Archives for 2022

Wisdom from the Strangest Places

Wisdom from the Strangest Places

I’m sentimental about Halloween the way most people are sentimental about Christmas.

Fall foliage and pumpkins bring the tang of childhood to my tongue like nothing else. So I spend the month of October watching new horror movies or horror mini-series, if there are any good ones. And if there aren’t, then there’s always the classics—Halloween and The Shining—to enjoy again.

In recent years, the director Mike Flanagan has become a favorite, and his notable Netflix series The Haunting of Hill House is even popular among people who don’t generally like horror, mainly because he’s willing to expose the deepest, darkest secret of the horror genre.

And that secret, if you didn’t already know it, is this: horror isn’t actually about death, hate, or despair—it’s about life, love, and hope. All Mike does is make those themes of life, love and hope more apparent and accessible, while still scaring you.

So imagine my delight when, settling in to watch his newest mini-series The Midnight Club (which premiered on Netflix recently), twenty minutes into the first episode the main character (a young cancer patient) has a conversation with her doctor about how wrong-headed the “battle against cancer” rhetoric is.

DOCTOR: “The thing I didn’t understand when we talk about cancer, or any terminal illness really—look at the language we use. The language of battle. ‘We’re going to fight this thing. We’re going to fight with everything we’ve got. Be brave for the fight.’ And then people say, ‘They lost the battle’. It’s so backwards. I get it. To talk about the fight it’s active, it’s visceral. Don’t look at the hard part. Look at all these shiny sharp weapons we’ve developed for you to try. It’s about permission to leave the battlefield. To focus on living instead of fighting. We aren’t about a fight and it certainly isn’t losing a battle. Every living day here is a win.”

I couldn’t believe my ears. It might have been cribbed verbatim from past blog posts, or from conversations I’ve been hearing in the clinic lately.

Though it’s not my place to tell people how to think about their illness (especially since I’ve never had cancer) I’ve worried about the “battling cancer” rhetoric for years, for a lot of reasons. First, battle implies a certain casualness about casualties and collateral damage that’s never ok. Second, an “all-or-nothing” mentality doesn’t gel with what an actual course of treatment looks like, which requires flexibility and adaptation, advance AND retreat.

But most of all, I dislike it because it disrespects another aspect of the cancer experience for some—dying.

Though death isn’t the result we want, it can be experienced with dignity, comfort, and peace—if we face it honestly and with acceptance when it becomes inevitable. But that’s something an all-or-nothing mindset cannot do.

There probably are times when the metaphor of “fighting a battle” can be very helpful for people with cancer, and I’m not here to take that away from anyone. But like any metaphor, it oversimplifies reality to gain clarity. That means there are other ways in which it distorts or omits very important truths.

Most notable among them are:

  • There are ways to win, even when cure is impossible
  • People who die from cancer aren’t losers

Thanks for putting this message out there on blast, Mike. I couldn’t agree with you more.

Survivorship: What Lies Beyond Cancer

Survivorship: What Lies Beyond Cancer

“Now what?” This is at the top of patients’ minds after completing cancer treatment.

For many, it comes with a significant amount of worry. You have achieved the “end goal” so it’s common to wonder, what’s next?

Patients are used to being supervised on a daily or weekly basis and that may abruptly change to monthly or yearly follow-ups. This can increase nervousness prior to lab tests and exams. Common fears include recurrence, symptom management, social and financial concerns, and chronic health problems that have accompanied or been delayed since their cancer diagnosis.

We’re here from the start, through the darkest days, and to help patients live beyond cancer. Survivorship is an all-encompassing term that refers to a patient at any point along their cancer journey. Cancer is a dramatic life-altering diagnosis that changes patients’ and their loved ones’ outlook on life. Learning to adapt following the burdens of treatment takes a village.

Our team of experts will guide you to resources aimed to help you survive and thrive during and after cancer treatment.

