A Story of Staying Active After a Lung Cancer Diagnosis

When addressing what was thought to be a routine eye concern, Dave Nitsche learned he had stage 4 lung cancer that had spread to his eye. As a lifelong nonsmoker and accomplished Ironman and ultramarathon athlete, he has since become an advocate for screening and breaking the stigma around who can develop lung cancer.

Despite ongoing treatment and side effects that limit his athletic abilities, Nitsche continues to stay active, fundraise for cancer programs and show others that a lung cancer diagnosis does not define what a person is capable of.

CURE sat down with Nitsche for an interview to learn more about his story during Lung Cancer Awareness Month, observed annually during the month of November.

CURE: How did losing vision in your eye ultimately lead to your lung cancer diagnosis?

Nitsche: Actually, I started losing my sight on a Tuesday. I went to the optometrist, and he said to get myself to the hospital because he thought it was a retina or cornea issue. At the hospital, multiple doctors looked at it, and they finally took a sample from the back of my eye because fluid was building up. That’s where they found lung cancer; the cancer had metastasized to my eye. That’s how they discovered it.

It was quite a birthday gift. The biopsy was done on my 50th birthday, and I lost vision in my left eye. It wasn’t the best of times, but that’s the way it is.

As a nonsmoker diagnosed with this disease, did you face any challenges in understanding the risk factors associated with lung cancer?

That was very hard. When people hear you have lung cancer, they often ask, “How long did you smoke?” I had never smoked. I was an Ironman athlete, an ultramarathon athlete. I did multiple Ironmans and 100-mile races. People knew I didn’t smoke, so it was tough to explain.

I’d even joke, “Maybe I should start now, we’ll see what happens.” But really, it’s definitely a stigma, that lung cancer only happens to smokers. A lot of us haven’t smoked. I’m glad there’s more research going into lung cancer in nonsmokers now and that the stigma is slowly changing.

Last year, I did a 1,000-kilometer bike ride on rail trails. I brought my ribbon with me and people would ask, “Who has lung cancer?” I’d say, “Me,” and they were surprised I could still do things like that. And again, the question came: “How long did you smoke?” Well, never.

Can you describe your treatment journey so far? Have you received any newer therapies, and how have they impacted your quality of life?

For sure. I started on afatinib, which was the drug of choice at the time. After three months, I had metastases to my brain, so I moved to Tagrisso, which wasn’t available when I was first diagnosed; I was about a month too early.

I spent six years on Tagrisso. Two years ago, I had another metastasis in my brain, so I had radiation for that. Now I’m on amivantamab, a newer drug. The timeline for that is about three to six years of survival for people, so I’m just going to let science catch up to me.

The hard part is the side effects — they make it more difficult to do the things I want to do. As an Ironman athlete and ultrarunner, it’s very hard for me to get out and do more. I still try, but I’ve had to cut back. It becomes a mind game. My mind wants to keep going, but my body can’t always keep up. So it’s always a question of, “How far can I push myself?”

How has that shaped your experience and approach to treatment, resilience, and your outlook throughout this journey?

Great question. In the 12 or 13 Ironmans I’ve done, there were always times when something went wrong (a flat tire, an injury) and you just keep going. With treatment, that’s how I’ve learned to be. If something goes wrong or I’m faced with something new, like the foot infections I’m dealing with now, it’s just another hurdle. You do what you can and keep moving forward.

In cancer, you’re always chasing the dragon’s tail. You think you have things figured out (your drugs, your routine) and then something changes. So you adjust, call your oncologist and deal with it. You always have to be on top of things.

What role has your identity as an athlete played in motivating you to stay active and engaged in your health during treatment?

Last year I did that big bike ride and raised over $10,000 for the cancer center here. I want to keep doing things like that. I’m going to do the Epic 1000 again next year with friends.

Lung cancer isn’t a death sentence. You can still do what you can. I have a shirt that says, “Start where you are, do what you can.” I remind myself of that.

I read somewhere that when you want to quit during exercise, that’s only 40% — you still have 60% left. I’m very motivated to show people that even with lung cancer, you can live your life. Maybe it’s on a smaller scale, but you can still hike, walk, spend time with your dog. Just keep living.

What message would you share with others about early detection and advocacy as we wrap up today?

Screening is so important. If you can get screened where you live, do it. I had no idea I had lung cancer. I was running 5 to 10 kilometers a day before my eye issue. Early screening is very important.

If you have lungs, you can get lung cancer. And if you are diagnosed (stage 1, 2, 3, or 4), it’s not a death sentence. I was diagnosed stage 4 six years ago and given a year. I’m still here. I know people who are 15 or 18 years down the road with stage 4 lung cancer.

You can live with it. Yes, there are side effects from treatment, but it’s manageable. You stay positive. I’m part of a group called Man Up to Cancer, and we support each other.

Transcript has been edited for clarity and conciseness.

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