Cancer Clear and Simple
Welcome to 'Cancer Clear and Simple,' the podcast dedicated to simplifying cancer. Join us as we discuss the world of cancer, breaking down complex concepts for our listening audience. One of our goals is to equip individuals and families dealing with cancer by providing clear, and concise insights. Through personal stories, expert interviews and practical tips, listeners are enabled to make informed decisions. Whether you're a patient, caregiver, or just simply wanting information, tune in to 'Cancer Clear and Simple' for a easy-to-follow guide on understanding and coping with cancer.
Cancer Clear and Simple
Dr. Noelle Loconte, UW Health | Caregiving Under Pressure
Caregiving changes you. Under the pressure of serious diagnoses and relentless decisions, we talk candidly about what keeps caregivers and clinicians going—and where the system falls short. With Dr. Noelle Loconte, a GI medical oncologist and community outreach leader at the UW Carbone Cancer Center, we unpack the skills that protect empathy, the boundaries that prevent collapse, and the uncomfortable truth so many avoid: alcohol is a carcinogen.
We explore why oncologists—already at high risk for burnout—often consume more alcohol and may hesitate to counsel patients about drinking. You’ll hear how an ASCO policy statement turned into a national wake-up call, the seven cancers firmly linked to alcohol (with more likely to come), and why tobacco’s clearer risk made it easier to communicate than alcohol’s nuanced reality. Then we shift from headlines to what actually helps: knowing your family history, understanding real drink sizes, following current guidelines, and staying on schedule with breast and colorectal screening. We also outline symptoms that should never be ignored, from difficulty swallowing to blood in the stool, and how to bring alcohol risk into an honest, judgment-free conversation with your clinician.
Caregiving needs infrastructure, not just inspiration. We make the case for flagging caregivers in health records, building a caregiver registry to track burden and outcomes, and compensating in-home care. On the ground, simple moves can change the day: add caregivers to patient portals with consent, use training apps and one-hour courses to build practical skills, and embrace humor as a powerful coping tool. Dr. Loconte shares a moving story from geriatrics that reframes the physician’s role as hands-on caregiver—proof that small acts of care carry profound weight.
If this resonates, share it with someone who’s caring for a loved one, subscribe for more grounded conversations on cancer care, and leave a review to help others find us. What’s one boundary you’ll set this week to protect your energy?
On today's episode of Cancer Clear and Simple.
SPEAKER_00:What the one of the keynotes discussed today was kind of really deeply knowing yourself and then having knowing you know what is too far, having boundaries, and knowing when you can say when you need to say no, when you need to just take a pause and say maybe, let me think about it, and when you can say yes. Physicians in general, including oncologists, are heavy consumers of alcohol. And oncologists are very likely to have burnout, and people that are burnt out are more likely to use alcohol. So for a couple of reasons, oncologists may not be talking to their patients about it and may themselves be at risk for alcohol-related cancers.
SPEAKER_01:Welcome back, everybody, to another episode of Cancer Clear and Simple, brought to you by the UW Carbone Cancer Center. I'm your host, Joshua Wright, and today we're joined by Dr. Noelle Lacante. Welcome. How are you doing today?
SPEAKER_00:Good. Thanks for having me.
SPEAKER_01:So we're here at the third annual fall cancer conference. And this year's theme is cancer caregiving, challenges, complexities, and choices. Can you tell a little bit about your role at the Carbone Cancer Center and what some of your specialties are?
SPEAKER_00:Yep. So I'm a medical oncologist. I'm a chemotherapy doctor for adults. So I trained in internal medicine first and then did a fellowship in oncology. My clinical practice is in gastrointestinal or GI tumors, so stomach, esophageal, all the way through rectum, venous, pancreas, liver, small bottle, you name it, we see it. And then I'm also the leader and part of a team that leads community outreach and engagement for the whole cancer center.
SPEAKER_01:Awesome. And from that perspective, is there a particular thing that jumped out to you or stuck with you in some of the messaging from today?
