A Focus on Quality and Quantity of Life

Dr. David Groteluschen, a medical oncologist with Green Bay Oncology, views himself as a guide helping people navigate a world skewed by a cancer diagnosis.

“I don’t think medicine is always about fixing people,” he said. “I think it is about guiding people and figuring out the best way to take care of our life. We all know we are going on a journey. Journeys have beginnings and endings. I really appreciate oncology for not only worrying about how to fix people, but also focusing on quality of life when we can’t fix people. That’s sometimes as important as giving people medicine.”

Groteluschen has been practicing oncology for 13 years and is excited by the many advances that have been made just in that amount of time.

“It’s extremely exciting with the amount of treatments and targeted therapies,” he said. “I think we’re at a very interesting point. The old way we used to do treatment, we gave people very hard drugs. It would do a good job of killing the cancer, but it would also make people sick. About 10 years ago we came up with drugs that did not cause nausea and vomiting. So now people could get their chemotherapy treatments as an outpatient. They wouldn’t have to be in a hospital so they could still go to work and carry on with their lives. The chemotherapy might still be toxic, but we have better medicines to make their side effects better. We started seeing the survival increase when we started doing that. Our two goals are quality and quantity of life. In the old days we sometimes had to make a choice about quantity and sacrifice quality. Now we can talk about quantity of life and not sacrifice quality. We’re still far away from ‘the cure,’ but we’re much closer to what I call a cure in some ways because we are able to maintain a quality of life and keep people from dying from cancer.

“Now we’re at a crossroads,” he continued. “In our advanced world of finding mutations and genetics and how they’ve mapped the genome, we’re actually now able to find drugs that can target the cancer and seek that out like a heat-seeking missile and don’t hurt the rest of you. It’s exciting, but we have a long way to go. They don’t work as well as we want, but they do work and they don’t make people sick. We’re making people do better for a longer period of time. We’re not curing things. But the way I always talk to my patients, we’re making it almost like a chronic disease state, just like diabetes or high blood pressure. We can get control of the cancer and keep it under control. With these new targeted drugs, with either pills or IVs, we can give that to people to maintain it so it doesn’t grow and they’re not sick.”

Groteluschen said certain treatments have much more success in terms of survival and targeted therapy.

“We put a lot of research into breast cancer and colon cancer in the last three to four years,” he said. “We’re starting to develop targeted drugs for lung cancer, and that’s really exciting because we’ve never really had any good, classic chemotherapy for lung cancer, and lung cancer has always been a deadly cancer. Even though we’ve had these advances with new drugs, lung cancer is still our biggest killer. Ovarian cancer has targeted therapies. In the last year we’ve seen a number of targeted drugs for melanoma. That’s for a disease – melanoma – where we really had no good treatments at all. There are still some where we are way behind the eight ball. Pancreatic cancer, we’re still looking for those targeted drugs. There are some we are still trying to catch up on.”

People have used the term “cancer epidemic” to describe the rate of cancer in northeastern Wisconsin and Door County.

“I think it is the older population. The older you get, the higher incidence of cancer,” Groteluschen said. “The demographics of Door County are one of older population. I think the other thing is improved screening. Prostate cancer screening, mammogram screening, colonoscopies. People in Door County – and the Midwest for the most part – have fairly good insurance and are more likely to see their doctors and have routine screenings. Yes, a lot of people get diagnosed with cancer, but if you have good health care, if we detect it early, that’s actually great. If we detect something early, we can cure you. Really the one cure right now is early detection. That’s still the biggest cure.”

Groteluschen said Green Bay Oncology is a big believer in bringing care close to people’s homes.

“We’ve been fortunate enough to partner with Door County hospital and the Affinity system here and [CEO] Jerry Worrick,” he said. “They have done a great job. We really try to support each other to build a cancer center. The doctors here are wonderful, the primary care physicians and the surgeons, they do a great job working with us. We’re able to bring our expertise here. We bring clinical trials up here so people can enroll in clinical trials and don’t have to travel. That’s the new drugs I’m talking about. The fact we can bring that here is pretty amazing. We started as a one-day a week clinic and now we’re here four days a week. We think it’s a great place to practice and very important to bring that care here.”

Age-adjusted Incidence Rates, 2007 – 2011

Incidence rates state the number of people estimated to be diagnosed with cancer per 100,000 people. For example, the U.S. incident rate for all cancers between 2007 and 2011 is 459.8, which means that approximately 460 people out of every 100,000 were diagnosed with cancer in that time period. The age-adjusted incidence rate adjusts age distribution differences so different populations can be compared.

Source: statecancerprofiles.cancer.gov.

All Cancers

Door County: 460.5; Mortality 157.6

Wis.: 462.1; Mortality 174.6

U.S.: 459.8; Mortality 173.8

Bladder

Door County: 3 or fewer

Wis.: 22.9; Mortality 4.7

U.S.: 20.9; Mortality 4.4

Brain & ONS (other nervous system)

Door County: 8.1; Mortality 9.3

(highest in state)

Wis.: 7.7; Mortality 5.0

U.S.: 6.7; Mortality 4.3

Breast

Door County: 140.8; Mortality 18

Wis.: 124.8; Mortality 21.0

U.S.: 122.7; Mortality 22.2

Breast in situ (when pre-cancerous cells remain in place without invading other cells).

