The Advantages of Local Cancer Treatment

Dr. Basem Goueli, a Duluth specialist in oncology and hematology, wants cancer patients to know something critical to their health: You can stay home, or at least in your home region, for almost every kind of cancer treatment.

In fact, local doctors often offer your best choices. “In going to a bigger name institution, they may actually be going to someone who’s not as equipped as the person they are seeing (locally),” says the director of St. Luke’s Hospital Cancer Care in Duluth. “People need to know that a lot of the doctors in Duluth chose to be in Duluth; they could easily be at Mayo or Stanford. People don’t get that; it’s an understandable reflex.”

“Understandable” because cancer is one of the scariest diagnoses you can receive and places like the Mayo Clinic in Minnesota or Stanford University in California have high-profile, well-marketed reputations.

But in the past two decades, treatments and prevention have advanced multifold for many of the 100 identified types of cancer, and so have the options for cancer care around the Lake region.

Skilled diagnosis, radiation therapy, infusion/chemotherapy and most surgeries, are all available in our major medical centers and even some smaller communities.

There are cancer centers in Duluth, Marquette, Thunder Bay and Sault Ste. Marie, Ontario. Thanks to medical partnerships, cancer care in some form, whether a visiting oncologist or treatments, are available in most rural clinics.

Even in Iron River, Michigan, population under 3,000, the Aspirus Hospital has a rotating oncologist.

“I think we’re pretty well versed in almost everything,” says Basem, himself proof of high-caliber training in local physicians. Before coming to St. Luke’s Hospital in Duluth, he attended medical school at Mayo Clinic, did postdoctoral research and a clinical fellowship at Stanford University and his residency George Washington University Hospital and the National Institutes of Health.

Bayfield, Wisconsin, resident and cancer survivor Julie Haugen-Hosszu well knows the quality – and evolution – in regional cancer care.

From the time of her successful radiation treatments in February to when we chatted with her in June, cancer care on the Bayfield Peninsula had changed so much that she would have 3,480 fewer miles on the family car if diagnosed today.

Not that she’s complaining. When Julie got the call telling her that she had breast cancer late in 2015, she was ready to accept it and hoped her husband was, too.

“A couple days before, I said to Frank, ‘I’ve had a few false alarms. Are you prepared for this, because I am.’ The hard part was telling my kids. I had to tell them on the phone, mom was going to be OK.”

The next day as she and Frank drove to visit her daughter, she discussed her options with the Essentia Health nurse navigator assigned to her. “Nancy called me as we were driving down. She was so thorough and so clear about explaining. I thought that breast cancer was breast cancer, but there are so many different kinds.”

There were as many different options for treatment, it seemed. Ultimately, Julie decided on a lumpectomy and radiation treatment.

In February 2016, that meant driving 174 miles round-trip from Bayfield to Duluth for 10 minutes of radiation therapy.

By May 2016, Julie and Frank’s daily drive would have been a short 20 minutes to Ashland. May 2 is when the $12 million Northwest Wisconsin Cancer Center opened in Ashland. The cooperative project between Memorial Medical Health Center and Essentia Health added radiation therapy to the already provided infusion therapy options. There are oncologists on staff and some who travel weekly between Duluth and the new center.

“To have all of this now in a community the size of Ashland is phenomenal,” says Terri Kramolis, cancer clinic manager for Memorial Medical. “Their oncologist is here, social services, chaplain, pharmacy, radiology, every aspect of support services.”

The project was seven years in the planning, Terri adds, as the two medical facilities and community members reviewed “the what if, could we, what is the demand, what’s really needed here in this community?”

When Terri, herself a cancer survivor, was taking six weeks of radiation in Duluth, an average of seven to 10 others also were traveling from as far as Michigan to the Twin Ports for treatments.

Many, like Terri and Julie, appreciated the ability to travel only as far as Duluth instead of to larger cities like Milwaukee or Minneapolis.

“When you have to drive, the best insurance in the world doesn’t put gas in your car,” points out Dr. Ross Perko, a pediatric oncologist and hematologist at Essentia Health in Duluth. “And we have this thing called winter up here.”