SPEAKER_00:Yeah, I think we tried to focus on caring caregivers like the person that directly is caregiving for the patient in the home, but also us as oncology professionals as caregivers for the patients and trying to see that, you know, ways to improve all of those types of caregiving, but also ways for us to build our resiliency and work on self-care. So it was a really multifaceted, I would say, discussion about caregiving, which is kind of a general term that you sort of throw around, but I feel like we really helped clarify exactly what that means and what are the opportunities to improve.
SPEAKER_01:And can you describe something that's a little bit unique to a provider in that caregiving continuum or the caretaking aspect?
SPEAKER_00:Yeah, I mean in oncology, we see these patients a lot, and the diagnoses we treat are very, very serious. So that makes the relationship sort of immediately important. Different than like, you know, a doctor you might see once a year or something like that, where you sort of don't really think about them in between visits. And also the severity of the illness that we treat, you know, some of our patients this could be a life-ending illness. So when when the medical situation is that dire, it can really be hard on us as caregivers. And I mean that in the direct sense of it, you know, administering chemo, prescribing chemo, getting CT scans. It can be hard on us as as people. And so there's a lot of burnout in the field. And so we've had discussions today about how do we build out, you know, a marathon. How do we run a marathon in this career?
SPEAKER_01:Can you talk about some of the pieces that go into having a successful um balance in that in that relationship between being a provider and the intensity of that relationship with the patient?
SPEAKER_00:Yeah, and uh what the one of the keynotes discussed today was kind of really deeply knowing yourself and then having knowing, you know, what is too far, having boundaries, and knowing when you can say when you need to say no, when you need to just take a pause and say maybe, let me think about it, and when you can say yes. I think we we tried to build out really practical skills for people today, in addition to kind of you know, big theory thinking as well. But for me, it always comes down to knowing what's in your tank and knowing when you're close to empty and you need to tap.
SPEAKER_01:Okay. Can we um get a little bit into some of the symptoms of what may be close to burnout? Is that something that you can share about what professionals kind of talk about in that way?
SPEAKER_00:Yeah, I mean it's things like dreading going to work, feeling disconnected, sleep disruptions, eating difficulties, eating too much and not eating enough. But really, it's when you sort of lose your empathy, is what that looks like in the day-to-day.
SPEAKER_01:That's interesting, just to kind of understand from a provider perspective. I'm really glad that you're able to bring in some of these perspectives. Um, and so some of your work has to do with alcohol and cancer. Um, can you just tell a little bit about that? And then I'd like to tie into what that means for caregiving as a context.
SPEAKER_00:Yeah, my interest in that came from actually a conversation with my partners. So when you fill out a death certificate in Wisconsin as a physician, you have to check a box that says, Did alcohol contribute to this death? Yes or no? And I had a conversation with some of my colleagues in oncology about, you know, when do you check yes? And the consensus was basically like, I don't know. Like none of us really knew exactly when. We sort of knew alcohol was not health food, but when it was directly impacting cancer was less clear. So that led me down this road of reviewing the literature, and then an opportunity came up to write a policy statement for the oncology professional organization, American Society of Clinical Oncology. And in that, we just reiterated the data of alcohol as a carcinogen and then supported some policy strategies that communities and organizations could get behind to lower the number of alcohol-associated cancers. It's about 5% of cancers. So I wrote this paper fairly quickly with some colleagues and really did not think it was going to go anywhere. And it ended up having a huge media footprint relative to any of my other papers. I think it's still the most downloaded paper for the Journal of Clinical Oncology, over three million downloads. And um I did media, I had to like New York Times, Fox News, all of these people were kind of coming out of the woodwork, which made me realize awareness was not particularly high amongst lay people, and also the people want to continue to talk about it. So that was my, you know, 15 minutes of fame. But I have continued to work in the alcohol space because many of the seven alcohol-associated cancers are the cancers I treat.
SPEAKER_01:Okay. Okay. And just um to help us put that in perspective, can you just list those? Yeah.
SPEAKER_00:So we collapsed some of the head and neck cancers together. Okay. So larynx and pharynx, a type of esophageal cancer called squamous cell, liver cancer, colorectal cancer, and breast cancer. And we think that when they update the list, stomach cancer and pancreas cancer are likely to be added.
