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.

COVID-19 and Cancer

COVID-19 and Cancer

Is this hype or is this real?

The death rate is about 1-3% – not as high as SARS, but about ten times higher than regular influenza.

But because COVID-19 is a new mutation, and humans have no innate immunity, the total number of cases may be extreme – so it could be 1-3% of a very, very large number.

It’s not hype.

It’s real.

How will my cancer treatment be affected?

If you’re currently receiving chemotherapy or radiation for your cancer, your treatments will continue without interruption.

If you’re newly diagnosed, consultations can still be scheduled in person or via a telehealth visit, depending on the nature of your specific problem.

Though non-urgent treatments and follow-up visits were previously on hiatus, as of early May 2020 we’ve resumed scheduling these visits. Depending on the nature of your problem, you may be offered the option of a telehealth visit instead of an in-person clinic visit.

As always, if you’re worried about recurrence or have a problem related to your cancer or its treatment that requires evaluation, we’re able to schedule a clinic visit for you.

Am I at high-risk to get sick from COVID-19?

Although even healthy people can become dangerously ill from COVID-19, the following types of patients are at especially high risk:

  • Patients currently receiving radiation therapy and/or chemotherapy (excluding CML patients taking oral medications)
  • Patients on chronic immunosuppression (such as steroids, anti-rejection medications, or medications for autoimmune diseases such as rheumatoid arthritis, lupus, or Crohn’s)
  • Patients who’ve ever received chemotherapy for leukemia or lymphoma (excluding CML patients who’ve taken oral medication)
  • Patients who’ve ever undergone a bone marrow or stem cell transplant
  • Patients with advanced stage CLL (> Rai stage 0)
  • Patients with untreated, advanced stage lymphoma (> stage 1)
  • Patients with any type of metastatic, non-hematologic cancer
  • Patients in remission from cancer, but who have significant heart disease, lung disease, kidney disease, liver disease, or diabetes

If any of these apply, it is even MORE important to strictly adhere to social distancing guidelines from the CDC and state health agencies – and avoid leaving home if at all possible.

Should I be wearing a mask?

REVISED: 4/3/2020

The CDC now recommends that all Americans wear a non-medical grade mask when leaving their homes.

It’s important to use a densely-woven fabric, because loose-weave fabric (such as T-shirt material) doesn’t keep you from spreading droplets.

Here’s a basic tutorial for sewing one:  

Keep in mind that the mask isn’t to protect you; it’s to protect other people FROM you. Like many thousands of others, you could have an asymptomatic COVID-19 infection – but yet still transmit it to someone else for whom it could be lethal. A properly-made cloth mask can reduce the likelihood that you’ll unintentionally harm someone else.

But masks don’t prevent airborne virus-containing particles from entering through your eyes. 

Masks don’t provide as much protection as good hand-washing, and following the social distancing and isolation recommendations from the CDC.

And you MUST NOT take these new CDC recommendations as an excuse to obtain or use a hospital-grade N95 mask for yourself, and further deplete the limited supply available for those on the front lines.

You have the freedom to keep a safe three-to-six foot distance from others, but healthcare workers don’t. Social distancing remains the most important thing the public can do to keep safe, and healthcare workers still need the N95 masks more than you do.

Use a cloth mask when you go out, not an N95. 

Are there effective treatments for COVID-19?

Because treatment options are so limited, the FDA is approving the use of drugs to treat COVID-19 based on very preliminary evidence.

Though this is an appropriate adaptation to our current circumstances, it may cause some treatments to appear – and then quickly disappear – as further study shows a lack of benefit (as happened with hydroxychloroquine).

At present, only the antiviral drug remdesivir has sufficient evidence to support its use, and it’s currently available for seriously ill COVID-19 patients.

There are presently no known drugs that prevent the illness. And though there’ve been some promising steps forward, a vaccine is still a long way off.



There is always another play.

There is always another play.

In April, I asked parents of these teams if they wanted join me in a donation system to give some deeper meaning to the girls’ season after my mom, Patty Thorne, had passed away from breast cancer on January 6th of this year. We have all had people we know affected by cancer and several families joined in from each team. For the 8U team I set up $1 for every run scored, $5 for every homerun and $5 for every win. For the 10U team, same thing but also adding $1 for every strikeout recorded by one of our pitchers.  The girls did us proud and played hard all season long. With us we have 2 pitchers that recorded over 200 strikeouts just themselves and a handful of players who hit a number of homeruns, not to mention all the runs scored and wins recorded. The 8U team finished with a record of 20-3 and the 10U team recorded 18 wins against just 9 loses. Both teams won multiple tournaments with many top 3 finishes. Outstanding seasons by both teams, we are very proud of them and their efforts made this possible.  

