1
00:00:00,080 --> 00:00:02,799
Welcome everyone to the Becker's Healthcare podcast series.

2
00:00:02,799 --> 00:00:05,519
I'm Mariah Muhammad, writer and moderator with Becker's

3
00:00:05,519 --> 00:00:07,440
Healthcare. And I'm thrilled to have with me

4
00:00:07,440 --> 00:00:10,179
today doctor Joseph Dominic Femeno

5
00:00:10,960 --> 00:00:12,900
from Keck Medicine of USC.

6
00:00:13,234 --> 00:00:15,154
Doctor, welcome to the podcast. We're very excited

7
00:00:15,154 --> 00:00:16,875
to have you join us today. To get

8
00:00:16,875 --> 00:00:18,754
a start, would you mind please introducing yourself

9
00:00:18,754 --> 00:00:20,355
and tell telling us a bit about your

10
00:00:20,355 --> 00:00:20,855
background?

11
00:00:22,114 --> 00:00:24,195
Sure. Thank you very much, Mariah. It's nice

12
00:00:24,195 --> 00:00:25,094
to be with you.

13
00:00:26,129 --> 00:00:29,649
My name is Dominic Fomino. I am Chief

14
00:00:29,649 --> 00:00:30,149
of

15
00:00:30,609 --> 00:00:31,829
the USC Musculoskeletal

16
00:00:32,369 --> 00:00:33,509
Oncology Center

17
00:00:34,130 --> 00:00:37,809
and an orthopedic oncology surgeon at Keck Medicine

18
00:00:37,809 --> 00:00:38,469
of USC.

19
00:00:39,655 --> 00:00:40,954
I have been practicing

20
00:00:41,815 --> 00:00:45,515
orthopedic oncology surgery for 25 years

21
00:00:45,975 --> 00:00:46,715
in various

22
00:00:47,094 --> 00:00:48,875
specialty sarcoma centers

23
00:00:49,255 --> 00:00:50,475
in Southern California.

24
00:00:52,054 --> 00:00:52,795
I have

25
00:00:54,909 --> 00:00:57,310
fellowship training experience in both,

26
00:00:58,109 --> 00:00:59,409
orthopedic oncology

27
00:01:00,109 --> 00:01:02,049
as well as pediatric orthopedics,

28
00:01:03,149 --> 00:01:03,649
which,

29
00:01:04,510 --> 00:01:07,390
meshes very well together as many of our

30
00:01:07,390 --> 00:01:07,890
patients

31
00:01:08,564 --> 00:01:11,545
with bone and soft tissue tumors are pediatric

32
00:01:11,844 --> 00:01:12,344
age,

33
00:01:13,125 --> 00:01:14,344
as well as adults.

34
00:01:14,805 --> 00:01:15,305
And

35
00:01:16,804 --> 00:01:17,304
the

36
00:01:18,965 --> 00:01:20,584
experience here at USC

37
00:01:21,444 --> 00:01:24,104
is one that I'm very excited about

38
00:01:24,659 --> 00:01:27,159
to to grow a new sarcoma program

39
00:01:27,859 --> 00:01:28,359
that

40
00:01:28,739 --> 00:01:29,560
was preexisting,

41
00:01:30,019 --> 00:01:33,640
but to, to fortify it and expand it.

42
00:01:34,260 --> 00:01:36,500
So I'm very excited to be at Keck

43
00:01:36,500 --> 00:01:37,640
Medicine of USC.

44
00:01:39,025 --> 00:01:40,784
Yeah. Absolutely. Thank you so much for giving

45
00:01:40,784 --> 00:01:42,245
us that background. So,

46
00:01:42,944 --> 00:01:44,564
what are your top priorities,

47
00:01:45,665 --> 00:01:48,084
ending this year and going right into 2025?

