Living With Stage 4 Cancer

A stage 4 cancer diagnosis comes with a unique kind of fear. Unlike earlier stage diagnoses, stage 4 cancer means the cancer has spread from its original location to other parts of the body, which is known as metastatic cancer. 

And now, thanks to advancements in treatment options, more people are living longer with metastatic cancer than ever before, which presents its own set of unique challenges for patients and their loved ones to navigate. 

The Reality of Living With Stage 4 Cancer

Not long ago, a stage 4 cancer diagnosis meant a matter of months. Today, more than 30% of people diagnosed with metastatic disease live for at least 5 years or more. And for some, it's even longer.

The New York Times recently profiled a woman living with stage 4 recurrent breast cancer, and she described something many of my clients with stage 4 cancer experience: a feeling of being in limbo. 

They’re in a place where treatment is working and they’re functional, but they’re also living in a state of uncertainty. There’s no clear answer as to how long it will last, and they have this underlying feeling all the time of not knowing what comes next. There could be many more years of this, depending on how treatment is going. 

Though having several years ahead instead of mere months may seem like an optimistic situation, this uncertainty can actually be quite difficult for most people. 

The Unique Challenges of Stage 4 Cancer

Living with stage 4 cancer means making decisions that earlier-stage diagnoses don't typically require, and there aren’t always clear answers, which makes it even more challenging.   

As a cancer coach and therapist, these are some questions my clients find themselves asking. I know many others living in this state of limbo are questioning these as well.  

Do you keep working, or do you spend your savings and cross things off your bucket list?  If you're living longer than expected, you may need income to sustain yourself and your family. But if time is limited, you may prefer to spend it doing what matters most. This is a difficult choice to make. 

When do you have "the goodbye conversation" with loved ones, and when do you continue living as normally as possible?  Many people struggle with balancing keeping things as “normal” as possible with their friends and family while also trying to make the most of the time together. Being constantly aware of the need to prepare for the worst while still hoping for more time is emotionally taxing.

Where should you spend your time? The reality for many people with stage 4 cancer is that they need to live near treatment centers to continue receiving care, which can often put previous dreams for travel or moving to a new location on hold. 

What milestones are you hoping to reach? 

Many of my clients hold onto specific goals, such as making it to a child's wedding, celebrating an anniversary, or attending a grandchild's graduation. These milestones give structure to the uncertainty, but they can also be a source of anxiety. 

When do you consider stopping treatment, if at all? This is perhaps the heaviest decision of all. There may come a time when quality of life matters more to you than extending life. But knowing when that time is, and having the courage to make that choice, is incredibly difficult.

Therapy for Cancer Patients 

One of the biggest struggles my clients with stage 4 cancer face is feeling lost. The plans you used to make for your future are no longer realistic. So what do you focus on? And how do you continue living in the present when the future is uncertain–even if it’s for several more years?

There's no "right" way to experience a stage 4 diagnosis. What works for one person may make another person miserable. You may prefer to continue to work, spend your savings on travel or bucket list experiences, or simply focus on treatment, and any of these choices are completely okay. You have to give yourself permission to do what feels right for you, even if it's different from what others are doing or expecting of you. 

This is where having support becomes crucial. A therapist or counselor who understands what you're going through can help you navigate these decisions, process the grief, fear, and limbo feeling that come with a stage 4 diagnosis, and find meaning and peace in the time you have.

Therapy can help you process what you’re experiencing and make decisions that align with your values. 

Learn More About Cancer Counseling