[Music] Lakeland Currents, your public affairs program for north central Minnesota.

Closed captioning is made possible by Bemidji Regional Airport, serving the region with daily flights to Minneapolis - St Paul International Airport.

More information available at bemidjiairport.org Hello, again everybody, I'm Ray Gildow and you're watching Lakeland Currents.

And tonight our topic is going to be a broad cancer, and my guest is Dr Wade Swenson who is an oncologist with the Lakewood Health System in Staples.

Thank you for jumping on board with us and before we do anything else what's the difference between an oncologist and a regular medical doctor?

Very good.

So thank you for having me.

An oncologist is a physician, a doctor who specializes in cancer care.

And my course, and most people who go into medical oncology, need to go through the general training to become a general doctor.

In fact after medical school it's a three-year program in Internal Medicine learning about all different systems in the body and then a three-year program after that to specialize in Oncology and Cancer Care.

Wow.

Most incorporate hematology, blood cancers and blood disorders as well so most oncologists or cancer doctors, you know, will have a specialty in both blood and cancer.

There's been a lot of reports lately about the shortage of doctors and even dentists and it's just amazing they're saying that rural areas, not just rural Minnesota, but rural areas are going to be hard hit by these shortages and a lot of doctors are leaving the profession.

What are some of the reasons that people leave the profession?

Well yeah, that's a trend that's really concerning and I agree it's going to affect rural, and is affecting rural disproportionately.

There was a study that looked at specifically with cancer doctors and found that over the years of Covid, 20 plus percent of oncologists left the field.

Wow.

They left to go to pharmaceutical companies, they left to retire, they left to do non-patient care issues with leadership or different programs, some left because of Covid and so the average age of the medical oncologist is older than average, older than the average physician and so this is creating a problem in all of healthare in all of rural healthcare and especially in cancer medicine.

You came from Fergus Falls I believe.

That's right.

And now you're set up in Staples and talk a little bit about what you're doing there because it's pretty exciting.

Yep so I had a great career in Fergus Falls, Lake Region Healthcare, I was there for 17 years.

I started in 2005 and it just seemed like it was a good time to make a move.

I was really impressed with Lakewood and one of my first exposures to Lakewood was at the Minnesota Hospital Association, I saw some of the work that they were doing around food insecurity and it was really impressive to me.

It's a really mission- driven place and that caught my attention and so I started paying a little bit more attention.

They reached out because they had some oncology services from Essentia, Essentia wasn't able to provide those services anymore and so they went a year without oncology services and so they reached out, that seemed like a really great opportunity.

There's some really I think strong things about Lakewood.

One is the culture and the leadership and it really allows you to thrive and it's really been a great fit, so about two years ago, two and a half years ago, I started there and we've really grown the program to include now two medical oncologists and three nurse practitioners in medical oncology and a large infusion staff and really I think the key to the success of our program is a lot of the supportive services.

So the patient navigators, the financial navigators, the social workers, the people that help support the patient and the clinic visits with the patients are really important but it's everything else that goes into caring for these people that really makes the difference.

And so last summer we broke ground on a cancer center that should be completed in about October of this year.

So it's going to include radiation therapy and the radiation oncologist who will be joining us this summer is fantastic, I worked with her in my previous position, she's down in Florida now but she's coming back.

She's coming back?

Yes.

So it must be a good draw.

But it's been a great team I feel like we got all the first place picks on the fantasy draft when we drew this team together, it's been really a fun experience to see this grow and it's been a just a really nice program that's developing.

I know if anybody's driving in towards Staples they'll see this big concrete block building and I think Lisa told me there were like 30 some truckloads of cement what's that for?

So that's the radiation center.

So the radiation unit which needs thick walls of concrete to protect everybody else around who's not getting the radiation, that's the radiation vault, and that does take a lot of very specific physics and construction so finding the right team to build that is important and so it's been really fun to see that go from the ground up.

So you've talked about your staff do you see that sort of being stable then for the next few years or do you still see that growing some.

I know I've heard that you actually have drawn patients even from the Twin Cities.

There's a large draw of patients and I think the primary service area for Lakewood for at least for primary care is about a half hour or an hour to around but we do see people from a lot of surrounding communities and there's quite a bit of travel.

In fact, the Minnesota Hospital Association had a report looking that for rural residents most are traveling the average is traveling 75 miles one way for cancer care and that's no different here people are driving a long ways for care.

I'm just amazed when you look at the license plates in the parking lot where people are from and I have a number of friends who came from the Brainerd Lakes Area and came over to deliver a baby and were so impressed with the service of the organization they brought all their business to Staples which is I think that's amazing.