Door County: 29.0

Wis.: 32.2

U.S.: 31

Cervix

Door County: 3 or fewer

Wis.: 5.9; Mortality 1.5

U.S.: 7.8; Mortality 2.3

Childhood (to age 15)

Door County: 3 or fewer

Wis.: 15.9; Mortality 2.3

U.S.: 16.0; Mortality 2.2

Childhood (to age 20)

Door County: 3 or fewer

Wis.: 17.6; Mortality 2.3

U.S.: 17.3; Mortality 2.4

Colon & Rectum

Door County: 37.75; Mortality 12.1

Wis.: 41.8; Mortality 14.8

U.S.: 43.3; Mortality 15.9

Esophagus

Door County: 3 or fewer

Wis.: 5.5; Mortality 4.8

U.S.: 4.8; Mortality 4.2

Kidney & Renal Pelvis

Door County: 14.96; Mortality 3 or fewer

Wis.: 16.6; Mortality 4.4

U.S.: 15.9; Mortality 4.0

Leukemia

Door County: 19.39; Mortality 3 or fewer

Wis.: 16.1; Mortality 8.0

U.S.: 12.9; Mortality 7.0

Liver & Bile Duct

Door County: 3 or fewer

Wis.: 5.9; Mortality 5.0

U.S.: 7.1; Mortality 5.8

Lung & Bronchus

Door County: 52.2; Mortality 38

Wis.: 62.1; Mortality 46.8

U.S.: 64.9; Mortality 48.4

Melanoma of the Skin

Door County: 35.1 (highest in the

state); Mortality 3 or fewer

Wis.: 19.5; Mortality 2.7

U.S.: 19.7; Mortality 2.7

Non-Hodgkin Lymphoma

Door County: 23.89; Mortality 3 or fewer

Wis.: 20.6; Mortality 6.8

U.S.: 19.3; Mortality 6.3

Oral Cavity & Pharynx

Door County: 11.06; Mortality 3 or fewer

Wis.: 11.3; Mortality 2.4

U.S.: 11.2; Mortality 2.5

Ovary

Door County: 13.65; Mortality 3 or fewer

Wis.: 12.9; Mortality 8.7

U.S.: 12.0; Mortality 7.9

Pancreas

Door County: 12.73; 11.98

Wis.: 12.7; Mortality 11.3

U.S.: 12.1; Mortality 10.9

Prostate

Door County: 141.6; Mortality 21.36

Wis.: 139.2; Mortality 24.3

U.S.: 142.3; Mortality 22.3

Stomach

Door County: 3 or fewer

Wis.: 6.1; Mortality 2.9

U.S.: 6.7; Mortality 3.5

Thyroid

Door County: 3 or fewer

Wis.: 11.4; Mortality 0.6

U.S.: 13.1; Mortality 0.5

Uterus

Door County: 30.7; Mortality 3 or fewer

Wis.: 28.2; Mortality 4.7

U.S.: 25.0; Mortality 4.3

Cancer Care Has Come a Long Way

Jody Boes, vice president of patient care administration at Ministry Door County Medical Center, has worked with local cancer care since the services were first offered at the hospital.

“When we started with cancer services, it was through outreach through Green Bay Oncology,” she said. “We started out with one-half day a week. Then a full day. Then I remember gearing up for two days, and then gearing up for three days. I think about that journey. The unfortunate thing is that we had that volume of patients to fill those openings in the schedule. The fortunate thing is that you can receive this excellent care with incredible physicians, with state of the art radiology with the new linear accelerator. It’s wonderful to be able to get that level of care so close to home. I’ve been here four-plus decades and I think of all the new services we’ve added here, our cancer center is the most positively received and thanked for new service we’ve initiated here at Ministry Door County Medical Center. We look at it as survivorship. That term is so important. It’s about treatments and survivorship.

“I’ve seen us hire nursing staff and watched them grow to the outstanding professionals that they are with incredible knowledge and experience around cancer care,” she said. “What I believe is second to none is the amount of caring that our staff provides to our patients and the special things that they do for our patients in terms of their caring, taking care of the whole person – mind, body and spirit.

“Keeping that cancer care close to home is so important,” Boes continued. “When they receive that cancer diagnosis, they are at the most vulnerable point in their life. To be able to provide this quality of care right here in Door County is really a testimony to the organization, Green Bay Oncology and HSHS St. Vincent’s. That collaborative approach to ensure our community receives the best care is outstanding.”

Boes said the latest development at the cancer center is launching a Navigator program, with one member of the nursing staff being assigned to a new cancer patient.

“That nurse will partner with that patient and go through the journey with the patient by navigating their care through primary care, through radiology and just being able to help that patient navigate the health care system,” she said. “We’re starting out on a pilot project with breast cancer and plan on expanding. That’s something Green Bay Oncology has been very instrumental in starting.”