The key to a successful relationship is the ability to adapt to the inevitable surprises and setbacks life throws one’s way. Good luck finding a better example of that than Tom and Peggy Pighetti.

They’ve had more practice than most of us. They’ve also had more surprises than most of us. None more extreme than two cancer diagnoses – one his, one hers – two decades apart.

Tom, 74, and Peggy, 69, met in 1956 when he was 10 and she was 5. Their families lived a few blocks apart in Pueblo. Her older brother and Tom were the same age, fast friends, and Cub Scouts. Peggy’s mom, a Cub Scout den leader, hosted meetings. Peggy, the self-described “pesky little sister,” baked a chocolate cake for one of those gatherings. The boys scarfed it down before she could get a slice.

While, as the adage goes, “The way to a man’s heart is through his stomach,” a few years would pass before Tom and Peggy clicked romantically. Both attended Southern Colorado State College (now Colorado State University – Pueblo), and Tom joined Martin Marietta (now Lockheed Martin) after graduating in 1968. Peggy graduated with a teaching degree in 1972; they married and she joined Tom in one of the model homes of Littleton’s Columbine Hills subdivision. A short commute to Martin’s Waterton Canyon facility was a central consideration, though the commute got a bit longer when the direct route south was submerged under Chatfield Reservoir.

Peggy taught fifth- and sixth-grade classes until daughters Vanessa and Jolena came along. Tom worked on space programs – Titan MOL, the Viking Mars landers, classified missions – and then as a software-engineering manager until his retirement in 2009 after 41 years of service.

His cancer diagnoses had come nine years earlier. In April 2000, Tom had returned from a business trip and wasn’t feeling well. He told Peggy he was going to go to bed and see how he felt in the morning.

“No, you’re not,” Peggy said. She was worried that he was having a heart attack.

He was admitted to a community hospital, then transferred to another. Two liters of fluid had been drained from his chest cavity before a CT scan showed a mass tucked behind his sternum. It was tough to access even for a biopsy. When the analysis came back, the news wasn’t good: squamous non-small cell lung cancer, relatively localized but stage 4. Smoking is a major risk factor of this sort of cancer. Tom had never smoked. Doctors told him he had a year, max 18 months, to live.

Attitude matters

Tom went on chemotherapy – Taxol (paclitaxel) and carboplatin – then 45 days of radiation. In August 2001 came more chemotherapy, this time eight rounds of Gemzar (gemcitabine) and cisplatin. By April 2002, “Things were pretty clear,” Peggy recounted.

“They would never say he was in remission, but they said it was controlled,” she said.

In 2004, that control lapsed, and his oncologist, Dr. David Link, prescribed Iressa (gefitinib), and then, in 2005, Tarceva (erlotinib). That year, Link went in for his own cancer treatment, and his colleague, Dr. Radhika Acharya, temporarily took over Tom’s care, changing his chemotherapy to Alimta (pemetrexed).

When Link came back, Tom stayed with Acharya. Over the next couple of years, Acharya prescribed different chemotherapies to keep Tom’s cancer in check: Tarceva and Nexavar (sorafenib); Taxotere (docetaxel), and finally Navelbine (vinorelbine) and Gemzar. These weren’t random choices, Acharya says.

“Oncology is not a perfect science,” she said. “We have to go on how he feels; we have to follow data, but we have to cater to him.”

Along the way, the Pighettis and Acharya came to know each other well. Acharya recognized patients who were, as Acharya put it, “savvy and intelligent. They ask questions, but they don’t over-question.”

“They’ve chosen their health care team and put faith in us. We talk through things. I want their buy-in – it’s a group decision,” Acharya said.

Tom’s and Peggy’s attitude toward to Tom’s cancer fight has been notable, she added. Discussing the power of the mind is a fundamental aspect of Acharya’s approach to cancer care, she says. Tom seems to have positive thinking deeply ingrained in his being.

“He has such a remarkable outlook, such an even keel. He just never thought it was going to come back,” Acharya said. “His attitude and expectations have a lot to do with where he is today.”

Tom explained it like this.

“How do you cope? Basically, it’s about having a positive attitude more than anything, because I’m not ready to go yet. And then you take it one day at a time,” he said

‘Spoil her’

When Acharya’s twins celebrated their first birthdays in 2009, Peggy – whose youthful chocolate-cake-baking skills evolved into those of an accomplished cake decorator – made them a cake with a rubber-duckie theme. Acharya learned about the Pighetti family’s Christmas celebration, which can happen as late as March. Years ago, Tom and Peggy explained, they recognized that, to continue the annual family get-together despite geographic dispersion and scheduling conflicts, the best option was to adapt and be flexible. (In 2020, the celebration fell on Leap Day, Feb. 29. Thankfully, the family was able to gather before worries about the spread of COVID-19 prevented such get-togethers.)

In 2015, the U.S. Food and Drug Administration approved Opdivo (nivolumab), one of a new class of immunotherapies that decloaks cancer cells so the body’s own immune system attacks them. Acharya prescribed it for Tom soon after that. While there have been occasional setbacks, the drug has worked for the better part of five years now.

Two years later, Tom and Peggy followed Acharya to UCHealth Highlands Ranch Hospital where she is now the hospital’s Chief of Oncology Services. That the hospital was closer to home was nice, but it wasn’t decisive, Peggy said.

“We would have followed her even if it meant driving across town,” she said.

In 2019, another surprise barged in on the Pighettis: Peggy was diagnosed with colon cancer. She became a patient of Acharya’s, and Tom became the invested family member.

“It was a role reversal. He was with her every single visit and advocating for her,” Acharya said.

Acharya told Tom she had high expectations for him.

“She spoils you, Tom – now you have to spoil her,” the doctor told her longtime patient.

Tom did, and Peggy withstood surgery and her own chemotherapy, though that was a slog. Through the worst of her cancer fight, and ever since, her husband has been an inspiration, Peggy says.

“You’re hit with it, and you question: ‘Why me?’” Peggy said. “And you look at how he handled it, and the faith he had, and the positive attitude that he has exhibited the whole time, and the fact that you take every day for what it is – and you do the best you can and go on from there.”

Tom added, “The outcomes could have been much different without the tremendous support of family, friends, doctors, nurses, and coworkers.”

There will be more surprises in Tom’s and Peggy’s lives, and not all of them will involve cake, as nice as that would be. Certain is this: they will consider the facts, look on the bright side, and adapt as they always have.