Living With Metastatic Breast Cancer and Learning to Cope With the New Normal

From the Editor's Desk
October 24, 2019
Lidia Schapira, MD, FASCO

No one would say that living with metastatic breast cancer is easy. It can be treated, but it cannot be cured. However, many people with metastatic breast cancer can live long lives with excellent quality of life. More and more women and men are living with breast cancer as a chronic disease.

While I was writing this blog, a patient who has been living with metastatic breast cancer for over a decade called me. She said she is still trying to make sense of the world and needs to stay around long enough to figure it out! When she walks her dog, she says she now “also sees the butterflies” and has learned to deal with her anxieties so that she doesn’t succumb to worry about what cannot be known and what cannot be fixed. It took years of practice for her to learn to accept imperfect test results and uncertainty, and this is the continual work that people living with chronic cancer understand so well.

Survivors living with metastatic breast cancer have said to me that coping gets better with time and experience, as they learn to adapt to the new normal.share on twitter A wise patient once explained that, despite knowing she would not be cured, she still got up every day and celebrated being alive. Cancer survivors speak of finding joy and learning to feel hopeful while managing the complexities of cancer and its treatment. They learn with time what to worry about and what they can safely ignore, to share feelings and fears in controlled settings, to decide when they simply won’t think or talk about cancer, and to find measures of peace and equanimity.

As an oncologist, I offer support and I listen attentively to the stories of cancer survivors. I admire the grace and strength of those who have learned to live with the ups and downs of metastatic cancer, and I use their example to provide encouragement and support to others when they are down. There are now several tested psychosocial interventions, including mindfulness-based stress reduction, cognitive behavioral therapy, psychoeducation, and support groups that can provide assistance and skills required for self-management. Conferences for people with metastatic breast cancer can be enormously helpful and reassuring and even provide practical tips about clinical trials or ways of coping well.

Telling friends and coworkers that you are living with metastatic breast cancer is tricky because it requires accepting that the cancer is not “beatable” but “livable.” Especially when someone looks well and healthy, it is difficult for others to understand that they are living with cancer as a chronic illness and may be on some form of treatment for the rest of their lives. Patients have reminded me of the importance of maintaining quality of life during and after treatment. Some of these patients have found that adding a palliative medicine clinician to their cancer care team can make a positive difference. Palliative care enhances our cancer care by focusing on the needs of the whole patient and family: managing symptoms, providing support, and helping to coordinate care.

There are a few things you can do that may help you cope with living with metastatic breast cancer:

  1. Take your time to accept and adapt to the new normal.

  2. Make sure that you have the right medical team to partner with you as new challenges present themselves.

  3. Focus on what is most meaningful to you and brings you joy.