  • SUPPORT: No one should carry the burden of cancer alone. A cancer diagnosis can make you and your loved ones feel isolated and alone, just when you need support the most. We know that meaningful connection brings strength and healing. Sharing the experience in a safe space with others on a similar path is often powerful and therapeutic. That’s why we offer a free monthly virtual cancer support group facilitated by our social workers for you and your loved ones. Wherever you are on your cancer journey, you are always welcome.
  • FINANCIAL: Our Navigating HOPE® financial counselors are dedicated to easing the financial toxicity that too often accompanies a cancer diagnosis. We understand that financial and insurance issues can be stressful and confusing. Let us go to battle for you.
    • SERVICES INCLUDE: Consultation to discuss insurance benefits and financial concerns to establish a joint path forward.
      • Review out-of-pocket expenses
      • Liaison between you and the insurance company
      • Collaborate with your care team
      • Verify in/out of network insurance coverage
      • Obtain insurance authorizations
      • Appeal insurance denials
      • Co-pay/Medication/Foundation Assistance
      • Disability referrals
      • Assistance with Medicaid or Marketplace enrollment
  • NUTRITION: Patients often ask what dietary changes they can make during treatment. We recommend working with our team of dietitians. They will guide you and take cardiac or diabetic needs into consideration.
  • MEDICAL: Our providers bring cancer treatment close to home, which helps with accessibility and allows for education, discussion, and support of long-term symptoms. We participate in clinical trials which investigate active treatments, preventative care, and symptom management. We also collaborate on mental health and with physical therapy to provide holistic survivorship care.

FOR MORE INFORMATION ON SURVIVORSHIP VISIT: The American Cancer Society – Survivorship During & After Treatment

Cancer is Political

Cancer is Political

Why? Well, first of all, people die from cancer. It’s the second leading cause of death in the US.

Second, it can happen to anyone. Cancer is extremely common. If they live a normal lifespan, half of women and a third of men will get it. And if you’re thinking it can’t happen to you, well—neither did the last few thousand of my patients.

Yes, we can tempt fate and increase our risk by bad lifestyle choices: alcohol, tobacco, and obesity are big risk factors. But a great many cases happen because of genetics or just bad luck. Doesn’t matter who you are, or how you vote.

Though it’s more common as we age, it can strike at any age. And it starts getting more frequent just as people enter the last decade of their working lives.

Third, it’s expensive. Though two of the most common types, breast and colon cancer, for instance, are very curable, the treatment may take 6-12 months, often interrupts work, and comes with significant out-of-pocket expenses even for those with insurance. A cancer diagnosis in the United States causes 60% of patients to have to deplete their savings, and increases the risk of bankruptcy 2 1/2 times.

So…

  • Common
  • Expensive
  • Life & Death

That’s political dynamite.

Cancer’s been overtly political since President Nixon signed the National Cancer Act in 1971, setting in motion a half-century of public investment in cancer care.

Green Bay Oncology was founded five years after that. And we’ve seen first-hand what our citizens have gotten in return for that investment. 

At a recent round table of our doctors (some retired and some still practicing), we compared life expectancies for several different cancer types from the 70s to now. Let’s consider the examples of stage 4 melanoma, kidney cancer, and colon cancer—we see they’re still uniformly fatal, but patients survive them much longer.

DISEASE 1970s NOW
Colon Cancer < 6 months 2-4 years
Melanoma < 6 months 2-5 years
Kidney Cancer < 6 months 2-4 years
Myeloid Leukemia 2 years Normal lifespan
Promyelocytic Leukemia < 2 weeks Normal lifespan
Myeloma 1 year 8-10 years
Source: Green Bay Oncology Physicians’ Roundtable, 8/2022

But several former death sentences can now be substantially delayed or cured altogether. 

Next, let’s compare the patient experience of one of the most common types—breast cancer—from then until now. We can see how we’ve learned to treat it with less surgery, less side effects, and less hospitalization.

EXPERIENCE 1970s NOW
Mastectomy > 90% < 30%
Receiving chemotherapy > 75% < 25%
Duration of chemo 6 months 2-3 months
Vomiting after chemo > 75% < 20%
Hair loss after chemo > 50% < 20%
Hospitalization after chemo > 50% < 10%
Source: Green Bay Oncology Physicians’ Roundtable, 8/2022

That’s a lot of lives, workdays, and wages saved.

Almost all of this progress has been the result of publicly-funded research that started back in the 1970s. It takes a long time. We know this because besides our clinical work, Green Bay Oncology devotes significant time and resources to help test new treatments through clinical trials. Our doctors, like the people of Wisconsin, are “get involved” kind of people, and that’s why our practice is able to achieve a 17% clinical trial enrollment rate—far above the national average of 2%. This research is happening right here in our hometown.

