Up for the Challenge: The June E. Nylen Cancer Center vs Cancer in Siouxland

By Alex Strauss

Iowa continues to have one of the highest rates of new cancer diagnoses in the country, second only to Kentucky in per capita cases. More concerning still, Iowa remains the only state in the nation with increasing cancer rates. For residents of Northwest Iowa, this sobering reality makes the presence of the June E. Nylen Cancer Center in Sioux City not just a convenience, but a necessity.

Since opening its doors in 1995 as a joint venture between MercyOne Siouxland Medical Center and UnityPoint Health–St. Luke's, the June E. Nylen Cancer Center has been at the forefront of bringing advanced cancer care to the tri-state region. Originally established as the Siouxland Regional Cancer Center (renamed in 2004), it was one of the first freestanding outpatient cancer centers in the Midwest.

Today, the center serves approximately 5,500 patients annually from a 15-county area spanning Iowa, Nebraska, and South Dakota, with nearly 42,000 patient visits each year. On any given day, about 150 patients come through the doors seeking diagnosis, treatment, and support.

"We're not stagnant," says Krista McCullough, Executive Director, who has been with the center since 1995 and was promoted to director in 2018. "We are continually looking for the best equipment, planning for improvements, and figuring out how to get the best treatments for our patients, in spite of the challenges."

Innovation in the Face of Obstacles

Those challenges are substantial. Five Iowa counties in the center's catchment area are among those with increasing cancer incidence rates. And, while the need has never been greater, costs continue to climb and providers are harder to find.

"One of our biggest challenges is recruiting medical oncologists," says McCullough. "There is a nationwide shortage as many older oncologists are retiring and larger centers are adding to their teams. In addition, the cost of drugs that we have to purchase has also increased."

But JENCC is undaunted. Rather than accept these limitations, they're constantly innovating to ensure that patient care doesn't suffer. "We can't just crumble because we don't have enough physicians," McCullough says. "We have had to figure out how to move forward, who we need to collaborate with, and how to continue to get the things we need."

One solution has been to develop strategic partnerships for delivering telehealth services. "We have implemented telehealth to help us, using providers that are outside of June E. Nylen Cancer Center to be part of our team," McCullough says. "That's how we are staffing our outreach clinics in Storm Lake, Onawa, and Cherokee."

McCullough says the support of the Siouxland community has also been a critical part of JENCC's forward momentum. Donors have funded state-of-the-art equipment and facility upgrades that might otherwise be out of reach for a regional cancer center.

"Thanks to our donors supporting our work and large projects, we have visitors that come through and say 'Your facility is beautiful!' and 'How do you have this or that piece of equipment?'," says McCullough. "It's largely because of donor support."

It's clear from their numerous accreditations that their strategy is working. JENCC recently received ASTRO's APEx Accreditation for Radiation Oncology—the first such accreditation in Iowa or Nebraska. The center's medical oncology program is also certified through the QOPI Certification Program.

"If there is something top level, we are going to go after it," says McCullough. "We don't just meet accreditation and forget about it. We take what we learn and continue to improve."

The Evolution of Cancer Treatment

The landscape of cancer care has changed dramatically since the center opened three decades ago and no one understands this evolution better than Dr. Donald Wender, Medical Director and Medical Oncologist/Hematologist. Dr. Wender has been with June E Nylen Cancer Center since its inception.

"When I first started, there were no targeted therapies except for CML [Chronic myeloid leukemia]," Dr. Wender recalls. "Now, most of the major tumors have targeted therapies and it has changed the way we practice. Thanks to next-generation sequencing (NGS), we are able to look for mutations that we can target."

The emergence of immunotherapy has been another game-changer. "It has dramatically altered the prognosis in the treatment of lung cancer and multiple other cancers," says Wender. "The chemotherapy that I used initially we only use a little now, so there has been a dramatic change."

Radiation Oncologist Dr. Lisa Chaiken, who joined JENCC just over two years ago after practicing for decades in California, says she has been impressed by what she found here. "The June E. Nylen Cancer Center offers state-of-the-art equipment even superior to highly ranked places at which I practiced in California," she says.

And that is a good thing, because Chaiken says cancer here is also different. "I do think I see some very sick and complicated and challenging patients in Iowa," she says. "There seem to be more advanced tumors and more rare tumors, including some of the most aggressive brain tumors."

But the news is not all bad. Dr. Wender says better treatments are leading to better outcomes. "People are living longer and some people are being potentially cured who never would have been cured before," he says.

"Cancer is more of a chronic illness for a lot of patients now," adds McCullough. "Thanks to a variety of advancements, patients tend to have fewer side effects, shorter courses of treatment, and treatments targeted to their specific types of tumors."

Strategic Collaborations and Investments

Strategic partnerships have been another key part of June E. Nylen Cancer Center's success. One of the most important has been with Nebraska Medicine/University of Nebraska Medical Center (UNMC), with whom JENCC has collaborated on a number of service lines over the last four years.

"Our collaboration with Nebraska Medicine opens up a pathway for our patients for referrals to the medical center and gives our providers access to specialist oncologists," says McCullough. The collaboration has been particularly valuable in the radiation oncology department, where the physicians, including Dr. Chaiken and another provider who will start at the end of the year, are actually employed by Nebraska Medicine.

"This hybrid of community practice and academic medicine was exactly what I had been looking for and is rare to find," says Dr. Chaiken. "I have all the advantages of a busy community practice with the best equipment and staffing, plus the availability of the University of Nebraska Buffet Cancer Center for support, research, and peer review."

The center is also at the forefront of emerging cancer treatments. Dr. Chaiken and the JENCC team worked with Nebraska Medicine/UNMC to bring PLUVICTO, an innovative radiopharmaceutical therapy for advanced metastatic prostate cancer, to Sioux City. This form of precision medicine uses radiation in peripheral intravenous infusion form to target cancer cells.

"We have some of the latest treatments available for our advanced prostate cancer patients and we are fully equipped to deliver whatever treatment the patient might need with our two linear accelerators," says Dr. Chaiken.

Despite the need to keep its belt tight, JENCC doesn't hesitate to invest where it's needed. In 2023, they enhanced their diagnostic capabilities with a $2.6 million PET scanner - the only permanent one in a 75-mile radius. Looking ahead, the center is planning facility upgrades including a $2.5 million renovation of the chemotherapy/infusion mixing area and oral dispensary, plus a dedicated theranostics room for delivering radioactive treatments. McCullough says the upgrades will allow for new kinds of treatments, decreased patient delays, improved workspace efficiency, and enhanced quality and safety.

"We are continually planning on the next thing that we can do to make sure that we can take care of people," says McCullough. "I always think that cancer doesn't stop so we can't either. At the end of the day, that patient still has cancer and is counting on us."