Welcome everyone to the Becker's Healthcare podcast series.
I'm Mariah Muhammad, writer and moderator with Becker's
Healthcare. And I'm thrilled to have with me
today doctor Joseph Dominic Femeno
from Keck Medicine of USC.
Doctor, welcome to the podcast. We're very excited
to have you join us today. To get
a start, would you mind please introducing yourself
and tell telling us a bit about your
background?
Sure. Thank you very much, Mariah. It's nice
to be with you.
My name is Dominic Fomino. I am Chief
of
the USC Musculoskeletal
Oncology Center
and an orthopedic oncology surgeon at Keck Medicine
of USC.
I have been practicing
orthopedic oncology surgery for 25 years
in various
specialty sarcoma centers
in Southern California.
I have
fellowship training experience in both,
orthopedic oncology
as well as pediatric orthopedics,
which,
meshes very well together as many of our
patients
with bone and soft tissue tumors are pediatric
age,
as well as adults.
And
the
experience here at USC
is one that I'm very excited about
to to grow a new sarcoma program
that
was preexisting,
but to, to fortify it and expand it.
So I'm very excited to be at Keck
Medicine of USC.
Yeah. Absolutely. Thank you so much for giving
us that background. So,
what are your top priorities,
ending this year and going right into 2025?
Yeah. So the top priorities for
our sarcoma program at USC
are,
really to expand
our offers of clinical trials.
And these are new,
targeted drug therapies that can be done in
can be administered
to patients with sarcomas in the research setting.
And also to expand
and continue to expand our
technologies that we use in surgery.
As an orthopedic oncology surgeon, we
have
lots of new emerging technologies that are very
important
for the treatment
of our patients for sarcoma.
And these help
improve the
quality of life of our patients as well
as reduce their complications,
hasten their recovery,
and provide,
you know, the
cutting edge,
quality of care, for these patients.
So those are really the top priorities,
for the coming year.
Wonderful. Thank you for sharing. Are are there
any programs or initiatives,
that have been the most needle moving for
you, in this year 2024?
Yes. There's,
there's been some significant changes in
treatment
for our orthopedic
tumor patients
and
some things that
have really changed
the way we treat their bone tumors,
particularly around the pelvis. So the first initiative
would be
a minimally invasive type of surgical intervention
for bone tumors around the pelvis.
Whereas before,
patients who had cancerous bone tumors around the
pelvis,
oftentimes
required large surgeries
to
resect their tumor and reconstruct
their pelvis around the hip joint.
It would involve a prolonged surgery,
a very prolonged recovery time,
delays in their chemotherapy
so that they could recover for surgery.
And now we have
technologies
that we've developed in the last
few years that
have changed this to minimally invasive,
percutaneous
techniques,
where through very small incisions,
we can
perform
ablation of the bone tumor
with a radio frequency probe
and then provide
stabilization
of the pelvic
bone lesion,
with injection
of cements or acrylic
bone fillers as well as
internal fixation
with hardware that can be done percutaneously.
It's been a big change for the treatment
of these patients and that
it significantly relieves their pain while allowing them
to recover
extremely quickly.
Most of these procedures are done with either
a one day hospital stay or outpatient
and the patients are able to get up
and walk immediately.
And they're having
excellent results with resolution
of their pain and
treatment of their tumors.
So that's a technology that I think is
really important
for our patients,
that's been developed recently.
Other things that we're looking forward to
for the future would be other surgical technologies
that
involve
the reduction of infections
around
large implants.
In sarcoma surgery, when we take out
a sarcoma, which is a cancerous tumor of
the bone or soft tissues that starts in
those locations,
we take out a large segment of bone
with a joint,
usually and we have to reconstruct that.
And there are some new techniques that we're
using
to
use implants that help
their metal implants that replace bones and joints
that,
have,
some bactericidal
components to them to help reduce the infection
rate.
In addition to that,
one of my partners, Doctor. Zuckerman,
has
been a pioneer
in using a biologic solution to replacing bone
defects after we take out
a bone tumor
and transporting the patient's remaining native bone
and advancing that very slowly
into the bone defect,
in a non invasive way using
a growing
rod that has a motor within it that
can transport a piece of bone to regenerate
new bone
in a defect.
And so these are things that I think
are really exciting
for our future,
as well
as things that we've been working on here
that
can really change the way we treat patients
and
provide solutions for them for their sarcomas.
Yeah. Absolutely. That that sounds very promising.
Is there any type of what you're thinking
about growth and patient experience,
going into 2025?
Yeah.
Growth is important.
It has to be done
to maintain the program,
but it's important not to lose sight of
the patient experience,
when you're growing.
Quality
of patient care needs to be maintained
and
patients want ease of access.
The thing about sarcomas is it's different than
many other cancers. There's only about
13,000
soft tissue sarcomas a year and about 8,000
bone sarcomas a year in the United States.
This is a very small percentage compared to
other more common cancers like breast or prostate
where there may be
270,000
a year.
So there's a very small patient population and
because of that,
it's really important for patients to be treated
at a sarcoma center where you have
a multidisciplinary
team
that has expertise in the treatment of sarcomas.
And
those types of centers are usually at major
academic centers
in major cities.
And
there is a significant difference in how a
patient
gets treated at a sarcoma center with an
expert sarcoma team compared to
a community hospital where somebody
may be treating only 1 or 2 sarcomas
a year or even every couple of years.
So in order
to get the best possible treatment with the
best possible outcomes,
it's important for patients to go to these
large sarcoma centers,
where we have the expertise.
Now, patients don't want to be traveling
100 of miles to get to a sarcoma
center. So,
unless you live in a major metropolitan city
like Los Angeles where I live,
patients don't have many options. So it's
so one of the things
that we can offer
patients is
our expansion
out into the community. So instead
of coming to downtown Los Angeles
to our Keck Medical Center,
We can offer much of our specialized sarcoma
team
care,
at other community offices that we have around
the Greater Southern California area where we have
the expertise
to physicians,
who have the expertise to
meet with patients in those centers, so they
can get localized care from the expert sarcoma
physicians.
And so that's one of the things that
we've done and we're continuing to do
to really offer that expert care out in
the community.
It's also important
to recruit and have the experienced team
in maintaining that patient experience.
If patients
get inadequate care or inappropriate care,
it really is detrimental
to the type of treatment
and their outcomes
and it may result in them coming to
us later
where they have to get
more extensive surgery,
may have to add
different types of
reconstructive
procedures
and things like that that may be detrimental
to their function and ultimately to their outcome.
So
we're really trying to
offer the best possible care upfront to those
patients
by making ourselves accessible
in those community sites where patients,
can get access to specialty sarcoma,
physicians,
in a more local setting.
Yeah. Thank you so much for sharing that
very important information. Those final thoughts, doctor. This
has definitely been, an informative discussion. So I
wanna again, I wanna thank you so much
for coming on Becker's HealthCare.
And I look forward to connecting with you
again soon.
Thank you very much. I appreciate it. Thank
you.