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- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Daniel Gomez,
director of Thoracic Radiation oncology
and vice chair of clinical operations in the Department
of Radiation Oncology at Memorial Sloan
Kettering Cancer Center.
Dr. Gomez, it's a pleasure to have you on the podcast today.
- Thank you for having me.
- Now, before we dive into my broader questions,
and I'm really excited to learn more about
what you're doing there at Memorial Sloan Kettering,
could you tell us a little bit about yourself?
- Sure. So I have been a radiation oncologist
for almost 15 years.
I, uh, completed my residency training here at Memorial
Sloan Kettering, and then I spent almost a decade at MD at
MD Anderson Cancer Center in Houston, Texas
before returning to Memorial Memorial Sloan Kettering.
About five years ago, I've had a focus in, uh,
clinical operations for much of my career,
and I currently serve as the vice chair
of clinical operations for my department.
Our department is housed within one
of the largest cancer centers within the
world, uh, in the world.
Um, it includes about 65 physicians spread across seven
different locations in the New York
and New Jersey area with about 350 to 400 faculty.
Uh, we treat approximately 12,000 patients per year,
and our department is both clinically focused
and research oriented.
- Well, that, that's amazing to hear.
And you know, it sounds like a lot happening
at Memorial Sloan Kettering.
So, you know, from your perspective, could you talk about
what special considerations there are
for operating in a highly specialized department like
radiation oncology?
- Great question. So radiation oncology is unique
in that there are so many components
to getting a patient treated.
So in addition to the clinical staff, like nurses
and uh, nurse practitioners, uh, there
we are operating on highly sophisticated equipment
that requires expertise
by other individuals in many different domains.
I tell patients that, uh,
and other people that, uh, to give them a sense of the field
that it's like flying an airplane.
So getting a patient through treatment
with minimal side effects requires, uh, all
of these disciplines working together and, uh,
and creating a treatment plan that is effective and safe.
These include physics, radiation, dosimetry,
radiation therapy, and then our clinical staff,
as I mentioned previously.
So coordination between all
of these components really does require significant
operational acumen to maintain this quality and safety.
This needs to be systematic
and done in a way where it's scalable
and really not dependent on one person.
Another way that this, uh, that our department is,
and the field is unique, is that it's relatively small
and it's highly specialized.
We perform a central component of cancer care,
but historically we've been somewhat siloed even in location
in that many times our department has historically been
housed in the basement of, of hospitals.
So as a field
and as a department, we have to ensure that we appropriately
communicate our treatment plans
to the multidisciplinary team in a way
that our referring providers can understand to attempt
to break these silos.
- Got it. That's really fascinating to hear
and certainly, you know, such an important aspect
of being able to provide, um, effective care is,
as you mentioned, having that communication
and the coordination, the ability to do what's right
for the patient, and then they'll have
a great experience as well.
I'm also wondering, what are the most exciting initiatives
that you observe in the field
and what are the challenges to moving them forward?
- Right, uh, another great question,
and one of the reasons I joined this field is
because it was, uh, very technology oriented, which,
which really appealed to me.
And there's a great deal of exciting technology
that's emerging, which could lead to really better ways
that we deliver our treatment.
There's, uh, MRI guided approaches
to delivering radiation therapy, new particles
that are being used
to deliver radiation in the form of proton therapy.
We're able to deliver higher doses to very confined, um,
fields, uh, through a blade of radiation.
And there are many techniques that we're now using
to guide our radiation, even while a patient's being treated
while the radiation is, is occurring to ensure at, uh,
the pinpoint accuracy.
So all of this has to be, has allowed us really
to be more precise in our approaches
and to treat tumors
to higher doses while sparing normal tissue.
This is great for the field and for patients.
Um, the, the main challenge that it brings is
how do we implement these approaches in a data-driven way
when resources of this advanced technology are limited?
Um, the other component of this that does create a challenge
that I, I think is surmountable, but, but a challenge
nonetheless, is how do we reach underserved populations
with this advanced technology?
This really requires both an innovative spirit
and relationships with community physicians that allow us
to improve access and, and,
and while we innovate to keep these considerations in mind.
Um, just as an example, one concept pertaining, pertaining
to this is in the field of remote planning, um, that is,
can we translate our technologies to actually deliver,
implement radiation plans in areas
that it does not currently exist,
and they don't ha where there, there aren't a lot
of resources, um,
and really develop plans that are consistent with
what we would see at larger academic centers.
The other big wave that that, that has, uh, begun
to occur is, is the integration with other modalities.
I mentioned previously that radiation's been relatively
siloed historically,
but I I think developments in medical oncology have directly
impacted how we, uh, operate in radiation oncology.
We've seen that many of the scientific advancements there
can affect, enhance the effectiveness of radiation therapy,
which has led to a lot of, uh, increases in opportunities,
uh, for the indications
of radiation across the, the cancer spectrum.
- Well, that's great to hear and certainly encouraging for,
um, the, you know, patients
that are needing cancer treatments and certainly will need.
So in the future now, where do you see the field
of radiation oncology headed in the next 10 years or so?
- Yeah, that, that's a big question.
I would say, uh, I would answer this in two ways.
I would say the first is that our collaboration
with multidisciplinary colleagues such as those in medical
oncology and surgery
and others will become even more critical.
Um, and that it's, we're going to have to prioritize ways
that we can integrate into these technologies
and, uh, operational enhancements that allow us to really,
um, uh, communicate effectively, uh, our, our advances
with these, uh, with our partners in these fields.
Um, one example is the delivery
of radiation in the metastatic space.
And historically, radiation's been largely palliative in
this space, meaning reserved for only those patients
that need relief of symptoms
or have, uh, cancer that's located in problematic areas.
But we've seen over the past several years
that radiation has played a, a larger role in this space
that we've able to actually been in, uh, a modality
where we're able to enhance the efficacy of, um, um,
other treatments, uh, in the metastatic realm.
So I think as we are able to better complement, uh,
systemic therapy, then, uh, then that will set the stage for
where the field, uh, goes over the next decade and beyond.
Um, second, I would say, uh,
precision medicine will become more important in radiation,
just like in medical oncology
and surgery where advances like molecular sequencing,
liquid biopsy and imaging analysis really allow us
to individualize care.
These same principles have become to apply mortar radiation.
That is we're beginning to determine
who will benefit from radiation,
who will have a re resistant tumor,
and who we should, uh, appropriately indi uh,
recommend this treatment to
beyond our standard, uh, approaches.
So I think applying our advanced technology
to deliver a high quality of care, but doing so selectively
and within a resource constrained environment is going
to be, uh, critical and,
and is going to require us
to be more nuanced in our approaches
than we have in the past.
- That's so fascinating to hear.
Dr. Gomez, thank you so much
for joining us on the podcast today.
Your insight and perspective has been extremely valuable
and, and interesting, and I hope you're able
to come back and join us again in the future.
- Me too. Thank you very much for having me.
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