SPEAKER_01:Okay. And just to kind of c do a comparison perspective setting, how much more research has been done about tobacco and its correlation with cancer than alcohol and its correlation with cancer?
SPEAKER_00:I mean, probably I don't have an exact number, but quite a bit more tobacco.
SPEAKER_01:Okay. Um so it's just easier in a research way or in this documentation way that we need to catch up with that area of tobacco, or kind of it's is it a completely different Well, tobacco is a much stronger carcinogen.
SPEAKER_00:So you see the association more clearly with less usage. That's that's partially why alcohol is difficult because it is a very nuanced message. And as soon as you add complexity to messaging in public health, people start to, you know, not pay attention to the message as much. So, you know, it's different volumes depending on what you drink, it's different cancers, it's not all cancers. The association is not nearly as strong as it is with cigarette smoking. So all of these work against us in terms of people paying attention.
SPEAKER_01:Okay. And um, because you said you've written and talked about this in other contexts, uh, would you recommend a place where somebody can go and get more focused conversation from you on this topic about alcohol and cancer?
SPEAKER_00:Yeah, I mean, there's a number. Uh, we did a patient-facing podcast for the American Society of Clinical Oncology on cancer.net.
SPEAKER_01:And then there was that podcast which I'm blinking on the Well Wisconsin radio podcast. Yeah.
SPEAKER_00:I just did one for them. Um Yeah, we've had write-ups in the New York Times. Believe it or not, Vogue did two stories about us, which is kind of like mind-blowing to me. Um, but if people want to also read about it from the patient perspective, there's a really good series in a magazine called Mother Jones about a reporter who got breast cancer. And breast cancer is one of the upgall-associated cancers. And she talks about how she was drinking, you know, a fair amount, and at no point did anyone bring this up with her. And she really had no other risk factors for this cancer, and she was sort of wondering, like, why aren't we talking about this? So that is a really good one if people want a high level.
SPEAKER_01:Okay. Um, and so just to be as straightforward as possible with alcohol, it is a carcinogen. Yes. Yeah. Okay. Um, and so just in terms of how that relates to the topic of cancer caregiving, where do you find intersections or areas that we need to be talking about more?
SPEAKER_00:Yeah. So physicians in general, including oncologists, are heavy consumers of alcohol. And oncologists are very likely to have burnout, and people that are burnt out are more likely to use alcohol. So for a couple of reasons, oncologists may not be talking to their patients about it and may themselves be at risk for alcohol-related cancers.
SPEAKER_01:Okay. So just to, you know, actually put some descriptors or names on it, so the feelings of maybe shame or guilt or embarrassment as being reasons of not talking to a patient, particularly about the impacts of alcohol.
SPEAKER_00:Yeah, or just cognitive dissonance. Like I drink, I like it. I don't want to I don't want to talk to people about that this might be bad.
SPEAKER_01:Okay.
SPEAKER_00:I don't even know if it gets to the level of shame or guilt.
SPEAKER_01:Okay. Okay. Um thank you, because I'm I'm just working off of how my mind would think about the situation and being like, hey, I'm over here, you know, uh consuming in what I feel would be a reasonable amount. And so why would I say that your drinking is dangerous or bad if it's not more than what I consider I'm doing?
SPEAKER_00:Aaron Powell Right. The counterpoint being, you know, physicians don't even ask about alcohol consumption. So, you know, fair point that moderation is always the answer pretty much from oncologists, but if we're not even asking about it, we're not really able to counsel patients about it.
SPEAKER_01:Aaron Powell Okay. Okay. Um so as far as with that understanding, what would you kind of recommend to a patient as far as their cues or what they might be what they may might need to ask as far as an annual physical or relation for their concerns around cancer and their consumption of alcohol.
SPEAKER_00:Right. You know, point one before getting into the alcohol is know your family history. You know, we're not up here saying at all that, you know, no one should drink or that, you know, abstinence is the only way. But we are saying that it would be good for people to know about alcohol as a carcinogen and incorporate that into their own decisions if they have a strong family history of one of these cancers or if they have a gene that puts them at risk for them. Maybe this is something that they can modify. A lot of our risk we can't really modify. So that's step one. Know your family history. You know, step two is we tell people to stay within the guidelines, which are probably going to be drastically revised. But as of right now, the guideline is up to one drink a day for females, up to two drinks a day for males. And no, like not drinking Monday to Friday, so you can like have seven on Saturday kind of thing.