When I moved to Staples we had two doctors and they're still both there, they're not practicing anymore, they're still both there.

That is a tribute to Tim Rice and the leadership there it is incredible that that organization has grown from a small practice of two physicians and I remember talking to Tim about this to a thriving critical access hospital.

It's really a leader for other hospitals in the state.

It's remarkable.

We're really fortunate because if you look at Aitkin all the way over to Perham there are a lot of really good health institutions and I've talked to, I have some friends in Long Prairie, I think Long Prairie is down to three doctors and Little Falls is down to five and Little Falls is a community, you know, almost the size of Brainerd and I think it's just probably because of the structure of some of these hospitals are more corporate than your hospital is.

I think that's true and I think that, you know, having practiced in rural Minnesota for 20 years I really see that there are a lot of institutions, large healthcare systems that speak like they're an advocate for rural healthcare and speak you know if you look at the community level it's a different story.

I feel like if you look at the community level you can really see where in healthcare institutions are helping communities and when they're not and so I feel like what we're able to do with this cancer program in Staples is build a community-based program for cancer care that's very rare that doesn't happen.

Most cancer care in the United States is located in large academic centers and large systems.

It's one of the most centralized types of medicine that you can find.

In fact, 10% of oncologists in the country work in only three counties and it's just it's a striking number but it just speaks to the highly concentrated nature of cancer care.

So what we're doing is essentially showing that we can decentralize cancer care and we're hoping that this is a model that other places across the country, across the state can replicate because it's really important.

When you think about a cancer diagnosis and the frequent treatments that are needed, the daily radiation, the weekly chemotherapies, the disruption to the patients life and family lives and the kids who have to take time off work to help their parents that it's really disruptive and so when we look at delivering cancer care in the community it helps both the patients and their families and the health systems.

There's a Twin Cities company or hospital that was building a cancer center and one of the large consulting groups in the country made it the quote that 40% of many healthcare systems revenue comes from cancer care and so when you think that that is bypassing rural infrastructure, the rural health care systems, it makes sense that we bring some of that back to the community.

I've never made a secret of it that I've been a cancer survivor and I was going through my treatment programs at the University of Minnesota, which was excellent by the way no complaints there, but when you came to Staples and I looked and heard about what you're doing that's when I decided to bring my business to you guys and I've been so impressed not only with the, I don't know all of your staff, but the people that I get a monthly infusion for IgG and the staff there has just been incredible and everybody that comes there says the same thing, you're a great person to work for and they like the hospital layout the way that they're operating so that's really encouraging and I can only second what you have said when you have to drive 80 miles sometimes every day if you have to have a radiation treatment somewhere that's really a disruptive thing to your life and to be able to come to a close place that's going to be a wonderful benefit.

No I couldn't agree more and I think the culture is what really helps us succeed and and that's something that I can't control, it's the leadership, it's sort of an intangible aspect of an organization but it really is a positive aspect to the organization.

I feel too that when I mentioned decentralizing care it's important to recognize too that there's always going to be things that we can't do.

We do send in our practice probably about 25 to 30% of our patients at some time to Mayo Clinic whether it's for an opinion or a procedure that we can't do, so I don't want to mislead people to think that we can do everything, there's things that we definitely need our tertiary care partners but the majority of cancer care can be delivered in the community.

Yeah that's amazing.

What kind of requirements do you have for continuing education I mean that must be challenging with what we're finding out all the time about cancer.

It is, it's a fast moving subject, and when I look at every 10 years we need to recertify our boards and so when I look at 20 years ago when I was certifying for the first time looking at those textbooks it's like the Dark Ages, I mean it's totally irrelevant, and so it is an ongoing process and we do attend meetings on continuing medical education both for hematology and oncology and general medicine and there are requirements from the state to have so much every year but as an oncologist it's well beyond that.

We, for example, I'll be in Kansas City this weekend scheduling a meeting but I'm going to catch a review of hematology on Saturday morning so it's just a part of our ongoing lifestyle I think.

It's you commit to a career of lifelong learning when you're doing this.

And I know there's like the Anderson Cancer Center, there's some phenomenal places in America and yet there's still lots of cancers we just can't.

I don't know if I could be a doctor and in oncology and tell somebody they have stage 4 brain cancer, I mean that's got to be it takes a special person to do that doesn't it.

Yeah it's hard to explain there's something about it that I enjoy being a part of that, you're impacting, you're a part of somebody's life during possibly the most traumatic or most difficult time of their life so helping them through, helping them understand what it is, helping them understand available options, and when it comes to to something like that that we can't cure, really focusing on things that we can do to make things better is a big part of that.

