Nicola Heart believed thought life couldn’t get much harder after holding her newborn babies in her arms as they died.
That was until 2020, when, at 37, she was diagnosed with stage IV metastatic breast cancer and told she would likely die within a year. She had a tennis ball-sized tumor in her chest that her OB/GYN had brushed off as a benign cyst months earlier.
There were other signs, in hindsight, that she and her doctor had missed, such as changes in the color and texture of her breasts, small lumps in her armpit and near her collarbone, intense abdominal pain, and nipple discharge.
Ms Heart said her symptoms also included ‘extreme weight loss without trying, sleeping 13 hours a day, and never being able to recover from a common cold.’
Her last option, after all of the cancer drugs she tried failed, was Enhertu, a targeted chemotherapy drug that finds cancer cells, delivers medication directly to them, shrinks tumors, and minimizes harm to healthy tissue.
The experimental medicine has worked better than expected, getting rid of her pain, reducing the cancer that had spread to her lungs, reduced swelling of her liver, and signs of tumor growth have reduced.
Now, feeling stronger than ever following her first year of treatment, she began making plans to travel with her eight-year-old son, including hiking through the jungles of Belize and Kauai.
‘Those moments are when I feel most alive – being able to crawl through cave systems with him when just a couple of years ago I was told I had less than a year to live,’ she said.
Nicola Heart thought that nothing could be more difficult than holding her newborn babies as they died, but in 2020, at age 37, she faced an even greater challenge when she was diagnosed with stage IV metastatic breast cancer
Her symptoms included nipple discharge, a sudden change in breast size, a lump in her armpit, skin texture changes such as dimpling, unexplained extreme weight loss, sleeping 13 hours a day, and an inability to recover from a common cold
She said: ‘I went from being put on hospice to where I am today – able to do most of the things I want to do and not be in pain.’
Around half of breast cancer patients are over 60, and the disease is generally one that is more likely to strike older adults.
But Ms Heart is trying to disabuse women of that, noting that it is possible for a relatively young, healthy woman to be stricken by the disease.
She said: ‘This is all new to me. It gets dark, not going to lie. But I keep reminding myself that I’m going to get through this, and things will start looking up soon.’
Ms Heart, from Dana Point, California, was diagnosed with stage four breast cancer, which has a five-year survival rate of around 31 percent. The disease had already spread aggressively to her bones, liver, and lungs, causing excruciating pain and severe complications.
At one point, her condition was so dire that she was advised to seek hospice care.
She said: ‘I’ve been trying to navigate the fact that I have arrived at my last line of treatment.’
However, her decline is slowing and her condition appears to be improving.
She has preserved her hair for years using Penguin Cold Caps, which reduce blood flow to the scalp, limiting chemotherapy exposure and protecting hair follicles
While she has reached the very last medical option – new treatment Enhertu started three months ago – her pain has gone away, the metastases in her lungs have disappeared, her liver is shrinking again, and her tumor markers are coming down.
Enhertu works like a targeted missile, finding cancer cells, delivering a powerful drug directly to them, and helping shrink tumors while minimizing damage to the rest of the body.
Ms Heart now feels able to spend more quality time with her son, something she struggled to do while she was undergoing a range of procedures, including a port placement, liver biopsy, and bone marrow biopsy, while also receiving countless blood transfusions.
At one point, her blood counts were so low that she couldn’t start her chemotherapy.
‘I’ve been in and out of the hospital, dealing with transfusion fevers and unbearable pain,’ she said. ‘It’s been a whirlwind. I don’t even remember a lot of it.’
‘The last few weeks have been extremely tough – dealing with chemo side effects and cancer pain. On top of that, it looks like I will lose my hair. I’m pissed. Losing my hair this late in the game feels really shitty. I don’t want my son to remember me without hair,’ she added.
She has maintained her hair for years using Penguin Cold Caps, a scalp-cooling process that temporarily decreases blood flow to that area, limiting the amount of chemotherapy drugs that reach them, thereby protecting hair follicles from damage.
But now she faces the near-guaranteed prospect of losing her hair, likely for good.
Ms Heart was exceedingly healthy before being stricken with cancer. She was in her 30s when she was diagnosed, a rarity given breast cancer generally strikes over women
After starting her last available treatment, Enhertu, three months ago, Nicola Heart’s pain has disappeared, the metastases in her lungs are gone, her liver is shrinking again, and her tumor markers are decreasing, allowing her to spend more quality time with her son
Even though Enhertu is highly targeted, the chemotherapy component is very strong and causes hair loss that even cold caps can’t prevent. Cold caps are more effective with older chemotherapy drugs but more aggressive drugs like Enhertu can overcome the protective effects.
‘There are so many “cute wigs and short hairstyles” – but no, that’s not me. When I look in the mirror, I won’t recognize myself,’ she said.
But since responding so positively to her last line of treatment, she is taking advantage of whatever time she has left.
‘I started making plans to travel with my son, taking him hiking through the jungles of Belize and Kauai. Those moments are when I feel most alive – being able to crawl through cave systems with him when just a couple of years ago I was told I had less than a year to live,’ she said.
She lost twins in 2018 and is now unable to have more children due to cancer. She said her eight-year-old son is her greatest motivation.
Ms Heart said: ‘He loves sports, and I love watching him play. He keeps me going.
‘I’ve had to accept that I’m not in control of this disease. I live in the now.’