But not all of the benefits I just described are accessible to all the people of Wisconsin. Rural people, for instance, many of whom live fifty miles or more from cancer clinics, find the frequent travel a significant burden. It’s expensive and time consuming, at a time when they already don’t feel their best. Because cancer patients in rural Wisconsin have to spend more money traveling for care, they tend to forego screening and delay diagnosis. These delays cause rural cancer patients to be sicker, with more advanced disease when they finally do walk in the door—with worse survival rates as a result.

Sources: WI Office of Rural Health JCO Oncology Practice, Levit et Al, 7/6/2022 Health Services Research, Holmes et Al, 4/2006

Green Bay Oncology is well aware of this because we’ve driven to the moon and back—quite literally the distance from the earth to the moon, and back—taking cancer care closer to rural residents, so they can have a fair share of what they’ve already paid for with their tax dollars.

What Green Bay Oncology, in partnership with the American Cancer Society Cancer Action Network asks of our lawmakers is this:

  • First, acknowledge the scope of the problem and the breadth of the people affected.
  • Second, stay invested in the long game. From the frequent advertisements for new immunotherapy drugs you see on TV, you might get the impression that immunotherapy is a new idea, but I can tell you…immunotherapy for cancer was a hot topic all the way back when I was an undergraduate in the 1980s. All of today’s progress is a result of decades of basic science research – most of which was publicly funded. So mistrust anyone who promises quick results on the cheap.
  • Third, don’t lose patience with the complexity of the problem. Yes, there are fantastic opportunities for private capital and public investment to work together, and yes—there’s a role for research and regulatory reform. But there’s no single, simple solution. We need public funds to support endeavors with little profit potential, and we need oversight and accountability anytime one group of people are tasked with spending other people’s money. The key is balance, and balance is complex—not simple. Sensible, incremental change and progress gets the results. Slow and steady. That requires patience and persistence. Mistrust anyone shilling simple solutions.
  • Fourth, let us help lawmakers identify and promote the most impactful reforms, and help craft a winning message to garner public support for the effort. The American Cancer Society Cancer Action Network and Green Bay Oncology understand that we only succeed together—lawmakers and healthcare leaders.
  • Fifth, keep the door open for rural people, who cannot bridge the gap without expanded access to care.

Only working together—clinicians, activists, and lawmakers—can we keep cancer treatment within reach of all the people of Wisconsin—rural, urban, or suburban. Much has been gained since the 1970s, and the people of Wisconsin have helped pay for that progress with their taxes. They rightly own a share of the returns.

Cancer Lobby Day

Cancer Lobby Day

If you’ve attended any local cancer event in the last twelve years—we’ve probably met.

My passion is connecting our community with their cancer doctors. This led me to serve on The American Cancer Society Wisconsin Leadership Board and to become an Ambassador Constituent Team Lead with The American Cancer Society Cancer Action Network.

While in DC for Cancer Lobby Day, we asked three important things of our Wisconsin lawmakers. Here’s why it’s important and how it will impact cancer care in our hometown.

  1. Support increased funding for cancer research & prevention programs.
    • The medical science can only advance as fast as people are willing to participate in trials. And Wisconsinites participate in cancer research at a 17-20% rate, consistenly outpacing the national average of only 2-4%. Our citizens know the currently available treatments are only good enough for yesterday—not tomorrow. They stand ready and able to carry the nation’s progress in cancer treatment forward.
  2. Co-sponsor the DIVERSE Trials Act
    • This would increase diversity in clinical trials and make it easier for all people with cancer to participate by reducing financial barriers to enrollment. 
    • This legislation allows trial sponsors to reimburse patients for non-medical costs associated with their trial participation, including parking, food, or lodging. It provides the necessary technology to facilitate remote participation. It also requires the Department of Health and Human Services to create guidance on the use of decentralized trials to increase diversity.
  3. Co-sponsor the Medicare Screening Coverage Act
    • This would create a pathway to allow Medicare to cover multi-cancer screening tests once they have been approved by the FDA. 
    • It’s widely accepted that public investment in cancer prevention and screening is good and necessary. But there’s another reason: the worsening shortage of U.S. oncologists. The Journal of Clinical Oncology estimated a shortfall of 3,800 cancer physicians in 2020. And we’re already experiencing the pinch, right here in rural Wisconsin. We must reduce the number of advanced cancer cases, and develop better, less burdensome treatments to relieve the strain on our health system. Because sooner or later cancer comes for all of us, or those we love.