SPEAKER_02:Okay.
SPEAKER_00:We are the home of Badger Games, so we do have to talk about this stuff. So there's both a daily and a weekly limit. And then learning what is a drink. So it's a bottle of regular beer, less if it's a malted or like a very strong micro brew. Five ounces of wine or a shot of hard liquor. So it's not just what you can fit in a glass. There's actually like volumes that you have to mind. Um so starting there is reasonable. I think you know, talking to their doctor about if there's concerns at all about their health and alcohol consumption. Um and then thinking also about things like family history of alcohol use disorder would be another thing to incorporate. Alcohol is also associated with like atrial fibrillation, cirrhosis. There's other health conditions that may drive how we counsel patients.
SPEAKER_01:Okay. Okay. Yeah, I'm just more in the lens of thinking about the overlap with cancer. So I appreciate that you're helping to place and situate this as hey, this is one aspect that's going to be impacted along with a lot of other things. And so when you're talking about that and my mind just kind of goes to symptoms um and just how the body works and the difference of smoking versus the difference of drinking. And so I think that with uh drinking something and knowing it's going down the esophagus into the stomach and things like that, it's easier to correlate that with alcohol versus smoking being something that's you know heavily on the lungs and the just that being associated with lung cancer, right? So in my mind, being able to say, hey, smoking, okay, I need to get lung cancer screening. So the difference for alcohol is there's a plethora of things that are going to be affected differently based on the amount and the intensity of what you're drinking. And so, in terms of a symptom approach, is that not an approach that's taken for diagnosing cancer when it comes to alcohol?
SPEAKER_00:Well, we don't recommend it more intensive screening necessarily. The only exception would be if you have cirrhosis, then we do do some more screening. But that's from the cirrhosis, not from the alcohol consumption. Um But I mean, symptoms of some of these cancers would be things like difficulty swallowing, unexplained weight loss. For breast cancer, it's feeling a mass in your breasts or up in your armpit. For colon cancer and rectal cancer, it can be blood in the stool or really narrowed stool, new severe constipation, belly pain. So any really persistent symptom though really should get worked up. Okay. Um, I think is probably the take-home message. And now colorectal and breast cancer, there is routine screening recommended for those. So that would be something anyone could get regardless of alcohol consumption.
SPEAKER_01:Okay. Okay. Um, so to bring it around back around to the caregiving perspective, um, you know, what are some areas that you might feel need to get a little bit more attention or may not have been brought up as much when it are when it comes to us thinking about the role of the caregiver?
SPEAKER_00:Yeah, the keynotes told us it would be great to have a way to flag caregiver information in the health record and really incorporate caregivers in healthcare decision making. So I think that could be a really important step forward. Another discussant talked about a caregiver registry so that we really have a better understanding of burden on them, health effects on them, financial effects on them. An immediate policy strategy could be better compensation for in-home caregiving. That would be something that, you know, policymakers could potentially do soon. And then I think as as professional caregivers, so you know, nurses, pharmacists, physicians, I think us looking out for each other and thinking about ways to support each other. We actually had a stand-up comedian as one of our keynotes this year, which was the first time for us, because humor is such a key part of coping with caregiving.
SPEAKER_02:Okay.
SPEAKER_00:And so we really wanted to normalize that. And so seeking out ways to kind of have a laugh at what are sometimes really just ridiculous situations that we sometimes have to go through.
SPEAKER_01:Yeah. Thank you for um elucidating a little bit on the reason for bringing in a comedian. Yeah. Um, you know, just uh that might not be something people think of right away, but just in terms of doing the outreach work and cancer being referred to as the C word sometimes. I know that care, contentness, you know, are other C words that I was introduced to, but comedy definitely is something that I shouldn't be overlooked in that thinking about the thinking about cancer. So I'm, you know, very happy that that worked out well for this year, and that one of the things that really jumped out for my message as well is that circle of life that he talked about, being able to do caretaking for his parents before having his own child. And then being able to make those connections and knowing that, hey, he was maybe better prepared with having this perspective or having these experiences than without them. And so I thought that was really key. And I look forward to having more of those types of opportunities to have people come in and share their experiences with them.
