoclonal antibody? Because I think it really the data are very clear about helping to reduce again hospitalizations in E. R. visits by getting the model. Analyze this for people who are symptomatic. Kobe. 19 infections. Thank you, Dr Sector. Thank you. Dr Schellman and Lindsey. I appreciate your time, everyone, for being with us today. Thank you. Thanks, everyone. Thank you.
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