48
00:01:49,984 --> 00:01:52,099
Yeah. So the top priorities for

49
00:01:52,479 --> 00:01:54,340
our sarcoma program at USC

50
00:01:54,640 --> 00:01:55,140
are,

51
00:01:56,319 --> 00:01:58,019
really to expand

52
00:01:58,479 --> 00:02:00,659
our offers of clinical trials.

53
00:02:01,200 --> 00:02:02,500
And these are new,

54
00:02:03,405 --> 00:02:06,385
targeted drug therapies that can be done in

55
00:02:07,484 --> 00:02:08,224
can be administered

56
00:02:09,004 --> 00:02:11,905
to patients with sarcomas in the research setting.

57
00:02:13,645 --> 00:02:15,185
And also to expand

58
00:02:16,389 --> 00:02:18,250
and continue to expand our

59
00:02:18,550 --> 00:02:20,569
technologies that we use in surgery.

60
00:02:21,750 --> 00:02:24,409
As an orthopedic oncology surgeon, we

61
00:02:24,870 --> 00:02:25,370
have

62
00:02:25,669 --> 00:02:29,110
lots of new emerging technologies that are very

63
00:02:29,110 --> 00:02:29,610
important

64
00:02:30,425 --> 00:02:31,245
for the treatment

65
00:02:31,544 --> 00:02:33,164
of our patients for sarcoma.

66
00:02:34,185 --> 00:02:35,245
And these help

67
00:02:35,544 --> 00:02:36,525
improve the

68
00:02:36,905 --> 00:02:39,305
quality of life of our patients as well

69
00:02:39,305 --> 00:02:40,844
as reduce their complications,

70
00:02:42,120 --> 00:02:43,340
hasten their recovery,

71
00:02:44,360 --> 00:02:45,259
and provide,

72
00:02:46,079 --> 00:02:46,860
you know, the

73
00:02:47,560 --> 00:02:48,439
cutting edge,

74
00:02:48,759 --> 00:02:51,099
quality of care, for these patients.

75
00:02:51,879 --> 00:02:53,659
So those are really the top priorities,

76
00:02:54,120 --> 00:02:55,340
for the coming year.

77
00:02:56,844 --> 00:02:59,085
Wonderful. Thank you for sharing. Are are there

78
00:02:59,085 --> 00:03:00,705
any programs or initiatives,

79
00:03:01,645 --> 00:03:03,805
that have been the most needle moving for

80
00:03:03,805 --> 00:03:05,585
you, in this year 2024?

81
00:03:07,325 --> 00:03:08,305
Yes. There's,

82
00:03:09,165 --> 00:03:12,099
there's been some significant changes in

83
00:03:12,719 --> 00:03:13,219
treatment

84
00:03:13,520 --> 00:03:14,500
for our orthopedic

85
00:03:15,199 --> 00:03:16,180
tumor patients

86
00:03:17,199 --> 00:03:17,699
and

87
00:03:18,240 --> 00:03:19,300
some things that

88
00:03:19,599 --> 00:03:20,979
have really changed

89
00:03:21,759 --> 00:03:24,180
the way we treat their bone tumors,

90
00:03:24,705 --> 00:03:27,925
particularly around the pelvis. So the first initiative

91
00:03:28,064 --> 00:03:28,724
would be

92
00:03:29,824 --> 00:03:33,525
a minimally invasive type of surgical intervention

93
00:03:34,305 --> 00:03:36,405
for bone tumors around the pelvis.

94
00:03:37,909 --> 00:03:38,810
Whereas before,

95
00:03:39,990 --> 00:03:43,110
patients who had cancerous bone tumors around the

96
00:03:43,110 --> 00:03:43,610
pelvis,

97
00:03:44,789 --> 00:03:45,289
oftentimes

98
00:03:45,750 --> 00:03:47,370
required large surgeries

99
00:03:48,069 --> 00:03:48,569
to

100
00:03:49,189 --> 00:03:51,210
resect their tumor and reconstruct

101
00:03:52,155 --> 00:03:54,094
their pelvis around the hip joint.

