The Unique Challenges of Living With Stage 4 Cancer

CANCER IS AN IMPORTANT entity not just in the medical field, but in terms of its societal impact. It is increasingly prevalent as we live longer and are exposed to more environmental and lifestyle risks worldwide. Among cancer cases, those that are metastatic pose an even larger burden on individuals and touch just about everyone. Metastatic, also called “advanced,” cancers are sometimes considered chronic diseases, as many are incurable yet some can be successfully treated for long periods of time. But words like “relapse” or “progressing” invariably bring up the fragility of life — the uncertainty as to how long one might live.

When it comes to making survival-time estimates, there is a big mismatch between population statistics and what to expect from an individual case. Both oncologists and patients sometimes equate the two — and may say or hear phrases such as, “You have X number of months to live …” But there are so many variables, and there is so much unpredictability in each unique situation. Statistics are important in choosing the best treatment options that can affect both quantity and quality of life. But in terms of self-perception, it may be better to cast off those numbers once key decisions are made, and contemplate the wider possibilities for what the future may hold. This may be a better place to find a sense of calmness and follow the age-old advice to live life to its fullest every day — a mindset we should all have in wellness and illness. This is easier said than done, as cancer patients face reminders of their disease — physically, emotionally, socially and financially.

One of our feature articles, “Life, Redefined” highlights the duality of living with metastatic cancer, in which the recognition of limited time can be countered with the appreciation of the richness one can still enjoy. The latter requires coming to terms with one’s mortality — something that psychologists and philosophers alike advocate as an attitude that all should pursue, regardless of health status. Staying engaged socially, intellectually and spiritually is critical. As an oncologist, I come across patients who are at peace with their situation, and it leads me to reflect on how I, myself, would handle an immediate threat to my life. It also motivates us all to learn more about how our minds adapt in this manner, and how we can harness and impart this special gift for all.

DEBU TRIPATHY, M.D.

Editor-in-Chief Professor of Medicine Chair, Department of Breast Medical Oncology The University of Texas MD Anderson Cancer Center