Latest / Becker’s Healthcare - Clinical Leadership Podcast / Daniel Gomez, Director of Thoracic Radiation Oncology and Vice Chair of Clinical Operations at Memorial Sloan Kettering Cancer Center

Transcript

Daniel Gomez, Director of Thoracic Radiation Oncology and Vice Chair of Clinical Operations at Memorial Sloan Kettering Cancer Center · Becker’s Healthcare - Clinical Leadership Podcast

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