I'm really lucky to work with a very strong palliative care team at Lakewood, we have some nurse practitioners and some physicians who specialize in palliative care.

Palliative care is controlling symptoms and whether we're able to cure a cancer or just make people comfortable that's a huge part of what we do, so I feel like there's still a lot of things to offer and it's really hard I mean people it would surprise you I think sometimes that some people have a sense of peace about some of these diagnoses and it's not as if it's harder on us than it is on them and other times it's very difficult, it's a hard process to go through, but I feel like we have the right team and the right resources to help people through this.

I think Jimmy Carter, President Jimmy Carter was a prime example of someone who accepted his fate and defied the rules and regulations and lived two more years beyond what anybody thought he would, but he always said he was not afraid to die and he dealt with that and so I think I suppose that and sometimes if we're not going to be killed instantly we have to deal with what we're going to be dealing with when our time comes.

And sometimes it maybe seems counterintuitive but sometimes we do better when we don't treat certain cancers that we can't cure.

When we introduce some of our treatments it's going to bring some side effects some decreased quality of life work where we could focus on improved quality of life, focus on palliative care and not subject people to some of these side effects.

So figuring out when that is the appropriate option for people is really important.

I bet yeah hard on families.

Yes.

But it's something that we all have to deal with.

When you look at cancers are you seeing growth in many different kinds or what are you seeing when you look at the field?

Some are getting better.

So we are seeing improvements in some cancers when there's good screening tests for example.

Lung cancer is the cancer with the most deaths each year and we do have a screening test for that with the low-dose CT scan for smokers and when we can find something early, which we do, and we can treat that as a stage one cancer they're cured, so we are seeing more and more options like that.

When it comes to breast cancer we have better techniques to detect it now with a 3D mamogram we can see the cancer earlier and cure the patients earlier so that's made a big difference.

There are cancers that are increasing for reasons we don't understand, in particular colon cancer, and in particular young people with colon cancer.

That's surprising to me.

I don't know that we have a good explanation for it, I mean presumably it's something in our diets we don't really know but it's maybe something like that.

It's really not clear but yeah it certainly raises a lot of suspicions about what it could be.

So when you, I've read that there are like about 80 different kinds of lymphomas.

That's right.

And when you are trying to decide what kind people have do you usually send that blood work out for someone else to analyze?

Yep so we have to make sure that we have the right diagnosis.

We're on the wrong track if we don't have the right diagnosis first so making sure the diagnosis is correct is essential and so when it comes to lymphomas, for example, blood cancers, there are about 80 different types.

So the standard of care is to have a hematopathologist read that and so typically we have our hematopathologist at Essentia or at Mayo Clinic look at that and it's not uncommon to get another opinion.

Again it's really important that we get the right diagnosis.

So this is one of the pieces where we could do the biopsy locally but we send out the reading or the interpretation to make sure we get the right diagnosis.

So in general what are the things that people will be able to find when you open your new center?

I mean talked about radiation but what are some of the other things you'll be offering?

Right so we have the infusion center, there's currently the infusion center at the hospital and we're going to keep that and then we'll have the new infusion center at the cancer center.

It will be a place where we're hoping right now we're spread out throughout the hospital and our patient navigators are down the hall and you know we're hoping that having everybody in close proximity will be a nice addition, being close to the infusion center where now it's downstairs and it's a bit of a walk.

I really want to have more of a presence throughout when I'm there just so I can I think having the accessibility and being available is really important so I think that's going to allow us to do a better job of communication and just it's going to be a game changer for us as far as just having the space and having everything right in one place.

That's really what your offering is not going to be offered really close by is it.

Yeah down the road here.

Pieces of it will be.

I really think though that with the comprehensive nature of what we're doing it's fairly unique.

Do you have access to government programs that help you?

In the sense that.

For funding?

Well our funding for the cancer center was done locally and so we, a lot of places use the USDA loans, but we didn't do that, we actually chose to fund locally within Staples.

So when it comes to some of the other pieces though we are looking at trying to solve the clinical trials dilemma when it comes to providing clinical trials in rural spaces it's hard to find and there's papers and editorials about this and how we can make this better.

Clinical trials are offering experimental medications that have proven to be effective before they're quite approved but they've shown to be very promising and so in a lot of different cancer types we have when we're at the end of the road for our known tried and true treatments, a clinical trial is often the best option and when we look at our national guidelines, clinical trials right up there is this should be the standard of care, so we're looking at ways to solve that and talking to some partners at the University of Minnesota and some other places where we can be offering that in the local communities.

That's rare, it doesn't happen too often so we're really hoping that if we can figure this out, again it's something that's reproducible that other places across the state and across the country could replicate.

