1 00:00:05,235 --> 00:00:07,285 - This is the Becker's Healthcare Podcast, created 2 00:00:07,285 --> 00:00:08,445 by the team of Becker's Healthcare, 3 00:00:08,605 --> 00:00:10,325 a multimedia company devoted to the people 4 00:00:10,345 --> 00:00:11,645 who power us healthcare. 5 00:00:11,915 --> 00:00:14,765 Four new 15 minute episodes are released daily containing 6 00:00:14,925 --> 00:00:17,285 industry news analysis and thought leadership from powerful 7 00:00:17,285 --> 00:00:19,605 healthcare decision makers Support our show 8 00:00:19,705 --> 00:00:22,525 by leaving it a five star rating and review on Apple Podcast 9 00:00:22,745 --> 00:00:24,005 or other platforms you use. 10 00:00:24,155 --> 00:00:26,005 It's a chance to tell us what you like about the show 11 00:00:26,025 --> 00:00:27,245 and act on your feedback. 12 00:00:27,265 --> 00:00:29,205 Thanks for listening. Now here's the episode. 13 00:00:30,515 --> 00:00:32,925 - This is Laura Dedo with the Becker's Healthcare Podcast. 14 00:00:33,665 --> 00:00:35,845 I'm thrilled today to be joined by Dr. Daniel Gomez, 15 00:00:36,365 --> 00:00:38,485 director of Thoracic Radiation oncology 16 00:00:39,425 --> 00:00:41,885 and vice chair of clinical operations in the Department 17 00:00:41,885 --> 00:00:44,005 of Radiation Oncology at Memorial Sloan 18 00:00:44,005 --> 00:00:45,085 Kettering Cancer Center. 19 00:00:45,385 --> 00:00:47,885 Dr. Gomez, it's a pleasure to have you on the podcast today. 20 00:00:48,555 --> 00:00:49,625 - Thank you for having me. 21 00:00:50,865 --> 00:00:53,165 - Now, before we dive into my broader questions, 22 00:00:53,165 --> 00:00:54,605 and I'm really excited to learn more about 23 00:00:54,605 --> 00:00:56,645 what you're doing there at Memorial Sloan Kettering, 24 00:00:57,375 --> 00:00:59,045 could you tell us a little bit about yourself? 25 00:01:00,415 --> 00:01:03,465 - Sure. So I have been a radiation oncologist 26 00:01:03,645 --> 00:01:04,905 for almost 15 years. 27 00:01:06,065 --> 00:01:09,385 I, uh, completed my residency training here at Memorial 28 00:01:09,625 --> 00:01:13,425 Sloan Kettering, and then I spent almost a decade at MD at 29 00:01:13,665 --> 00:01:15,905 MD Anderson Cancer Center in Houston, Texas 30 00:01:16,565 --> 00:01:19,265 before returning to Memorial Memorial Sloan Kettering. 31 00:01:19,395 --> 00:01:23,725 About five years ago, I've had a focus in, uh, 32 00:01:24,125 --> 00:01:25,925 clinical operations for much of my career, 33 00:01:26,865 --> 00:01:29,085 and I currently serve as the vice chair 34 00:01:29,085 --> 00:01:31,165 of clinical operations for my department. 35 00:01:31,945 --> 00:01:33,685 Our department is housed within one 36 00:01:33,685 --> 00:01:35,805 of the largest cancer centers within the 37 00:01:35,805 --> 00:01:37,045 world, uh, in the world. 38 00:01:37,745 --> 00:01:42,245 Um, it includes about 65 physicians spread across seven 39 00:01:42,245 --> 00:01:44,085 different locations in the New York 40 00:01:44,105 --> 00:01:47,325 and New Jersey area with about 350 to 400 faculty. 41 00:01:48,385 --> 00:01:52,245 Uh, we treat approximately 12,000 patients per year, 42 00:01:52,985 --> 00:01:55,485 and our department is both clinically focused 43 00:01:55,585 --> 00:01:56,925 and research oriented. 44 00:01:59,235 --> 00:02:00,845 - Well, that, that's amazing to hear. 45 00:02:00,845 --> 00:02:02,725 And you know, it sounds like a lot happening 46 00:02:03,065 --> 00:02:04,445 at Memorial Sloan Kettering. 47 00:02:04,465 --> 00:02:07,445 So, you know, from your perspective, could you talk about 48 00:02:07,555 --> 00:02:09,445 what special considerations there are 49 00:02:09,465 --> 00:02:12,005 for operating in a highly specialized department like 50 00:02:12,005 --> 00:02:13,125 radiation oncology? 51 00:02:14,745 --> 00:02:19,135 - Great question. So radiation oncology is unique 52 00:02:19,755 --> 00:02:21,535 in that there are so many components 53 00:02:21,675 --> 00:02:23,175 to getting a patient treated. 