SPEAKER_00:Yeah, he is very profound for me.
SPEAKER_01:Okay. Um, would you can you share a little bit about a caretaking situation that you've experienced in your life?
SPEAKER_00:Well, yeah, so my dad died of cancer. I've had three kids, one who has a chronic illness. And then every day, I mean, we're taking care of patients. Um, I often find my most important caregiving role is one what we call the laying on of hands, where I'm literally touching patients and helping them, you know, take a path towards healing or wellness. I will say in my training, one of the most profound things. So, you know, I came up through college and then straight to med school and then straight to residency. And, you know, you sort of get a chip on your shoulder that, like, you know, the physician is the team leader, and you know, you know, I I'm the one in charge here. And I worked with a mentor in geriatrics. I also did a geriatrics fellowship. And we were going to visit patients in nursing homes. And I thought it was going to be like do a quick physical exam, adjust the meds, talk to the nurse, write the orders. And he brought a little bag with him, and it was like a toiletry bag, basically. And he spent time trimming their nails, washing under their fingernails, washing under their toenails, mending their clothes. It was deeply profound for me, Joshua, in that it was caring for the person. And he didn't have to do that, right? That was not necessarily the role of the physician, but it was caregiving in its most essential form. And these were all patients who had severe dementia. They didn't know he was doing, you know, he wasn't doing it for like some award or fame or something. He was doing it because he could see human to human what that meant. So that's probably my most profound moment of like the physician is the caregiver.
SPEAKER_01:Okay. And just uh that was in the caregiving space, you said, uh, or excuse me. I just like to understand what space. So that was not in a home setting. That was a nursing home. It was okay, it was in a nursing home setting. Okay. Okay. That helps just bring me to more of what the surrounding area. Because it's like, is it a uh uh the the family sofa, you know, no right, right. Well, yeah, and so um that helps me just take me right there with him in in terms of what that looked like. But um thank you for sharing that because the depth is there. I'm feeling the depth, I'm feeling the importance of what that moment meant. And just again, we're we're wanting to give uh experience, give light to the experiences that are happening. And when you're sharing that, you know, I know that those tur get turned into services, you know, just in terms of Yeah, you can't build her toenails. Yeah, yeah, yeah. Well, I mean, just in terms of how people that are not in those places go about finding self-care for themselves. Right. Right, but um hearing it from a per like the medical professional, being able to set aside the necessities, right, the necessities of the the medical aspects of it, right? And then just thinking of, you know, as I'm going to scratch my arm, if I have a sweater on and I get hung up in that, it's because I don't have proper grooming for my nails, right? And just to think of the simplicity of having that, but the annoyance that it could cause in just a moment, right? And to have that removed from somebody's experience that's going through something that is really tough already.
SPEAKER_02:Yeah.
SPEAKER_01:Um, that that makes me feel really good that people are thinking in that type of way, that people are peering into somebody else's experience in that type of way. And I I'm really grateful to know that that's part of people's training, that people are seeing that, people are picking that up. Um, because as the concept of caregiving has a spectrum and a continuum, I don't know if I would have been able to catch that if I It was really profound. Okay.
SPEAKER_00:It was really profound.
SPEAKER_01:Okay. And so can you share something that you may have learned from a caregiver over the years that changed how you think about cancer care?
SPEAKER_00:I mean, I learn from caregivers all the time, up to and including this week. I think um I have a better appreciation for um the intensity of caregiving for a patient with cancer, but also once the patient dies, we kind of disappear and how they're sort of left, the caregivers left in this vacuum. So being a little bit more attentive to continuing to follow up with them, not because I have to, but because it's healing for them. And then I learned the importance of like all these community nonprofits, Gilda's Club, etc., in building that bridge between like care in the hospital or clinic and care in the home.
SPEAKER_01:What would you share with somebody who's just entering into the caregiving space or just taking on a caretaking role?