An Iron Range native, Ross appreciates that even his distant patients travel only about an hour rather than four hours or more. Otherwise, the long-term care needed by some young patients could mean uprooting the family for months.

“As long as the treatment is exactly the same – and you get the exact same treatment here as anywhere else – it’s better to sleep in your own bed at night.”

Ross points out the top-notch training that he and his local colleagues have gotten at St. Jude Children’s Research Hospital in Tennessee, the Lurie Children’s Hospital of Chicago and the Cincinnati Children’s Hospital Medical Center.

“Sometimes people do feel like they need to go other places, but you’ve got this care in Duluth.”

Ross has a name for that lure of trying the “big name” medical facilities over local options. “I call it the ‘Air Jordan effect.’ People think you have to wear Air Jordans to play basketball, but you don’t.”

Why physicians choose this area to practice varies, of course. Ross’ work with terminally ill children inspired him to return home. “I’ve seen some things that I never want to see again, and it makes me think about being a good dad and being a good husband. I wanted to come back to Minnesota, I wanted to be close to family. Duluth really provides me a good work-life balance. It’s a great place to grow up; it’s a great place to raise a family.”

It’s also a great place from which to taunt your weary medical school friends in bigger cities. “I love social media,” he chuckles. “My friends write, ‘Dude, why are you always so happy?’ And I write, ‘Check out the view from my front door’ or ‘Before I went to work today, I took a fat-tire bike ride.’”

Both Ross and Basem say time for patients also keeps them here.

“I spend all the time my patients need,” Ross says. “I don’t have any limits. If we need 15 minutes, we take 15 minutes. If we need an hour, it takes an hour.”

Basem, too, describes two-hour consultations that sometimes make him late, but put his patients first.

Basem’s additional lure here was the ability to teach at the University of Minnesota Duluth Medical School. “The draw for me personally was the ability to practice academic medicine in a clinical setting.”

Medical schools in Duluth and in Thunder Bay help both cities’ medical industries in recruiting physicians and in netting clinical trial studies, which are a measure of how cutting-edge a community’s cancer care truly is.

At UP Health System Marquette, the Marquette General Hospital staff has ties to Duke University, which “brings an interesting partnership here,” says Dr. Philip Lowry, clinical director of the system’s cancer care. In a video, he adds, “Our goal is to deliver the best possible cancer care as close to home as possible.”

Kathleen Castro with the U.S. National Cancer Institute (NCI) grew up in North Dakota and knows the challenges of medicine outside large urban hubs. “I understand driving 80 miles for a movie.”

She heads cancer care delivery research for NCI and points out that cities like Duluth and even smaller can have access to the clinical trials that can mean life or death for patients with cancers considered currently untreatable.

The NCI Community Oncology Research Program strives “to really reach patients in the community setting.” Its ncorp.cancer.gov website allows patients to input their cancer type and location to check for clinical trials close by that match their type of cancer. “It absolutely gives you access to studies that are being done so you don’t have to drive all the way to Minneapolis or the (Mayo) Clinic.”

Don Hermanson of Houghton, Michigan, and who helps to distribute Lake Superior Magazine and its products, was devastated when diagnosed with non-Hodgkins lymphoma in April 2013. “When they say, ‘Cancer,’ it will bring you to your knees.”

He also, though, heard something good that day: “We can treat you here in Hancock.”

On 21-day cycles for six months, Don underwent fatiguing chemotherapy at UP Health Systems Portage in Hancock. His oncologist/ hematologist, Dr. Lloyd Geddes, brings impressive credentials to the Keweenaw Peninsula. After completing a residency and fellowship program at Washington Cancer Institute in Washington, D.C., he went on to 15 years of experience at clinics in Atlanta.

Don heaps high praise on his physician – “He’s very, very good” – and is grateful his community can attract such medical talent, which meant that when Don was weakened by the chemo, he could live with his nephew near home and have the help and support he needed.

In a Portage video, Lloyd explains his philosophy of care – “curing cancer, one patient at a time, so really a patient-centered approach” – and appreciated his U.P. location. “I’ve never lived in a city that had less than 6 million people, and one of the things that we’ve been surprisingly happy with is the whole small-town feel, and the fact that everyone knows everyone and everyone is willing to help.”