54 00:02:23,955 --> 00:02:27,255 So in addition to the clinical staff, like nurses 55 00:02:27,875 --> 00:02:31,535 and uh, nurse practitioners, uh, there 56 00:02:32,395 --> 00:02:36,055 we are operating on highly sophisticated equipment 57 00:02:36,445 --> 00:02:37,975 that requires expertise 58 00:02:38,075 --> 00:02:40,575 by other individuals in many different domains. 59 00:02:41,415 --> 00:02:43,615 I tell patients that, uh, 60 00:02:43,615 --> 00:02:46,615 and other people that, uh, to give them a sense of the field 61 00:02:46,615 --> 00:02:48,095 that it's like flying an airplane. 62 00:02:48,995 --> 00:02:51,295 So getting a patient through treatment 63 00:02:51,295 --> 00:02:55,215 with minimal side effects requires, uh, all 64 00:02:55,215 --> 00:02:58,495 of these disciplines working together and, uh, 65 00:02:58,675 --> 00:03:02,885 and creating a treatment plan that is effective and safe. 66 00:03:03,255 --> 00:03:06,125 These include physics, radiation, dosimetry, 67 00:03:06,195 --> 00:03:09,565 radiation therapy, and then our clinical staff, 68 00:03:09,625 --> 00:03:10,925 as I mentioned previously. 69 00:03:11,345 --> 00:03:12,565 So coordination between all 70 00:03:12,565 --> 00:03:14,525 of these components really does require significant 71 00:03:14,525 --> 00:03:18,205 operational acumen to maintain this quality and safety. 72 00:03:18,635 --> 00:03:20,165 This needs to be systematic 73 00:03:20,225 --> 00:03:22,325 and done in a way where it's scalable 74 00:03:22,745 --> 00:03:24,725 and really not dependent on one person. 75 00:03:25,395 --> 00:03:28,285 Another way that this, uh, that our department is, 76 00:03:28,385 --> 00:03:31,125 and the field is unique, is that it's relatively small 77 00:03:31,125 --> 00:03:32,725 and it's highly specialized. 78 00:03:33,865 --> 00:03:36,645 We perform a central component of cancer care, 79 00:03:37,305 --> 00:03:41,725 but historically we've been somewhat siloed even in location 80 00:03:41,785 --> 00:03:44,725 in that many times our department has historically been 81 00:03:44,725 --> 00:03:46,885 housed in the basement of, of hospitals. 82 00:03:47,545 --> 00:03:48,645 So as a field 83 00:03:49,145 --> 00:03:51,885 and as a department, we have to ensure that we appropriately 84 00:03:52,405 --> 00:03:53,645 communicate our treatment plans 85 00:03:53,745 --> 00:03:56,205 to the multidisciplinary team in a way 86 00:03:56,205 --> 00:03:58,685 that our referring providers can understand to attempt 87 00:03:58,705 --> 00:04:00,005 to break these silos. 88 00:04:02,315 --> 00:04:04,215 - Got it. That's really fascinating to hear 89 00:04:04,315 --> 00:04:06,695 and certainly, you know, such an important aspect 90 00:04:06,715 --> 00:04:09,295 of being able to provide, um, effective care is, 91 00:04:09,295 --> 00:04:10,935 as you mentioned, having that communication 92 00:04:10,935 --> 00:04:14,335 and the coordination, the ability to do what's right 93 00:04:14,455 --> 00:04:16,415 for the patient, and then they'll have 94 00:04:16,415 --> 00:04:17,495 a great experience as well. 95 00:04:18,395 --> 00:04:21,215 I'm also wondering, what are the most exciting initiatives 96 00:04:21,215 --> 00:04:23,175 that you observe in the field 97 00:04:23,315 --> 00:04:25,735 and what are the challenges to moving them forward? 98 00:04:27,605 --> 00:04:29,315 - Right, uh, another great question, 99 00:04:29,655 --> 00:04:32,475 and one of the reasons I joined this field is 100 00:04:32,475 --> 00:04:36,635 because it was, uh, very technology oriented, which, 101 00:04:36,635 --> 00:04:37,835 which really appealed to me. 102 00:04:38,455 --> 00:04:41,075 And there's a great deal of exciting technology 103 00:04:41,135 --> 00:04:44,435 that's emerging, which could lead to really better ways 104 00:04:44,435 --> 00:04:45,755 that we deliver our treatment. 105 00:04:46,265 --> 00:04:48,915 There's, uh, MRI guided approaches 106 00:04:48,915 --> 00:04:52,395 to delivering radiation therapy, new particles 107 00:04:52,395 --> 00:04:53,395 that are being used 108 00:04:53,535 --> 00:04:56,635 to deliver radiation in the form of proton therapy. 