For many people living with cancer, “metastatic” is a dreaded word. Hearing it means that cancer cells have broken away from the tumor and traveled or spread to lymph nodes or other organs, often significantly changing the prognosis. When people are diagnosed with a metastatic cancer, they are abruptly confronted with their mortality. Furthermore, they have to now deal with the reality that the cancer will never go away in their lifetime. Cancer goes from being something to beat or cure, to being something people have to live with every single day.
Sara is a 38-year-old woman living with metastatic breast cancer. Prior to her diagnosis, she had never had any medical problems, was busy with a career in graphic art and raising her 7-year-old daughter. Sara had no family history of breast cancer, but a friend had gone for a mammogram so she thought “might as well check it out.” Sara was completely shocked when her mammogram came back positive, and beyond stunned when the workup of the tumor revealed that the cancer had spread to lymph nodes in her arm and chest. Given her young age, Sara had not spent any time thinking about end of life issues, had barely started saving for retirement, and had never given a thought to not being around to raise her daughter. “I went from planning a birthday parties and playing Santa to writing a will and wondering what are advance directives! How am I supposed to go on knowing that I have this metastatic disease that will likely be what I die from?”
Of course there is no “right” answer, no simple or easy solution, to confronting a catastrophic medical diagnosis like metastatic breast cancer. For Sara, the emotional reaction to her diagnosis changed over time. Initially, she felt defective and abnormal because she was so young and had cancer, but after connecting with a group of young women who also had metastatic cancer she realized she was not alone. “I never thought that cancer could affect so many young people. I wish it didn’t, but I am really glad I have support from people who get what it is like to be a young parent and live with cancer.” Over the months since the diagnosis, Sara had spells of grief and sadness related to the loss of her sense of well-being and physical fitness. There were also periods of intense anxiety, especially at celebrations like birthdays and holidays, because she would wonder “how many more” she would have with her daughter. The skill that helped Sara manage the grief and the anxiety is called mindfulness. When the wave of emotion came over her, Sara would stop whatever she was doing and focus on her breath. Long, slow, deep breaths helped Sara bring her mind into the present time. The phrase “I am here today, I will do what I can today” was something that Sara found soothing to repeat to herself.
For some patients with metastatic cancer, going ahead and getting end of life planning done may be a relief. When worried thoughts come up about death or dying, patients who have their advance directive paperwork completed are able to say to themselves “I have done what I can to be ready, my wishes are known” and then let the worried thoughts pass on out of their mind. People with dependent children often struggle to contain worry about what will happen to the children, and this was true of Sara whose daughter was only 7 when she was diagnosed with metastatic cancer. What helped Sara was to know that there was a written plan for who would take care of her daughter, as well as a memory box that Sara created and added to a couple times a year. “I have photos, videos, toys, life lessons in journal all tucked away for her in a beautiful box. I want to be here as long as possible, but when I die, my daughter will know she is loved and will have memories of me.” Knowing that the metastatic cancer would shorten her life, Sara also made a constant effort to take advantage of opportunities for travel or adventure with her daughter. Recently a friend offered a place to stay at the beach, and Sara immediately talked to her oncologist about rescheduling her maintenance chemo so that she would be able to travel and have enough energy to enjoy the ocean with her daughter.
Being diagnosed with metastatic cancer is not what anyone wants, but when it happens, there is still some living yet to do. Yes, you may have to tackle grief and anxiety, and doing so may prove very difficult at times. Imagine you have a container in the closet, visualize the color and shape that works for you. When thoughts come up about cancer, try to put them away, in the container and back in the closet, and shut the door. Yes, there will be times you have to get the container out (appointments, treatment, managing medications), but when you are out and about, enjoying events, music, or school plays, try to put cancer thoughts away in the container, and shut the door to the closet. By paying attention to your thoughts, conceptualizing metastatic cancer as a condition to manage, and containing the thoughts as much possible, you will have a chance keeping living as fully as possible. You are here today. What are you going to make of it?