Archives for 2020

Has COVID-19 lost us the war on cancer?

Has COVID-19 lost us the war on cancer?

For several months in the spring of 2020, clinics and hospitals across the United States temporarily suspended routine cancer screening during the early phase of the COVID outbreak. Patients we’d reminded by mail and phone not to forget their mammograms or colonoscopies or PAP smears were suddenly told to cancel them and sit tight.

Most places have now resumed routine cancer screening, but the pause understandably raised lots of questions:

  • “Did the delay put me in danger?”
  • “Will there be a spike in advanced cancer cases now?”
  • “If this was so important, why was it delayed in the first place?”

A recent article in the Milwaukee Journal Sentinel suggested the delay might have cost us the chance to cure people. But there’s reason to doubt this.

Cancer screening depends on—and only works for—cancers that grow and spread slowly in the early stages. The most common types of breast, colon, lung, and cervical cancer take a few years to become dangerous. This long lead time is the very reason screening is possible. It’s also why it’s hard to see how a 3-6 month screening delay could be enough to allow a significant number of early-stage cancers to become incurable.

Right now you’re probably asking, “don’t some cancers appear more quickly and spread more aggressively than the usual type?”

Yes, there’s an exceptional minority of cancers that can appear and spread rapidly, sometimes within a few months. But screening doesn’t work for these aggressive cancer sub-types, and it never has. Cancer screening was never designed with this tragic minority in mind, since we have so little power to alter their clinical course.

I’m not worried about the brief interruptions in cancer screening we experienced earlier this year, since services have mostly resumed and we’re able to get back on track. I’m more worried that many of us will conclude cancer screening couldn’t have been important in the first place, if we can safely pause it—and that patients won’t reschedule. I fear that public skepticism and reactive rhetoric might interfere with cancer screening long enough to matter.

If we lose the war on cancer over this, it’ll be because we surrendered what cancer screening had already won for us.

The Other Side

The Other Side

I have been at Green Bay Oncology caring for patients for nearly eleven years. I am used to being in charge, having the answers, the results, the plan.

Since I have always been a perfectionist and need to control things, part of empathizing with my patients is treating them the way I’d want my family treated. I love dotting the i’s and cross the t’s for them.

I have had some pretty emotional days at work. Lots of them, in fact. But despite delivering hard news to countless others, I still never thought I’d be on the other side with my father getting this news.

But now I know the other side is filled with emotions one can only explain when they’ve been there. There’s overwhelming worry. Tears consume quiet moments in the car. But there’s also the battle to stay positive, to not worry, and to balance faith, hope, and reality. And there’s that darkness back there where you don’t want to go…the worse case scenario.

This is the struggle, the minute by minute, day to day of what being on the other side is like.

And though all I really want to do is control everything, I realize there is really nothing I can control. Suddenly the bloodwork, talks of scans, pathology, biopsy… are all so fast. These words are common to me, they are my everyday lingo. It is getting thrown at him so fast but he doesn’t understand what the biopsy means? Who cares about the grade? What the hell is adenocarcinoma anyways? We review the guidelines…then the real question, “Can it be cured?” he asks “How will this change me and how will my life be different?”.

But you know what? I really just want to be his daughter. I want to pretend everything is ok.

The fact is that we really haven’t even started treatment yet, and there are way too many uncertainties about the future. But I know everything has changed. I have been walking around in a “bubble” thinking it couldn’t happen to us. Well, here we are, on the other side. The side where you have very little control of anything. The side where you don’t really sleep well anymore. The side where your brain makes you come face to face with possible loss and the perpetual “What if?”. The side where you choose hope and faith EVERY TIME because it’s really the only thing you have.

I have learned a lot from this moment on the other side. Even when he beats this, we will still have appointments, labs, “stuff” that will forever make us to some degree worry about cancer.

As I treat patients, I will always try to remember what it is really like to be on the other side.

COVID Testing in Brown County: Why You Should Bother

COVID Testing in Brown County: Why You Should Bother

The Wisconsin Department of Health Services has recommended COVID testing for all persons who live and work in Brown County.

The testing centers have a pretty convenient registration and drive-through process, but it’s still about a half hour of your life spent waiting.

“But I feel fine, and I’ve barely been out of my house! I don’t need a test!” you might be saying. And you’re right…you personally don’t need one, just like you personally don’t need census data.

But it’s still important to do it.

Asymptomatic testing ain’t about you. The data isn’t for you. It’s for the health departments and the epidemiologists who are still trying to get a better estimate of what the virus has done, is doing, and can do.

After everything COVID has already cost us all – the fear, the disruptions, the jobs, the isolation and boredom, and the growing mistrust in our public servants – another ask for the greater good seems like a lot.

But think back to all those numbers you heard early in the pandemic about transmissibility, the high number of asymptomatic carriers, and the estimated death rate…all those numbers you used to decide how scared (or not) to be, and how seriously (or not) to take the isolation recommendations. Those figures didn’t come from nowhere. They came from countries that were already grappling with COVID-19 and had some clumps of data to work with.

Yes, some of the numbers we’ve heard haven’t always been very accurate. But the only way they get more accurate is with better measurement, and that means a lot more data points…like yours.

Better numbers will hopefully help us make smarter decisions about when we can go back to something like normal life, and what we do (and don’t) need to do when COVID breaks out again. Maybe it’ll be less than we’ve done, maybe it’ll be more.

But wouldn’t it be better not to have to guess?

FAQ – Testing in Brown County

No Illusions

No Illusions

Though I’m an oncologist and not an infectious disease expert I’m getting bombarded with questions about the pandemic. Patients and staff are asking me and every one of my partners similar things, over and over:

How long until things go back to normal?

How much danger am I in?

Is it all going to be ok?

Though I’m supposed to have all the answers, I haven’t felt too sure of anything lately. It must show on my face, because recently one of my patients (a young woman living with incurable breast cancer) asked “how you doing there, doc?”

“Honestly, I’m not sure,” I said. “My regular routine is wrecked, I don’t feel as safe as I used to, and I don’t know what’s coming.”

“Welcome to my world,” she said, with a wry smile.

I suppose like everyone else in my privileged corner of the planet, where war is remote and epidemics are rare, I’ve been fooled into believing that the world is a safe place, that nature wants the best for us, and that we have control.

Somehow I’ve mistaken privilege for entitlement.

But the pandemic has stripped those illusions from me, just as cancer stripped them from my patient long ago. I’ve had to accept that there’s no such thing as safe – only safer. I’ve had to admit that I don’t have as much control as I’d like. And I’ve had to consider the very real possibility that I or someone I love might not survive.

And even if we and all our loved ones come through safely, somehow I doubt we can ever go back to the sleepy (and false) security of before. We may well divide our lives into distinct sections: “Before COVID” and “After COVID”, just as many patients have distinct lives before and after cancer.

And maybe we’re better off living without illusions of safety.

If life becomes more precarious, maybe it’ll also be more precious. Maybe in facing the truth of our mortality we’ll learn a deeper compassion for all survivors, everywhere – since every human breathing is a survivor of something. And if I’m spared, perhaps the me that comes after will have learned to live with more dignity and courage.

Maybe my patient will teach me.