SPEAKER_00:Yeah, get formal training. So we learned about apps today. We learned about a one-hour class that's online. Connect with social worker nurse navigators, or ideally both, to find out any resources that might be available to you as the caregiver. Make sure that the patient voices that they want you as the caregiver involved in care decisions. Um, for example, you can get added onto their my chart messages. Many people don't know that. So you see what the patient sees.
SPEAKER_01:But yeah, that's in addition to like um the authorization or it's not a power of attorney role, but it's the medical release of information.
SPEAKER_00:Yeah, and it's not the it's it's how the my chart is set up that you can designate that other people can also get your my chart message.
SPEAKER_01:Without having to go through other kind of sign-offs in office or something like that.
SPEAKER_00:It's it's part of your my chart sign-up, but it can be modified. But I think there are some steps involved in doing it. It's not just simple click a button. Sure. So you probably have to do something in the clinic, but it's really helpful. Also just to keep you on track with things like appointment days and times and test results and so forth. Yeah, and then I think anticipating that this is gonna be, if not the most, one of the most challenging roles. And so how do you stay strong and how do you get through it? And who's your support and you know, who's making sure you're exercising and you're eating and you're taking care of yourself, because that can be the first thing to go.
SPEAKER_01:Okay. And um I think the thought just came back to me. So you mentioned having a registry for caregivers or caretakers. And when you said at the transition and after the patient dies, that would potentially be a source of a resource to make sure that follow-up is happening potentially.
SPEAKER_00:Yeah.
SPEAKER_01:Okay.
SPEAKER_00:Sure.
SPEAKER_01:Okay. Making that connection. You is that something that's in place already?
SPEAKER_00:No, it sounds like it's a big need.
SPEAKER_01:A registry of caretakers or caregivers.
SPEAKER_00:Like we have a cancer registry.
SPEAKER_01:Yeah. Okay. Okay. Wow. Okay. Um, but yeah, just to you were pointing out, hey, you need to mentally prepare yourself for the challenges to come.
SPEAKER_00:Yeah.
SPEAKER_01:Okay. And I was remembering as well, one of the gems that Hesloo's trail was able to provide for us was that understanding, and he said that this took a long for him time for him to really embrace, is that I am doing the best that I can with the things that I have. And so is that what would you add to that, or would you just give that the stamp of approval?
SPEAKER_00:I mean, I think that's right. I think it's not reasonable to expect if you have no background in healthcare, that you're gonna know how to manage an ostomy or something, you know, a drain. Asking for help is totally fine and expected. But yeah, I think he's exactly right that we're as long as you're doing the best you can in the moment, that is all all you need.
SPEAKER_01:Okay. And not to open up another new episode, but you mentioned a really cool thing that I didn't know was available. What were you meaning when you said training for a caregiver in that space?
SPEAKER_00:Yeah, Dr. Litzelman, who's one of our UW faculty, gave uh a breakout session. Um, and she talked about there's both a website that's kind of just general caregiving resources, and then through that you can get an app for free that has caregiver training. But there was also a one-hour training for healthcare providers and teams. That one was developed through Canada, but she said it's getting applied to Wisconsin and should be launching soon. But you could certainly watch the Canadian one. I don't think there's a lot about, you know, the main difference between Canada and the US is their single-payer health system and we're not.
SPEAKER_02:Yeah.
SPEAKER_00:Um, but it sounds like it's just kind of real practical how to take care of an adult human kind of stuff. So she might be a good guest for you.
SPEAKER_01:Thank you for that. I definitely need recommendations. And let's let let's end off with a call to action. What would your message be in terms of understanding caregiving and the roles of caregivers?
SPEAKER_00:I would say the call to action is really on the healthcare side, that we need to pay more attention to who is the caregiver, actively put them on the team, and actively include them in decision making. And then the flip side to that is we need to be very active about taking care of ourselves, to really stick in this game for a long time. Because our wisdom goes away when we leave. So we owe it to our patients.
SPEAKER_01:Thank you so very much for joining us on another episode of the Cancer Clear and Simple podcast. I'm your host, Joshua Wright. Please tell your friends, families, and loved ones how to find us, and please tune in next time for another wonderful episode of Cancer Clear and Simple.