109 00:04:57,405 --> 00:05:01,115 We're able to deliver higher doses to very confined, um, 110 00:05:01,495 --> 00:05:04,115 fields, uh, through a blade of radiation. 111 00:05:04,695 --> 00:05:06,475 And there are many techniques that we're now using 112 00:05:06,495 --> 00:05:09,595 to guide our radiation, even while a patient's being treated 113 00:05:10,125 --> 00:05:13,915 while the radiation is, is occurring to ensure at, uh, 114 00:05:14,415 --> 00:05:15,875 the pinpoint accuracy. 115 00:05:16,535 --> 00:05:19,395 So all of this has to be, has allowed us really 116 00:05:19,415 --> 00:05:21,355 to be more precise in our approaches 117 00:05:21,655 --> 00:05:22,715 and to treat tumors 118 00:05:22,715 --> 00:05:24,915 to higher doses while sparing normal tissue. 119 00:05:25,545 --> 00:05:27,875 This is great for the field and for patients. 120 00:05:28,135 --> 00:05:31,755 Um, the, the main challenge that it brings is 121 00:05:31,775 --> 00:05:34,595 how do we implement these approaches in a data-driven way 122 00:05:34,945 --> 00:05:37,995 when resources of this advanced technology are limited? 123 00:05:38,775 --> 00:05:42,835 Um, the other component of this that does create a challenge 124 00:05:42,945 --> 00:05:45,475 that I, I think is surmountable, but, but a challenge 125 00:05:45,475 --> 00:05:49,555 nonetheless, is how do we reach underserved populations 126 00:05:49,555 --> 00:05:51,075 with this advanced technology? 127 00:05:51,825 --> 00:05:54,315 This really requires both an innovative spirit 128 00:05:54,455 --> 00:05:57,270 and relationships with community physicians that allow us 129 00:05:57,270 --> 00:05:59,005 to improve access and, and, 130 00:05:59,065 --> 00:06:02,925 and while we innovate to keep these considerations in mind. 131 00:06:03,705 --> 00:06:06,965 Um, just as an example, one concept pertaining, pertaining 132 00:06:06,965 --> 00:06:10,125 to this is in the field of remote planning, um, that is, 133 00:06:10,545 --> 00:06:14,405 can we translate our technologies to actually deliver, 134 00:06:14,915 --> 00:06:17,925 implement radiation plans in areas 135 00:06:17,955 --> 00:06:19,645 that it does not currently exist, 136 00:06:19,705 --> 00:06:21,805 and they don't ha where there, there aren't a lot 137 00:06:21,805 --> 00:06:23,525 of resources, um, 138 00:06:23,585 --> 00:06:25,845 and really develop plans that are consistent with 139 00:06:25,845 --> 00:06:28,045 what we would see at larger academic centers. 140 00:06:28,665 --> 00:06:31,405 The other big wave that that, that has, uh, begun 141 00:06:31,405 --> 00:06:33,965 to occur is, is the integration with other modalities. 142 00:06:34,805 --> 00:06:37,205 I mentioned previously that radiation's been relatively 143 00:06:37,865 --> 00:06:38,885 siloed historically, 144 00:06:38,985 --> 00:06:42,565 but I I think developments in medical oncology have directly 145 00:06:42,885 --> 00:06:45,965 impacted how we, uh, operate in radiation oncology. 146 00:06:46,575 --> 00:06:49,165 We've seen that many of the scientific advancements there 147 00:06:49,185 --> 00:06:52,365 can affect, enhance the effectiveness of radiation therapy, 148 00:06:53,015 --> 00:06:56,085 which has led to a lot of, uh, increases in opportunities, 149 00:06:56,585 --> 00:06:57,805 uh, for the indications 150 00:06:57,805 --> 00:07:00,445 of radiation across the, the cancer spectrum. 151 00:07:02,515 --> 00:07:05,085 - Well, that's great to hear and certainly encouraging for, 152 00:07:05,305 --> 00:07:07,485 um, the, you know, patients 153 00:07:07,515 --> 00:07:10,125 that are needing cancer treatments and certainly will need. 154 00:07:10,125 --> 00:07:13,125 So in the future now, where do you see the field 155 00:07:13,125 --> 00:07:15,845 of radiation oncology headed in the next 10 years or so? 156 00:07:17,965 --> 00:07:19,775 - Yeah, that, that's a big question. 