For someone like Don with a cancer that must continue to be monitored even when in remission, the home-field advantage means easy access to care and being surrounded by that community and family support.

For Julie, whose breast cancer is gone, it’s a blessing to know that if she needs future treatments, they can be closer still to home. That the end to her daily travel between Bayfield and Duluth brought relief but, she admits, also a bit of sadness at no longer seeing the Essentia Health caregivers.

“The staff was just remarkable, I just can’t say enough. The last day it was kind of bittersweet because these people had been so kind.”

She and Frank used the long drives to get to know each other better. “We talked about a ton of things. It’s the first time we really thought about our mortality and appreciating each day.”

It’s an appreciation they continue to acknowledge and enjoy.

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Cancer Survival

The director of St. Luke’s Regional Cancer Center, Dr. Basem Goueli, gave a talk in July 2015 titled, “Behind the Curtain: A Never-Before Seen Look at Cancer Survivorship.” Here, in a nutshell, are his six cancer survival tips.

1. Understand Your Cancer

“Our understanding of cancer is changing at breakneck speed,” Basem says. Research exactly what your type of cancer is and what options are available. Especially for those with metastatic tumors, check clinical trials. “There are people who are alive today who would not have been 10 years ago because they got on a clinical trial.” Basem suggests searching your type of cancer on a few websites, including clinicaltrials.gov, pubmed.com and nccn.org (a National Comprehensive Cancer Network used by oncologists. “Go to the doctor version,” Basem says. “If you don’t understand it, ask your doctor to explain.”).

2. Choose Your Cancer Doctor Wisely

“I’m a firm believer that your cancer doctor could make or break you,” says Basem. Check out doctors on patient review websites (healthstream.org, vitals.com) and consult with friends or family who were their patients. Also ask these questions of them or of yourself: Where did they train? Do they have a commitment to clinical research? How much time do they spend with you? Do you feel rushed? Do they listen? What is their experience level? What is your comfort level with them? “You want a doctor who treats you holistically, all of your health needs. … You want a doctor with a big heart. It’s what I would look for.”

3. Inches Matter In Cancer Care

For early detection and for care after a diagnosis, you and the people who help you must sweat the small things. Don’t ignore frequent headaches, back pain, abnormal moles, etc. These can be signs of worse things. If you are diagnosed with cancer and are being treated, pay attention to those same things and also fevers that might indicate infections, or diarrhea and vomiting that can lead to dangerous dehydration. “Inches are everywhere in this business. Don’t you ignore it; don’t let your doctor ignore it. … Call your doctor; if they get annoyed, find another doctor.”

4. Don’t Forget What You Are Fighting For

“Do not live simply to not die. Try to see the forest through the trees. Stay true to that which bewilders you, and find solace in it. Remember the love you are fighting for.”

5. You Are the Captain of This Boat

“I’m the navigator, you're the captain. It’s your boat. We do what you want.” Basem suggests getting a second opinion if you are concerned with a diagnosis or treatment suggestion. Also remember that you make the choices, even if your family might disagree with a decision.

5. Cancer Is a Marathon, It Is Not a Sprint

“There is never a cancer patient who has a very short race – it’s always in your conscience somehow. … Surround yourself with people who can help you run this race.”

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Care Centers

Below is a list of Lake-region cities with major cancer-care services, including on-staff oncologists, radiation therapy, infusion/chemotherapy, major surgical options and clinical trials.

Duluth

Essentia Health Cancer Center, www.essentiahealth.org

St. Luke’s Health Care System Regional Cancer Care Center, www.slhduluth.com

Marquette

UP Health System Marquette Cancer Center, www.mgh.org

Upper Michigan Center for Interventional Oncology (in Marquette General Hospital), www.northerninterventional.org

Thunder Bay

Thunder Bay Regional Health Sciences Centre Regional Cancer Care Northwest, www.tbrhsc.net

Sault Ste. Marie, Ontario

Sault Area Hospital Algoma District Cancer Program, www.sah.on.ca

Ashland, Wisconsin

Northwest Wisconsin Cancer Center of Memorial Medical Center, with Essentia Health, ashlandmmc.com

Hancock, Michigan

UP Health System Portage, www.portagehealth.org