Being Well, Finding Stability, Research

Facing cancer in the midst of motherhood and her medical career, Dr. Kelleher gains a deep gratitude for her UVA colleagues and empathy for her patients

Picture of a couple with two young children
Susan Kalergis Photography

by Kelly Casey

Her mother, her grandmother and her grandfather—each one died shortly after a cancer diagnosis and all very young in their 30s to 50s. With such a strong family history of cancer, Nicole Kelleher, MD, had long known that facing cancer could one day be her fate. But it was almost unimaginable that it could happen when she and her husband were just about to start trying for their 3rd child.

“On March 18th (2019), my worst nightmare was realized with a breast cancer diagnosis. I was 36 with a one- and three-year-old—two joyful little boys, Aden and Connor,” shares Kelleher. While her children were her first concern, she also immediately thought of her UVA Health colleagues, and her patients—most of whom also have breast cancer.

As a physical medicine and rehabilitation (PM&R) doctor at UVA Cancer Center, Kelleher is among a team of experts who care for patients who experience musculoskeletal and neurological problems following cancer treatment. “The day I was diagnosed, the first call I made out of the doctor’s office was to Dr. Robert Wilder, my department chair,” Kelleher shares. “The next day, I had to do clinic. I just couldn’t do it that day … Instantly, Dr. Wilder was overwhelmingly supportive. It was almost reflexive for him. He didn’t have to think about the right thing to do…

“I’m just so thankful that he is my chair. I can’t imagine going through this without such support. One thing you worry about is the strain on your colleagues, your department, and caring for your patients. He really eased a lot of that stress so I could focus on treatment and my family.”

Kelleher is also incredibly grateful to Regan Royer, MD, her PM&R clinic colleague, who covered for her when she was out for treatment. “Regan and I are good friends. I owe her big time. Through all of this, from Regan and everyone at UVA, I haven’t heard anything but ‘How can I help you more?’”

Fated to Get Cancer

Even before Kelleher devoted her career to caring for cancer patients, cancer has long had a major impact on her life. In 2007, Kelleher first came to UVA to begin her first year in medical school, paying her way through as a professional triathlete. “I have won several national titles and I was a collegiate runner on a team that has seen two other teammates pass away early from cancer,” she shares.

During her first year in medical school, Kelleher’s mother received a breast cancer diagnosis at age 49. She left Puerto Rico where her husband’s job was based to move in with her daughter and start treatment at UVA Cancer Center. Unfortunately, her cancer was an aggressive type and found after it had already spread. She died during Kelleher’s second year of medical school.

Kelleher is forever grateful to her mother, as it was her late-stage cancer diagnosis that made Kelleher diligent about her own health. When Kelleher was only in her early 30s, she began to be closely followed at the UVA High-Risk Breast and Ovarian Cancer program, one of the nation’s first such dedicated programs and only one of its kind in Central Virginia.

Blood testing turned up no genetic defects, such as the BRCA mutation, but that didn’t mean Kelleher wasn’t among those who inherit a high risk for cancer, notes the high-risk clinic’s founder, Susan Modesitt, MD, one of the nation’s leading authorities on high-risk cancers.

Personalized Screening

Dr. Modesitt adds, “Nicole has a horrible family history of cancer. She’s absolutely high risk. We think something hereditary is there but we don’t know yet what the specific cause is for her increased cancer risk. We can’t tell Nicole’s children yet if they have inherited a cancer-risk gene or genes. But research in this area is progressing rapidly so in 20 years, and for her children or , we hope to be able to tell them definitively what the cause is and whether they carry such a high risk.”

For Kelleher, Dr. Modesitt recommended an aggressive approach to cancer screening: regular breast MRI (magnetic resonance imaging) scans, which are recommended for those at high risk for breast cancer and are better than mammograms at detecting cancer, Dr. Modesitt explains.

Kelleher’s MRIs were normal through her second pregnancy. But last March, right after she stopped breastfeeding her youngest child, cancer showed up. “My cancer was found by Dr. Carrie Rochman in Radiology, and in April, I had a double mastectomy (removal of both breasts) done by Dr. Shayna Showalter. Dr. Chris Campbell did my breast reconstruction … My cancer was aggressive but caught early. This is not typical for women under 40, who tend to present at later stages of disease,” notes Kelleher.

Dr. Modesitt hopes one day she never again has to tell a young mother that her cancer is beyond a cure. She is relieved that Kelleher came to her at a young age: “If one just looked at Nicole’s negative genetic testing, it is possible that someone could have missed her incredibly high-risk status and simply had her doing regular cancer screenings starting at 40 or 50,” Dr. Modesitt says.

Kelleher says, “I cannot tell you how grateful I am to the UVA high-risk program and everyone at the Cancer Center. Thanks to them, I am very likely to watch my cherished children grow and to see them graduate high school and college.” She adds, “My mother’s only life’s regret was not getting to meet her grandchildren. Because of her passing and the diligence of UVA physicians, my cancer was diagnosed early. Today, I am cancer free and have an excellent prognosis for permanent cure.”

New Level of Empathy

Kelleher missed two weeks of work following breast cancer surgery and went back with a renewed passion as her clinic continues to grow. “I think I have a new level of empathy for my patients. While I know I’ve always done the right thing and given them good care, but with time constraints and all of the pressures we have, it can be challenging to maintain a degree of empathy that each patient deserves. I don’t think that I had that and now I have that on a new level. It’s an understatement. My investment in giving a personal degree of care has really gone up … I strongly believe that this will hopefully benefit my patients no matter what my future holds.”

Kelleher knows she will have to continue to be diligent about her health as colon and ovarian cancer also run in her family. But she also knows that she has the support of a family that extends well beyond a blood line.

“I have found everybody to be so supportive during my entire tenure here (for medical school, residency training and joining the faculty). I’ve never had a problem because of that support … Despite me being here for the last 12 years, I have never felt more a part of the UVA family as I did during that phone conversation with Dr. Wilder on the 18th of March. I’m just so thankful that he is my chair … He’s always been a servant leader but I think particularly in this situation, he has been incredibly strong for me.”

Kelleher writes at theunspeakablelove.com—a blog she started to help other families facing cancer while raising young children.

Why See a High- Risk Cancer Specialist?

You can learn whether you carry a genetic mutation putting you at greater risk for cancer. You can get a cancer screening program tailored just for you. You can find out if you need medication to help prevent cancer. For example, birth control pills can cut the risk in half for endometrial and ovarian cancer in women with a strong family history of these cancers. You can also learn whether risk-reducing surgery could help bring a future free of cancer.

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Kelly Casey