157 00:07:20,295 --> 00:07:22,815 I would say, uh, I would answer this in two ways. 158 00:07:23,775 --> 00:07:26,975 I would say the first is that our collaboration 159 00:07:26,975 --> 00:07:29,575 with multidisciplinary colleagues such as those in medical 160 00:07:30,095 --> 00:07:31,175 oncology and surgery 161 00:07:31,395 --> 00:07:33,855 and others will become even more critical. 162 00:07:34,555 --> 00:07:38,655 Um, and that it's, we're going to have to prioritize ways 163 00:07:38,655 --> 00:07:40,855 that we can integrate into these technologies 164 00:07:41,715 --> 00:07:45,935 and, uh, operational enhancements that allow us to really, 165 00:07:46,275 --> 00:07:50,895 um, uh, communicate effectively, uh, our, our advances 166 00:07:51,125 --> 00:07:54,135 with these, uh, with our partners in these fields. 167 00:07:54,835 --> 00:07:56,775 Um, one example is the delivery 168 00:07:56,795 --> 00:07:58,775 of radiation in the metastatic space. 169 00:07:59,235 --> 00:08:02,295 And historically, radiation's been largely palliative in 170 00:08:02,295 --> 00:08:04,615 this space, meaning reserved for only those patients 171 00:08:04,615 --> 00:08:05,975 that need relief of symptoms 172 00:08:05,995 --> 00:08:10,615 or have, uh, cancer that's located in problematic areas. 173 00:08:11,595 --> 00:08:14,175 But we've seen over the past several years 174 00:08:14,285 --> 00:08:17,575 that radiation has played a, a larger role in this space 175 00:08:17,575 --> 00:08:21,735 that we've able to actually been in, uh, a modality 176 00:08:21,735 --> 00:08:26,375 where we're able to enhance the efficacy of, um, um, 177 00:08:26,425 --> 00:08:29,415 other treatments, uh, in the metastatic realm. 178 00:08:30,155 --> 00:08:33,615 So I think as we are able to better complement, uh, 179 00:08:33,975 --> 00:08:38,455 systemic therapy, then, uh, then that will set the stage for 180 00:08:38,455 --> 00:08:41,655 where the field, uh, goes over the next decade and beyond. 181 00:08:42,475 --> 00:08:44,375 Um, second, I would say, uh, 182 00:08:44,405 --> 00:08:47,575 precision medicine will become more important in radiation, 183 00:08:48,325 --> 00:08:50,575 just like in medical oncology 184 00:08:50,675 --> 00:08:53,815 and surgery where advances like molecular sequencing, 185 00:08:54,235 --> 00:08:57,365 liquid biopsy and imaging analysis really allow us 186 00:08:57,365 --> 00:08:58,525 to individualize care. 187 00:08:59,055 --> 00:09:02,685 These same principles have become to apply mortar radiation. 188 00:09:02,995 --> 00:09:04,965 That is we're beginning to determine 189 00:09:05,265 --> 00:09:06,845 who will benefit from radiation, 190 00:09:07,145 --> 00:09:08,845 who will have a re resistant tumor, 191 00:09:09,585 --> 00:09:13,605 and who we should, uh, appropriately indi uh, 192 00:09:14,325 --> 00:09:15,565 recommend this treatment to 193 00:09:16,185 --> 00:09:18,485 beyond our standard, uh, approaches. 194 00:09:19,065 --> 00:09:21,605 So I think applying our advanced technology 195 00:09:21,625 --> 00:09:24,965 to deliver a high quality of care, but doing so selectively 196 00:09:25,465 --> 00:09:28,525 and within a resource constrained environment is going 197 00:09:28,525 --> 00:09:30,245 to be, uh, critical and, 198 00:09:30,305 --> 00:09:31,525 and is going to require us 199 00:09:31,525 --> 00:09:33,605 to be more nuanced in our approaches 200 00:09:33,635 --> 00:09:34,725 than we have in the past. 201 00:09:38,455 --> 00:09:39,955 - That's so fascinating to hear. 202 00:09:40,055 --> 00:09:41,355 Dr. Gomez, thank you so much 203 00:09:41,355 --> 00:09:42,955 for joining us on the podcast today. 204 00:09:42,955 --> 00:09:45,675 Your insight and perspective has been extremely valuable 205 00:09:45,735 --> 00:09:47,475 and, and interesting, and I hope you're able 206 00:09:47,475 --> 00:09:48,755 to come back and join us again in the future. 207 00:09:49,455 --> 00:09:51,275 - Me too. 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