'It's not good enough': 1 oncologist on why patients need more than today's care

Richard Carvajal, MD, was drawn to oncology because of the physician-patient relationship and the significant advances in cancer care driven by a better understanding of cancer biology.

Dr. Carvajal started his leadership in drug development and translational medicine clinical trials at New York City-based Memorial Sloan Kettering Cancer Center. In 2014, he took on a role at New York City-based Columbia University Irving Medical Center to build a phase 1 experimental therapeutics program and grow the cutaneous oncology and melanoma program. In January 2023, he joined New Hyde Park, N.Y.-based Northwell Health Cancer Institute as deputy physician-in-chief and director of medical oncology.

In his current role, Dr. Carvajal oversees over 70 hematologists and medical oncologists across 10 cancer centers and 21 hospitals.

"This move represented a significant leap in terms of leadership responsibility," he told Becker's. "I suspect in many cases, individuals do not have the full complement of skills and experiences that would be ideal for each leap, and this is true for my move to Northwell. However, I have learned a lot through prior experiences, which has served me well thus far."

Here, he discusses providing the future of cancer care in today's world.

Question: What cancer study, technology or innovation are you most excited about right now?

Dr. Richard Carvajal: My career has focused on the development of novel cancer therapeutics. When I started, there was a major focus on angiogenesis. Then we moved into the era of genomically guided precision therapy, and then to the era of immunotherapy and checkpoint blockade, where we are now. There's so much to talk about in terms of molecular diagnostics, precision medicine, cellular therapy, gene therapies, novel diagnostics, theranostics, personalized cancer models and so on. But one lesson we learned from the pandemic is one that I hope will continue to impact cancer care and healthcare in general — that is the ability to care for patients remotely and increase access to specialized and subspecialized care to individuals who may not have previously had this opportunity. While the idea of telemedicine visits and decentralized care does not represent the hottest technology, it's one that I think can have a major impact on the scope and scale of care we are able to deliver if developed properly.

Q: What aspect of your work or the field keeps you up at night?

RC: At the Northwell Health Cancer Institute, we take care of 19,000 patients with new cancer diagnoses each year. I want to take advantage of all the resources we have in this health system to ensure that each patient has access to the very best care, regardless of where they live. I frequently tell patients and trainees that my goal is NOT to provide my patients the standard of care we have today. It's not good enough. Too many patients are dying. I want to give them the standard of care of tomorrow, the care that will be standard in five or 10 years, or beyond. I want to ensure access to patients wherever they are in the system, ensure they get compassionate subspecialized care with all the right technology and therapies regardless of where they live, and ensure that they do not have to spend time traveling for the right care that they should be able to receive in their own community.

Q: What's one thing your hospital or system is doing in cancer care that you're most proud of?

RC: Delivering the future standard of care through clinical trial access across 10 cancer centers. Health systems and cancer institutes are all trying to offer access to novel therapies at all centers throughout their network, but we're actually doing it. We have one central IRB for approval for all those sites, which makes it more efficient. We have research staff at all the centers; we have systemwide research meetings to coordinate the trial portfolios, translational projects and research activities for breast cancer, for GI malignancies and so on. Everything is tightly coordinated and centralized so these novel therapies can be given at all our centers, which is awesome.

Q: What's the best leadership advice you've received?

RC: Whenever you're making critical decisions, or frankly any decision, imagine that you've got one of your faculty members or employees in the room. Imagine there is a patient in the room or a family member. Then say your solution. If your solution serves everyone's best interests, then that might be your answer.

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