When we lose someone we love, whether it is to cancer or any other reason, the reality is that the world around us goes on and barely skips a beat.  But to those closest to that loss, we know that is not the case. There are many random moments when we are left feeling, man, I wish they were here to share this moment with us.  Or we tell our kids things like, Grandma or Grandpa would have been so proud of you. We are faithful people so we know that the person missing is in their true home with the Lord, but let’s be honest, we would sacrifice a lot for even one more moment to hug our loved one. 

In a busy world that stops for no one, our loved ones remain alive with us in our hearts as we remember them and thinking about all the things that we shared with them. We as coaches always like to think that the games we teach are metaphors for life. Some parents may think we are a little crazy, but I do believe that the lessons we learn in sports, especially as our kids are growing into teenagers and then young adults, are lessons that they can carry with them all of their life.  Working hard for something you love, being a great teammate, carrying a positive attitude, and learning how to gracefully win and lose are all things we teach among many other things. These are all lessons those that passed on before us would want us to know and remember as we navigate this life without them.

Personally, I teach my players that “There is always another play.” This means, for example, that after the out is recorded at first base, the players on the field need to be ready to perhaps throw the baserunner out at third or watch for a play at home.  In other words, we can’t be content with just that one out. From when open gyms started in December to just a couple weeks ago, that was our play to first. We got that out. Now, today, this is the other play. This is the part of a being a teammate that carries off the field and into the community. We have the ability to impact those around us, often times its people we won’t ever know or the smallest gesture like a friendly hello that can change a person’s entire day or more. Your actions and attitude matter more than you’ll ever know, so just keep that in mind on and off the field.  A positive attitude and a giving heart have the ability to literally change the world.  

With that the girls of Denmark Softball, would like to present these funds, in the total amount of $3,237, to the cancer center to help those currently battling this terrible disease.  We hope that they know that even though we don’t know them individually, that there are people out there thinking and caring about, and praying for their successful recovery.

You voted us “Best.” We call it “nothing less than you deserve.”

You voted us “Best.” We call it “nothing less than you deserve.”

Biggest. Boldest. “Best.”

From the day we opened 43 years ago, Green Bay Oncology has had only one focus, one guiding star for every decision: what is best for our patients? And now, we are deeply honored and humbled to have been recognized for that dedication—by you, our patients, families, and friends.

Thanks to you, through the Green Bay Press-Gazette, Appleton Post Crescent and Oshkosh Northwestern, we’ve been voted the 2019 “Best Cancer Care Team” in each category throughout Northeast Wisconsin.

The awards include:

  • BEST OF THE BAY – Green Bay Oncology
  • BEST OF THE VALLEY – Green Bay Oncology at Ascension St. Elizabeth Hospital Cancer Center
  • BEST OF WINNEBAGO COUNTY – Green Bay Oncology at Ascension Michael D. Wachtel Cancer Center

We’ve always believed where you live shouldn’t impact your access to ground-breaking cancer care and research. In fact, we know being close to home can help with healing and make some tough treatment options a little more comfortable. It’s why we’ve reinvented how our doctors collaborate, making sure that no stone goes unturned in finding the right therapies for our patients. And it’s why we commit to treating the complex cases others won’t.

Because cancer won’t give up until we force it. It’s something we’re relentless about.

Green Bay Oncology

Bladder Cancer Awareness

Bladder Cancer Awareness

Though the treatment of cancer of the urinary bladder is complex and evolving, it isn’t necessary to travel to a distant medical center for this problem.

At Ascension, we have the specialty expertise you need to treat you close to home.

What we commonly call bladder cancer can actually arise from any part of the urinary system: the bladder, the tubes that connect the bladder to the kidneys (called ureters), or even the collecting pouch within the kidney itself (called the renal pelvis). Wherever they start, these cancers of the inner lining of the urinary tract (or urothelial cancers) tend to look the same under the microscope, and share a tendency for aggressive growth and early spread.