102
00:03:54,474 --> 00:03:57,455
It would involve a prolonged surgery,

103
00:03:58,395 --> 00:04:00,495
a very prolonged recovery time,

104
00:04:00,794 --> 00:04:02,175
delays in their chemotherapy

105
00:04:02,635 --> 00:04:04,574
so that they could recover for surgery.

106
00:04:04,955 --> 00:04:06,175
And now we have

107
00:04:07,449 --> 00:04:07,949
technologies

108
00:04:08,250 --> 00:04:10,110
that we've developed in the last

109
00:04:10,650 --> 00:04:11,710
few years that

110
00:04:12,810 --> 00:04:14,750
have changed this to minimally invasive,

111
00:04:16,810 --> 00:04:17,310
percutaneous

112
00:04:17,769 --> 00:04:18,269
techniques,

113
00:04:18,810 --> 00:04:20,430
where through very small incisions,

114
00:04:21,895 --> 00:04:22,634
we can

115
00:04:23,415 --> 00:04:23,915
perform

116
00:04:24,535 --> 00:04:26,235
ablation of the bone tumor

117
00:04:27,095 --> 00:04:28,955
with a radio frequency probe

118
00:04:29,814 --> 00:04:30,955
and then provide

119
00:04:31,334 --> 00:04:31,834
stabilization

120
00:04:32,455 --> 00:04:33,834
of the pelvic

121
00:04:34,500 --> 00:04:35,240
bone lesion,

122
00:04:36,259 --> 00:04:37,240
with injection

123
00:04:37,699 --> 00:04:39,240
of cements or acrylic

124
00:04:39,620 --> 00:04:41,480
bone fillers as well as

125
00:04:41,860 --> 00:04:43,000
internal fixation

126
00:04:43,860 --> 00:04:45,960
with hardware that can be done percutaneously.

127
00:04:47,134 --> 00:04:50,334
It's been a big change for the treatment

128
00:04:50,334 --> 00:04:51,794
of these patients and that

129
00:04:53,134 --> 00:04:56,014
it significantly relieves their pain while allowing them

130
00:04:56,014 --> 00:04:56,834
to recover

131
00:04:57,774 --> 00:04:58,754
extremely quickly.

132
00:05:00,009 --> 00:05:02,170
Most of these procedures are done with either

133
00:05:02,170 --> 00:05:04,189
a one day hospital stay or outpatient

134
00:05:04,810 --> 00:05:06,410
and the patients are able to get up

135
00:05:06,410 --> 00:05:07,470
and walk immediately.

136
00:05:08,730 --> 00:05:09,709
And they're having

137
00:05:10,089 --> 00:05:12,189
excellent results with resolution

138
00:05:13,095 --> 00:05:14,634
of their pain and

139
00:05:15,014 --> 00:05:16,395
treatment of their tumors.

140
00:05:16,935 --> 00:05:19,254
So that's a technology that I think is

141
00:05:19,254 --> 00:05:20,074
really important

142
00:05:20,535 --> 00:05:21,435
for our patients,

143
00:05:22,615 --> 00:05:24,154
that's been developed recently.

144
00:05:24,775 --> 00:05:27,275
Other things that we're looking forward to

145
00:05:27,810 --> 00:05:31,110
for the future would be other surgical technologies

146
00:05:31,490 --> 00:05:31,990
that

147
00:05:33,170 --> 00:05:33,670
involve

148
00:05:35,089 --> 00:05:36,790
the reduction of infections

149
00:05:37,810 --> 00:05:38,310
around

150
00:05:38,610 --> 00:05:39,589
large implants.

