When she was diagnosed with breast cancer, Missy O’Maley knew little about the role a cardio-oncologist would play in what amounted to her seven-month battle against the disease.
O’Maley didn’t know the chemotherapy prescribed to help kill her cancer also could adversely affect her heart.
In time, she became educated on the four-and five-syllable medications she would need to take in order to put her on the path to recovery. They did, after all, represent hope.
Cardio-oncology is relatively new in the medical industry. It identifies patients with cancer who may be at high risk for heart rhythm abnormalities, high blood pressure, heart valve complications and more.
A cardio-oncologist works with the oncologist to protect patients by watching the heart and recognizing any possible warning signs.
O’Maley, who in April was told she was cancer-free, continues to take two prescribed medications daily to make her as heart healthy as possible.
“I didn’t know at the time that connection. I’m going to someone who is very connected with my oncologist (Dr. Anuj Agarwala), and they’re sharing notes about my treatment plan,” said O’Maley, an Indianapolis resident who lives just north of the Johnson County line.
“They are able to share information about my test results and treatment plan to ensure that I didn’t trade a cancer diagnosis with potential heart failure.”
The role of cardio-oncologists combined with advancements in medicine play a part in the cancer survival rate rising from what was 50 percent in the mid-1970s.
“Right now the paradigm in the treatment, particularly of breast cancer patients, but this applies to all types of cancer, success is not measured anymore in just beating cancer alone,” said Dr. Rey Vivo, who helped treat O’Maley. “The paradigm has shifted where success is now defined where you beat cancer, but also you don’t develop adverse effects — particularly in relation to the cardiovascular system.
“We don’t want the cancer patient of today to be the heart patient of tomorrow. Our goal is to make sure we catch any possible toxic effects from cancer therapies and manage them pro-actively. We want to ensure that the ideal outcome is to beat cancer and at the same time ward off any possible cardiovascular disease.”
O’Maley is grateful to have benefited from Vivo’s training.
The hardest thing for me is it’s OK to ask for help. I have learned to let others do things for me. The other thing is patience. I like to research and know what’s going on. I just needed to let things work out the way they work out.
On Aug. 29, 2016, O’Maley felt what seemed like a pebble or button pressing into her right breast as she lay down in bed. Even without a history of breast cancer in her family, she called to set up an appointment with Dr. Jeanette McDonald, her OB/GYN.
Five months after turning 50, O’Maley felt her world turned upside-down.
“I went to see Dr. (Erin) Zusan on Sept. 12 for a mammogram, which turned into an ultrasound, which turned into a biopsy,” O’Maley said. “The next day she called and said I have cancer.”
Only instead of the right breast as she had feared, the cancer was in her left breast in the form of a tumor the size of a golf ball. It had been hidden behind some dense fibers, which is why O’Maley, who had always performed regular self-checks, couldn’t feel it.
“I cried a lot. Really, just disbelief. You kind of go, ‘Gosh, so what does this mean for my daughter?’ It was very overwhelming. The next part is how do I tell my husband? I just called him right away,” she said.
O’Maley, who works in human resources at Regents Bank in Indianapolis, prides herself on being extremely organized. Once diagnosed, she began filling a three-ring binder with notes, whether it was something a doctor said or potential side effects of a prescribed medication.
In time she needed a second binder.
“I know a bunch of stuff is coming at me, and I’m going to need to be organized. What can I control? I can’t control that I have cancer, but I can control that I’m organized,” she said.
O’Maley battled her cancer with a plan and with as much positivity as she could muster.
This included appointments with Vivo.
An echocardiogram was performed at the end of September. O’Maley’s ejection fraction, the percentage of her blood being pumped back out, was 63. A second echocardiogram five months later scored an ejection fraction of 37 — which is considered too low.
Chemotherapy sessions in October and November consisted of doses of Adriamycin, an anti-tumor drug frequently used to treat early stages of breast cancer. Also used was cyclophosphamide, which suppresses the patient’s immune system.
In time, the chemotherapy caused O’Maley’s hair to begin falling out in clumps. A 12-week chemo cycle lasted from December to February.
“The chemo had definitely impacted my heart, and its ability to just pump, which meant I had a lot of shortness of breath. I’m tired a lot,” O’Maley said. “(Dr. Vivo) did a great job of explaining the chemo drugs have made an impact.”
“Basically, the one drug that I’m on that we believe is the biggest contributor would be my Herceptin. I was supposed to stay on that drug for a year. I took it for 12 weeks. They recognized right away this is impactful.”
Changes in medication combined with a Livestrong program started in August — O’Maley exercises in a group setting for one hour, 20 minutes every Wednesday evening and Saturday morning at the Baxter YMCA — are intended to strengthen her heart.
She had a unilateral mastectomy performed on her left breast on March 9. At the end of April, a third echocardiogram reveled O’Maley’s ejection fraction had risen to 46 — or closer to normal.
On April 3, Zusan delivered what this time was the best news O’Maley could hear.
“I asked for clarity. She said everything was good with the lymph nodes and talked to me about how everything was able to be taken care of with the mastectomy,” O’Maley said. “I kind of looked at her and said, ‘So what I hear you’re saying to me is I am cancer-free.’”
“There’s a sense of relief, but there’s a fear that comes with (cancer) because you just don’t know.”
On July 24, O’Maley underwent breast reconstruction surgery performed by Dr. Eugene Hsiao at Community South. She continues to be affected by chemotherapy sessions she took months ago — suffering from peripheral neuropathy, which affects one’s nerves.
O’Maley has constant tingling in her hands and at the bottom of her feet, but in July began monthly acupuncture treatments at Franciscan Health Indianapolis, and it has helped.
“The hardest part is that I should feel good now because I don’t have cancer. But I have all of these little things that happen as a result of going through the chemotherapy,” O’Maley said.
“I’m still tired. It’s things like the neuropathy in my feet and in my hands where I have this constant tingling.”
“I’m extremely fortunate. I know there are a lot of people who have had a much harder path than I have had.”
Date of diagnosis: September 13, 2016
Type of cancer: Breast cancer
Treatment: Unilateral mastectomy to left breast. Currently two daily heart medications (metoprolol tartrate and anastrozole) and quarterly shot (triptorelin).
What cancer taught me: The hardest thing for me is it’s OK to ask for help. I have learned to let others do things for me. The other thing is patience. I like to research and know what’s going on. I just needed to let things work out the way they work out.
How cancer changed me: I’ve always been pretty reserved and not one who really likes to share a whole lot. This was a big step for me. We have been going to the same church for 17 years. We sit in the same pew. We sit by the same people because we’re all creatures of habit, right? After my mastectomy I decided I’m done wearing my wig, and what hair we have we’re just going to go with this pixie cut and figure it out. It’s going to take a long time to grow out so we may as well get used to it. The first week I went to church with what now is my hair, people were like, ‘Something happened to her. We didn’t know she was sick.’ Almost six months into it, a lot of the people we see every week had no idea.
What I would tell someone: Ask questions. Don’t over-research. I didn’t want to be overwhelmed with everything at once, so breaking it down helped. Find someone who you can trust. I have a really good friend who lives in St. Louis, and she went through this five years ago. She was my first phone call. I said, ‘I don’t even know where to start. Who to talk to.’ She was really reassuring, but she also told me what I needed to know. It at least gave me a place to start. She was my go-to person, so find a go-to person.