I know something about clinical trials, I know sometimes it's a big step for a patient to try to step into something that we may not know a whole lot about but sometimes miracles happen with those clinical trials don't they.

That's right, when it comes to a clinical trial if it's going to be offered in the community it's generally shown to be effective it's just maybe comparing that to the standard of care or it might be looking at a new way or a new order of things.

Basically, we're not going to be doing experimental treatments necessarily in the sense that there's a lot of unknown but it is nice to be able to offer some of these trials that patients would otherwise have to travel to Minneapolis or Rochester for.

When you look at screening do you think it's still a very big challenge to get people to screen at appropriate times?

Yep I do.

It really depends on the type of screening.

I think most people understand the value of mammograms and screening for breast cancer, when it comes to lung cancer that's a different story.

I feel like we have a lot of opportunity to improve knowledge and sort of compliance or agreement to proceed with that test.

I think there's a lot of anxiety about some of these screening tests soo that's a big part of it.

When it comes to colon cancer screening we have our colonoscopies and those I think we do pretty well with that but there's also a lot of tests now that are much easier where they can take a stool sample and with a high degree of certainty test without going through the procedure of a colonoscopy.

I feel like there's a lot of opportunity to improve there too.

The state of Minnesota does track that for health systems and communities and throughout the state we can do better.

Do you have a group that you work with in Minnesota that's working on the same kinds of cutting edge things?

Well we do.

About three years ago Emily McGovern, Dr McGovern who joined me at Lakewood in September, she and I about 3 years ago started a nonprofit called the Rural Cancer Institute.

We started it with a few others, there's some doctors at Mayo Clinic who work with us, there's some medical students all across the country for some reason in Texas, in Kansas, in North Dakota, Michigan, and Illinois and Minnesota we work on some projects.

We've done some advocacy work, we had a day at the capital last year we'll have one again this year, and we're really advocating for things to help rural cancer providers and rural cancer patients.

And so I'll be in Kansas City this weekend we're hoping to put our first national conference together this summer that would be in Lawrence, Kansas and we're really hoping to be a platform to connect people, to show best practices, to advocate for rural cancer patients but it's been really enjoyable to get this project off the ground and to see the goodwill that people come and offer help, it's really been a fun experience.

So this initiative then is going to try to spread the gospel of what's working and what's been successful to other places.

Exactly.

That's a wonderful plan.

So in April we are meeting with several oncologists in Washington DC and we're hoping to have one to three oncologists from every state if we can just as a starting point so that's our internal goal in the next couple years.

Have you had good success it sounds like it working with the bigger institutions Mayo Clinic, University of Minnesota, are they the top two probably cancer institutions in Minnesota?

They are and they have a national draw as well in Mayo Clinic as you you mentioned Emily Anderson Mayo Clinic some of the large cancer centers in Los Angeles and New York City as well but it's very nice to have them as close as they are, there's still a four to five hour drive, but they're an international resource and they're just down the road so we do utilize them a lot and they're very good about sending patients back to the community to get most of their care and so when we need that second opinion, when we need that procedure that's rare and very important part of the cancer treatment we really, really rely on them to get to be a team member while even though it's an unofficial partnership it's a very important partnership.

If you live in Big Lake, Big Fork, way up in northern Minnesota, how do they approach you, how do they get in touch with you and I would assume most people when they're having a problem work through a local doctor but how do they work with you?

So you just reach out to the hospital and ask for the cancer team, Courtney is usually the one who answers the phone, and she would get you to where you need to be.

We have some patient navigators, Erin Kennedy and Tammy Mark, who would help arrange the appointments and get all the information, a big part of it is just gathering information so that we have everything we need to understand the issue.

And that's a big part of this too, it's the care team that really makes this whole project work.

So they don't need any special referrals?

No.

They can just contact you directly and I know you have a website through the hospital system too, that people can contact you there.

It's just fascinating you said the new center is going to open in October I believe you said and then you will do some remodeling I suppose of the old part.

Well I think we need the space desperately so they're glad to get us out of the existing space.

Gone through a lot of changes over the years since they built a new hospital.

Yes it was really it's such a nice facility in the sense that it just seems like it's brand new, it's 15 or 17 years old, but it seems new.

It really does.

Well, thank you for jumping on board with us, we are out of time, and it's amazing work that you're doing there and I encourage people if they're not familiar with what you're doing in the oncology center at Lakewood Health to look into that because it's amazing, you have an amazing team and wonderful things you're doing there.

Thanks for jumping on with us, appreciate it.

Thank you.

You've been watching Lakeland Currents, I'm Ray Gildow, so long until next time.