151
00:05:40,210 --> 00:05:42,949
In sarcoma surgery, when we take out

152
00:05:43,625 --> 00:05:46,345
a sarcoma, which is a cancerous tumor of

153
00:05:46,345 --> 00:05:48,585
the bone or soft tissues that starts in

154
00:05:48,585 --> 00:05:49,324
those locations,

155
00:05:50,824 --> 00:05:52,745
we take out a large segment of bone

156
00:05:52,745 --> 00:05:53,564
with a joint,

157
00:05:53,944 --> 00:05:56,365
usually and we have to reconstruct that.

158
00:05:57,189 --> 00:05:59,509
And there are some new techniques that we're

159
00:05:59,509 --> 00:06:00,009
using

160
00:06:00,550 --> 00:06:01,050
to

161
00:06:01,509 --> 00:06:03,370
use implants that help

162
00:06:03,670 --> 00:06:06,149
their metal implants that replace bones and joints

163
00:06:06,149 --> 00:06:06,649
that,

164
00:06:07,350 --> 00:06:07,850
have,

165
00:06:08,550 --> 00:06:09,449
some bactericidal

166
00:06:10,975 --> 00:06:13,395
components to them to help reduce the infection

167
00:06:13,455 --> 00:06:13,955
rate.

168
00:06:14,654 --> 00:06:15,955
In addition to that,

169
00:06:17,055 --> 00:06:18,995
one of my partners, Doctor. Zuckerman,

170
00:06:20,254 --> 00:06:20,754
has

171
00:06:22,254 --> 00:06:23,314
been a pioneer

172
00:06:24,339 --> 00:06:27,540
in using a biologic solution to replacing bone

173
00:06:27,540 --> 00:06:29,240
defects after we take out

174
00:06:29,699 --> 00:06:30,600
a bone tumor

175
00:06:31,139 --> 00:06:34,920
and transporting the patient's remaining native bone

176
00:06:35,779 --> 00:06:38,199
and advancing that very slowly

177
00:06:39,115 --> 00:06:40,495
into the bone defect,

178
00:06:41,274 --> 00:06:43,294
in a non invasive way using

179
00:06:44,875 --> 00:06:45,454
a growing

180
00:06:46,074 --> 00:06:48,634
rod that has a motor within it that

181
00:06:48,634 --> 00:06:50,975
can transport a piece of bone to regenerate

182
00:06:51,194 --> 00:06:51,935
new bone

183
00:06:52,310 --> 00:06:53,210
in a defect.

184
00:06:54,069 --> 00:06:56,069
And so these are things that I think

185
00:06:56,069 --> 00:06:57,210
are really exciting

186
00:06:57,589 --> 00:06:58,490
for our future,

187
00:06:59,430 --> 00:07:00,089
as well

188
00:07:00,870 --> 00:07:02,970
as things that we've been working on here

189
00:07:03,589 --> 00:07:04,089
that

190
00:07:04,470 --> 00:07:07,270
can really change the way we treat patients

191
00:07:07,270 --> 00:07:07,770
and

192
00:07:08,084 --> 00:07:10,185
provide solutions for them for their sarcomas.

193
00:07:11,925 --> 00:07:14,904
Yeah. Absolutely. That that sounds very promising.

194
00:07:16,324 --> 00:07:18,245
Is there any type of what you're thinking

195
00:07:18,245 --> 00:07:20,504
about growth and patient experience,

196
00:07:21,365 --> 00:07:22,745
going into 2025?

197
00:07:25,009 --> 00:07:25,509
Yeah.

198
00:07:26,449 --> 00:07:27,509
Growth is important.

199
00:07:29,009 --> 00:07:30,230
It has to be done

200
00:07:30,770 --> 00:07:32,150
to maintain the program,

201
00:07:33,089 --> 00:07:35,330
but it's important not to lose sight of

202
00:07:35,330 --> 00:07:36,310
the patient experience,

203
00:07:37,569 --> 00:07:38,550
when you're growing.