As these cancers develop, patients may experience frequent or burning urination, a feeling of incomplete bladder emptying, and sometimes pain in the side or the back. But the most common symptom is bloody urine – and the more blood there is and the more often it occurs, the more likely it’s signaling a cancer.

Because urothelial cancer isn’t particularly common and because the symptoms closely mimic a bladder infection or kidney stone, most people don’t think to alert their doctors until the signs have been there a long time – which often delays diagnosis, and far too often gives the cancer time to spread.

Surgery remains a crucial part of treatment, and we’re fortunate to have talented urologists at Ascension with extensive bladder cancer experience. When we’re fortunate enough to find a cancer while it’s still small, it can often be removed while leaving the rest of the bladder intact. Larger, more invasive tumors often require removal of the whole bladder, with construction of an artificial urine collection pouch made from a small piece of intestine that opens from a surgically-created hole in the abdomen (called an ileostomy). In some cases, using chemotherapy and radiation before surgery can shrink a tumor enough to allow for a more limited surgery – and allow patients to avoid having their entire bladder removed.

Because urothelial cancers often “seed” the bloodstream while they’re still small – a process called micrometastasis – tumors can appear throughout the body months or years after an attempt at surgical cure.  This is another reason why chemotherapy can be crucial before or after the primary tumor is removed, depending on the extent of disease and the estimated risk of recurrence. The medical oncologists of Green Bay Oncology who serve Ascension have almost a century of accumulated training and experience, and can customize the treatment approach based on individual needs and preferences.

Even with treatment, far too many patients experience recurrence and ultimately die of widespread disease. But there is some good news: new classes of molecular inhibitors and immune checkpoint inhibitors are highly effective for patients whose tumors harbor specific gene expression profiles, and are helping improve and prolong the lives of patients with incurable bladder cancer – but without the typical side effects of chemotherapy.

Urothelial cancers pose significant challenges to afflicted patients and can significantly impair their quality and length of life. At Ascension, we take this challenge seriously and are dedicated to protecting and improving the lives of our patients, right here at home.

Cynthia’s Scholarship Story

Cynthia’s Scholarship Story

Dr. Jules Blank actually treated my mother when she had leukemia. She passed away very young and I was just 12 years old at the time.

I never would have imagined that I would come full circle and be receiving a scholarship in Dr. Blank’s name to continue my education in healthcare. They didn’t know it then, but my mother’s nurses had a huge impact on me.

When a patient receives a cancer diagnosis, there is often little positivity in their lives at that time. As a registered nurse, it means a lot to me to be a small ray of hope in the lives of my patients and the lives of their families. Losing my mother to cancer gives me a unique perspective and a drive to be a source of strength for my patients.

One of the core values of Green Bay Oncology is to embrace the difficult. My patients have taught me so much about what this means. Seeing the strength it takes to endure what our patients go through gives me a different perspective on life. It shows me what is truly important and that often when we are pushed to our limits, there is still more to give.

I have always been driven to learn, and I am grateful for the support from Green Bay Oncology to pursue my dream of becoming a Nurse Practitioner.

Recently, I became a first-time mom. And while being in graduate school is not conducive to this, the support I have received from Green Bay Oncology and the JULES BLANK Oncology Knowledge SCHOLARSHIP while going back to school will never be forgotten.

Jessica’s Scholarship Story

Jessica’s Scholarship Story

Healthcare can be challenging but the satisfaction I feel from changing peoples lives for the better is what has made me passionate about this field.

When I was given the opportunity to work in the Green Bay Oncology clinic at OSF I was excited to learn a new nursing specialty but I didn’t anticipate how special the bond with oncology patients would be. I look forward to building caring relationships with our patients that are scared or nervous at the beginning of their treatment journey. Providing relief from unnecessary worry and helping patients feel as comfortable as possible is a top priority.

I was driven to pursue a BSN degree to increase my nursing knowledge and provide high quality care for the patients I care for as well as possibly open doors for professional advancement down the road.

At the time I was awarded the JULES BLANK Oncology Knowledge SCHOLARSHIP, my next course was scheduled to start in a couple weeks and I was a month away from going on maternity leave. I was reluctantly considering taking the upcoming semester off due to changes in family finances that the baby would bring. The gift of the oncology scholarship couldn’t have come at a better time. I was able to continue furthering my education and move closer to completing my degree with much less stress.

Thank you again to Dr. Jules Blank and Green Bay Oncology for the scholarship award!