🔒New Yale Cancer Center director Winer eyes expansion, new research collaborations

Yale executives approached Dr. Eric Winer three times in recent years about taking the top post at the Yale Cancer Center, but he turned them down twice.

“This time was a little different,” Winer said. “I’m in a different place in my career and I wanted to have the opportunity to build something bigger.”

Winer started his new job as the director of Yale Cancer Center (YCC) and physician-in-chief of Smilow Cancer Hospital on Feb. 1.

He took the role after 25 years at Boston’s Dana-Farber Cancer Institute, one of the top five cancer programs in the nation. There he held the posts of Thompson Chair in Breast Cancer Research, chief clinical development officer and senior vice president for medical affairs. He also served as professor of medicine at Harvard Medical School.

“Among a field of outstanding candidates, Eric stood out for his leadership and for his commitment to ensuring that Yale Cancer Center and Smilow Cancer Hospital have a lasting and transformative impact on the prevention, diagnosis and treatment of cancer,” said Dr. Nancy J. Brown, dean of Medicine at Yale School of Medicine.

Chris O’Connor, who is set to become Yale New Haven Health’s new CEO next month, was equally generous in his praise.

“Dr. Winer’s commitment to excellence in patient care and vast experience in the field of oncology will help to move Smilow and YCC forward in the state and the nation,” O’Connor said.

Taking Yale to the next level

That both Brown and O’Connor spoke of sustaining and enhancing Yale’s profile in cancer care tracks with Winer’s ambitions to make Yale an international destination for cancer treatment.

“I think on some level, for the first time there’s a true commitment to building an unparalleled cancer program,” Winer said. “I felt if I came [to Yale] I would have total support to build and grow.”

Currently, Yale New Haven Health cares for about 45% of people diagnosed with cancer in Connecticut, with top programs within Smilow drawing patients from across the nation. Located between cancer-care behemoths New York and Boston, Yale ranks as a regional leader among the 71 National Cancer Institute-designated cancer centers in the U.S.

The cancer center’s Smilow Hospital on Yale’s medical campus is the state’s largest single provider of cancer care, with 168 beds, 400 nurses on staff and 377,442 square feet of clinical space.

Yale doesn’t place in the top 50 on U.S. News & World Report’s ranking of “Best Hospitals for Cancer” but does earn “high performing” status and high scores for colon cancer and lung cancer surgeries.

Yale does score among the top nationally for its cancer research efforts, ranking No. 13 in National Institutes of Health funding and No. 14 for National Cancer Institute funding, with nearly $99 million in grants as of 2020.

Smilow patients can tap into more than 300 open clinical trials and receive chemo at the hospital’s high-tech Phase I Clinical Trials Infusion Unit.

On the cancer research front, Yale discoveries include the protein PD-L1, a foundation for the development of immunotherapy, a trending form of cancer treatment that uses the body’s own immune system against a disease.

That strong research component plays a key role in Winer’s plans for Yale Cancer Center.

“The best cancer care has to include some attention to the ongoing research,” Winer said. “The best care is delivered by people who also are pushing the envelope and doing clinical trials and looking into the future.”

Winer said he plans to strengthen the link between patient care and laboratory research at Yale, with a hope of increasing collaboration and sparking new discoveries.

His first action toward that goal was hiring Dr. Ian E. Krop, who on March 2, will take the posts of chief clinical research officer, associate cancer center director for clinical research and director of the Yale Cancer Center Clinical Trials Office.

Also a top breast cancer researcher from Dana-Farber, Krop has a national profile as an expert in optimizing oncology clinical trials.

The goal is simple, yet ambitious: “build and support an internationally-recognized clinical research program,” Winer said when he hired Krop.

Improving patient care will also be a focus, Winer said.

Challenges facing patient care in the near future include the impact of the COVID-19 pandemic, which has caused a steep decline in cancer screening and preventative programs.

Cancer screenings dropped by between 86% and 94% in the first months of the pandemic and the National Cancer Institute predicts almost 10,000 excess deaths over the next decade from breast and colorectal cancer alone due to delays in screening and care, according to a ProPublica report.

“People didn’t stop getting cancer because there’s a pandemic happening, they just didn’t get care,” said Matt Sturm, leader of oncology services for ECG, a national healthcare consulting firm.

Other challenges

As an industry, cancer centers like Yale’s face two overarching trends that will challenge them in coming decades.

First, “the rate at which science is evolving is more rapid than in any other discipline in medicine,” Sturm said. Second, keeping up with that science is expensive and the cost of care is ballooning to pay for new drugs and technology.

The cost of cancer drugs alone in the U.S. reached $71 billion in 2020, with Medicare estimating that a third of its cancer expenditures are for drugs, according to Global Oncology Trends 2021.

“Cancer care is becoming much more expensive moving forward,” Sturm said. “That’s driving a lot of the other systemic changes within the industry as it tries to respond.”

As a result, payers are putting pressure on cancer centers to maximize the value of care and cut programs and services that aren’t making the grade.

As for innovation, Yale's strength in immuno-oncology positions it well for a future of personalized cancer care, in which treatments like CAR T-cell therapy, which uses a patient’s T cells to attack cancer cells, become a standard of care.

“Academic centers — the Yales, the Memorial Sloan Ketterings, the Dana-Farbers — they are literally creating the science,” Sturm said. “Those are the places to go, the latest therapy is only available at these places.”

Costs drive consolidation, expansion

High costs in general are impacting cancer centers as a sector, Sturm said, driving some consolidation in the industry as weaker centers bow out.

“Costs are increasing, the cost of providing care is increasing and the revenue from Medicare or other sources is not growing at the same pace,” Sturm said. “The margin that the centers have to live off of is compressing.”

In one major development in December, nonprofit hospital system City of Hope announced it would buy Cancer Treatment Centers of America for $390 million. The deal would expand the reach of the Los Angeles-based system across three states.

Expansion may be the key to thriving in the wake of the pandemic as patients increasingly seek convenient care in non-hospital settings.

Yale Cancer Center already operates outposts of Smilow in 14 locations across the state, and another in Westerly, Rhode Island. Efforts last year to expand Smilow in Greenwich were rebuffed by neighbors due to traffic concerns, but Cynthia Sparer, senior vice president for ambulatory services at Yale New Haven Health, said the system planned continued expansion of cancer care in Fairfield County.

Offering cancer care outside of the main hospital is also a crucial approach to expanding access to care and addressing health disparities, Winer said.

“We have to think about how we deliver care, taking the expertise of big centers and allowing people to get care more conveniently, closer to home,” Winer said.

With therapies improving, the key to better care and higher survival rates for cancer is increasingly about getting treatments to those who need it, he added.

“We’re going to realize the way we drive down cancer mortality is making sure cancer care is available to everyone,” Winer said. “There is a much greater awareness of the need to reach out to the community and to make sure that everybody in New Haven and surrounding areas has access to the same cancer care.”