204
00:07:38,925 --> 00:07:39,425
Quality

205
00:07:39,725 --> 00:07:41,824
of patient care needs to be maintained

206
00:07:42,605 --> 00:07:43,105
and

207
00:07:43,485 --> 00:07:45,504
patients want ease of access.

208
00:07:47,485 --> 00:07:49,884
The thing about sarcomas is it's different than

209
00:07:49,884 --> 00:07:51,824
many other cancers. There's only about

210
00:07:52,759 --> 00:07:53,259
13,000

211
00:07:53,639 --> 00:07:56,379
soft tissue sarcomas a year and about 8,000

212
00:07:56,520 --> 00:07:58,939
bone sarcomas a year in the United States.

213
00:07:59,560 --> 00:08:02,460
This is a very small percentage compared to

214
00:08:02,520 --> 00:08:05,100
other more common cancers like breast or prostate

215
00:08:05,160 --> 00:08:06,220
where there may be

216
00:08:06,785 --> 00:08:07,285
270,000

217
00:08:07,745 --> 00:08:08,404
a year.

218
00:08:09,745 --> 00:08:12,145
So there's a very small patient population and

219
00:08:12,145 --> 00:08:13,045
because of that,

220
00:08:13,425 --> 00:08:16,245
it's really important for patients to be treated

221
00:08:16,464 --> 00:08:18,884
at a sarcoma center where you have

222
00:08:19,264 --> 00:08:19,925
a multidisciplinary

223
00:08:20,545 --> 00:08:21,045
team

224
00:08:21,425 --> 00:08:24,829
that has expertise in the treatment of sarcomas.

225
00:08:25,129 --> 00:08:25,629
And

226
00:08:26,729 --> 00:08:29,370
those types of centers are usually at major

227
00:08:29,370 --> 00:08:30,430
academic centers

228
00:08:30,889 --> 00:08:32,110
in major cities.

229
00:08:32,730 --> 00:08:33,230
And

230
00:08:33,769 --> 00:08:36,089
there is a significant difference in how a

231
00:08:36,089 --> 00:08:36,589
patient

232
00:08:37,134 --> 00:08:39,534
gets treated at a sarcoma center with an

233
00:08:39,534 --> 00:08:41,714
expert sarcoma team compared to

234
00:08:42,254 --> 00:08:44,514
a community hospital where somebody

235
00:08:45,134 --> 00:08:47,634
may be treating only 1 or 2 sarcomas

236
00:08:47,694 --> 00:08:49,954
a year or even every couple of years.

237
00:08:50,540 --> 00:08:51,440
So in order

238
00:08:53,179 --> 00:08:55,259
to get the best possible treatment with the

239
00:08:55,259 --> 00:08:56,639
best possible outcomes,

240
00:08:57,340 --> 00:09:00,059
it's important for patients to go to these

241
00:09:00,059 --> 00:09:01,519
large sarcoma centers,

242
00:09:02,700 --> 00:09:04,000
where we have the expertise.

243
00:09:04,300 --> 00:09:06,774
Now, patients don't want to be traveling

244
00:09:07,955 --> 00:09:09,975
100 of miles to get to a sarcoma

245
00:09:10,115 --> 00:09:11,315
center. So,

246
00:09:11,955 --> 00:09:14,674
unless you live in a major metropolitan city

247
00:09:14,674 --> 00:09:16,455
like Los Angeles where I live,

248
00:09:17,235 --> 00:09:19,315
patients don't have many options. So it's

249
00:09:20,259 --> 00:09:21,319
so one of the things

250
00:09:21,940 --> 00:09:23,000
that we can offer

251
00:09:23,539 --> 00:09:24,519
patients is

252
00:09:25,220 --> 00:09:25,879
our expansion

253
00:09:26,339 --> 00:09:28,360
out into the community. So instead

254
00:09:29,459 --> 00:09:31,639
of coming to downtown Los Angeles

255
00:09:32,419 --> 00:09:34,199
to our Keck Medical Center,

256
00:09:35,144 --> 00:09:38,125
We can offer much of our specialized sarcoma

257
00:09:38,184 --> 00:09:38,684
team

258
00:09:39,065 --> 00:09:39,565
care,

259
00:09:40,704 --> 00:09:44,184
at other community offices that we have around

260
00:09:44,184 --> 00:09:47,225
the Greater Southern California area where we have