The week ended with a Lights of Hope walk to remind everyone why we continue to come to DC year-after-year. Over 60,000 candlelit bags lined the pond at the Washington Monument and were dedicated to someone impacted by cancer.

For more ways to be involved, check out: ACS-Cancer Action Network

Cancer Action Network – Wisconsin Team

BREAKING: e-cigarettes pulled from shelves

BREAKING: e-cigarettes pulled from shelves

BREAKING: The FDA announces all JUUL e-cigarette products, including menthol-flavored e-cigarettes, must be pulled from shelves across the U.S.

E-cigarettes have been touted as a “safer” version of tobacco products. This may be true in regards to lung toxin exposure but many of the same and even new risks remain. Nicotine, the main active ingredient increases risk of cardiovascular events including heart attack and stroke, similar to traditional cigarettes. Thus, making e-cigarettes just as addictive as traditional ones.

In addition, e-cigarettes are not the best tool for tobacco cessation, essentially tobacco users are replacing one evil with one slightly less toxic one. Most concerning is the use among teenagers and young adults. E-cigarettes, especially flavored products, have attracted a population that may have never used tobacco products if e-cigarettes did not exist.

American Cancer Society Cancer Action Network – ACS CAN

Public health is paramount when regulating tobacco products—especially a product proven to be driving the country’s youth e-cigarette epidemic. 83% of youth e-cigarette users say they use flavored products like JUUL. In 2020, 1.3 million kids were frequent or daily users of e-cigarettes.

ACS CAN commends the FDA for this decision and for doing the right thing to protect public health, especially for our kids. We urge the agency to enforce this decision swiftly and we remain committed to working with Congress, state, and local lawmakers to end the sale of all flavored tobacco products.

Can prostate health be found in a bottle?

Can prostate health be found in a bottle?

There are many different names for products that manufacturers are hoping you think that if taken as recommended will lead to a “healthy prostate”.  You have most likely noticed them in the store or online with names ranging from Prostate Defense to Super Beta Prostate Support. Other than a high price tag are they really any better or even just as good at enhancing men’s health than what we can ingest naturally in our food?

There is significant evidence that focusing on a plant based diet contains the necessary nutrients to promote prostate health. Diets that a rich in fruit, vegetables, whole grains, fish, and healthy oils provide an appropriately balanced amount of these nutrients that you would unlikely even need a multivitamin. 

Specific nutrients that may help decrease the risk of prostate cancer include isoflavones including soybeans, tofu, and edamame beans. Green tea also includes flavonoids which act as an antioxidant which may prevent precancerous growths from beginning cancerous tumors. Antioxidant properties can also be found in red fruits such as watermelon, pink grapefruit and tomatoes, or vegetables such as broccoli, cauliflower, kale, and brussel sprouts.  

The supplement of magnesium is fairly easy to get in your diet. Sources of magnesium include fruits, veggies, whole grains, nuts, seeds, tofu, and dark chocolate.  

When considering whether to reach for a pill it is also important to realize that your body tends to absorb food nutrients better than supplements in the form of a pill. Furthermore, many of these products include higher levels of certain supplementation that are not needed or used by the body or may actually be dangerous for certain men.

If you make the above food choices in your daily diet, you will both save money and enjoy a healthier lifestyle.

Remission in Every Patient

Remission in Every Patient

Promising clinical response for rectal cancer patients

This weekend, Green Bay Oncology providers attended ASCO in Chicago where the results of a phase II trial was discussed involving patients with mismatch repair deficient locally advanced rectal cancer. These patients received treatment with PD-1 blockade, dostarlimab, and had a complete clinical response. This is exciting news for this subgroup of cancer patients.

Typically, locally advanced rectal cancer is treated with combination chemotherapy and radiation therapy followed by surgical resection. The standard approach does demonstrate a reasonable overall positive response but can have permanent effects of fertility, sexual health and bowel and bladder function. The implications of this study are quite profound and may lead to a remarkable change in our treatment approach.

The results are preliminary, and the long-term follow-up has not been completed to define if the responses are durable. However, with all these caveats, it is still quite impressive.

It encourages us to be relentless in research. Patients willing to participate in clinical trials are the hope for improving long-term survival and overall quality of life.

Dr. Tony Jaslowski

NY Times Article
New England Journal of Medicine Study