261
00:09:47,225 --> 00:09:47,884
the expertise

262
00:09:48,504 --> 00:09:49,740
to physicians,

263
00:09:50,200 --> 00:09:51,899
who have the expertise to

264
00:09:52,519 --> 00:09:54,759
meet with patients in those centers, so they

265
00:09:54,759 --> 00:09:58,540
can get localized care from the expert sarcoma

266
00:09:59,320 --> 00:09:59,820
physicians.

267
00:10:00,679 --> 00:10:02,725
And so that's one of the things that

268
00:10:02,725 --> 00:10:05,225
we've done and we're continuing to do

269
00:10:06,565 --> 00:10:08,884
to really offer that expert care out in

270
00:10:08,884 --> 00:10:09,544
the community.

271
00:10:10,085 --> 00:10:11,065
It's also important

272
00:10:11,524 --> 00:10:14,585
to recruit and have the experienced team

273
00:10:15,149 --> 00:10:17,329
in maintaining that patient experience.

274
00:10:18,190 --> 00:10:19,089
If patients

275
00:10:19,709 --> 00:10:22,449
get inadequate care or inappropriate care,

276
00:10:23,309 --> 00:10:24,690
it really is detrimental

277
00:10:25,709 --> 00:10:26,929
to the type of treatment

278
00:10:27,709 --> 00:10:28,769
and their outcomes

279
00:10:29,605 --> 00:10:31,524
and it may result in them coming to

280
00:10:31,524 --> 00:10:32,264
us later

281
00:10:32,725 --> 00:10:34,345
where they have to get

282
00:10:34,725 --> 00:10:36,105
more extensive surgery,

283
00:10:36,884 --> 00:10:38,024
may have to add

284
00:10:38,884 --> 00:10:40,424
different types of

285
00:10:40,804 --> 00:10:41,304
reconstructive

286
00:10:42,165 --> 00:10:42,665
procedures

287
00:10:43,679 --> 00:10:46,580
and things like that that may be detrimental

288
00:10:46,799 --> 00:10:49,279
to their function and ultimately to their outcome.

289
00:10:49,279 --> 00:10:49,779
So

290
00:10:50,559 --> 00:10:51,779
we're really trying to

291
00:10:52,799 --> 00:10:55,759
offer the best possible care upfront to those

292
00:10:55,759 --> 00:10:56,259
patients

293
00:10:56,799 --> 00:10:58,580
by making ourselves accessible

294
00:10:59,274 --> 00:11:01,355
in those community sites where patients,

295
00:11:01,754 --> 00:11:04,095
can get access to specialty sarcoma,

296
00:11:05,034 --> 00:11:05,534
physicians,

297
00:11:06,235 --> 00:11:07,934
in a more local setting.

298
00:11:09,595 --> 00:11:11,514
Yeah. Thank you so much for sharing that

299
00:11:11,514 --> 00:11:14,309
very important information. Those final thoughts, doctor. This

300
00:11:14,309 --> 00:11:16,950
has definitely been, an informative discussion. So I

301
00:11:16,950 --> 00:11:18,389
wanna again, I wanna thank you so much

302
00:11:18,389 --> 00:11:19,850
for coming on Becker's HealthCare.

303
00:11:20,230 --> 00:11:21,670
And I look forward to connecting with you

304
00:11:21,670 --> 00:11:22,410
again soon.

305
00:11:23,029 --> 00:11:25,190
Thank you very much. I appreciate it. Thank

306
00:11:25,190 --> 00:11:25,690
you.