Being treated for cancer is a marathon, and each day might bring a new difficult feeling. Experts have advice about how to stay mentally well while in treatment
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Key Takeaways
- One woman shares her experience living with stage 4 metastatic breast cancer and its emotional challenges
- Experts emphasize the importance of social connection and aligning life with personal values to improve quality of life
- Peer support and helping others with similar diagnoses can provide purpose and reduce feelings of isolation and anxiety
For Megan Rae Hershman, a 39-year-old from Tennessee navigating stage 4 metastatic breast cancer, figuring out what “normal life” looks like is an unending challenge.
Hershman is still a mother, a friend, a woman trying to enjoy her life—she’s just doing so while also living with incurable cancer.
“It's less about returning to normal and more about learning to build a life alongside an ongoing diagnosis,” she says. “On the outside, I can look like I'm managing just fine, while internally I'm a completely different person who might just be aggressively refreshing my patient portal like it owes me money.”
Hershman’s cancer diagnosis has brought immense grief for the life she expected to have, who she was, her dreams, and all the possibilities that are now uncertain.
For those living with a mBC diagnosis like Hershman, in which the cancer has spread to other parts of the body, all of the uncertainty that comes with a diagnosis can present challenges to your mental health. But experts have advice on how to maintain your joyful, fulfilling life while also treating your mBC.
Living With Perpetual Uncertainty
A recent study found that more than half of the women with mBC experienced depression, while 60% experienced anxiety. It also found that patients with metastatic disease had nearly four times the odds of developing depression compared to non-metastatic cancer patients.
Unlike early-stage breast cancer, metastatic breast cancer means you are never really done with treatment and you are constantly adapting and pivoting as the disease evolves, says Xiomara Rocha-Cadman, MD, a psycho-oncology psychiatrist and the chief of psychiatry at City of Hope Comprehensive Cancer Center.
Stage 4 breast cancer is treatable, but it isn’t curable. According to the National Breast Cancer Foundation, some women live only one to two years after a diagnosis, while others may live up to a decade or more, depending on how they respond to treatment.
“Living with ongoing uncertainty, and having to repeatedly reset your expectations, brings its own layer of anxiety that is distinct from what other cancer patients experience,” Rocha-Cadman says.
Heavy Emotions Can Creep Up Over Time
After receiving an initial stage 0 diagnosis in 2022, Hershman later learned her cancer had spread to her lungs, liver, hip, and ribs. She says learning to build a life alongside her diagnosis has, in some ways, been even more difficult than the most intense phases of treatment.
In the beginning, there is a flurry of activity. “You don’t have a lot of time to sit and feel your emotions because you’re too busy getting to the next appointment,” Hershman says.
But when that intensity eased, everything she hadn't had the bandwidth to process before started surfacing, and she was forced to face her feelings. Grief, sadness, and overwhelm all came rushing in.
“What surprised me most was how isolating that period could feel, even surrounded by people who love me,” she says.
She also deals with persistent “scanxiety,” or the stress that comes with every scan.
“No matter how well things are going, there's always a moment when I hold my breath while waiting for news,” Hershman says. “Learning to live with that uncertainty without letting it consume the good days is something I'm still working on every day.”
Prioritize What Matters
A key way to work with feelings of loss and anxiety is to lean into what is truly meaningful and important to you, says Maureen Sessa, PsyD, a health psychologist at the Neuroscience Institute of Hackensack University Medical Center.
“Moving towards what we value and engaging with our values in day-to-day life can bring on improved quality of life, even if loss and anxiety remain,” Sessa says.
This might mean making the active choice to reconnect with friends and loved ones, or engaging in activities that work for your body now. Whatever it may look like, living in line with your values and priorities can provide perspective, fulfillment, and make life feel meaningful during a difficult time.
In Hershman’s case, that has meant no longer trying to “do it all” and spending less time on her work while focusing on being with her family and friends.
Lean Into Your Social Network
Social connection, particularly with those in a similar situation, is critical to mental well-being while being treated for mBC, Rocha-Cadman says.
“Many patients and survivors tell us that talking to someone who has been through a similar experience feels different since there's less need to explain,” she says. “While family and friends are invaluable peer support, connecting with others who truly get it can help carry some of the weight in a way that even the closest loved ones sometimes can't.”
Finding peer support can significantly reduce depression and anxiety while also improving overall quality of life, she says. Hershman uses the app CancerBuddy to connect with other mBC patients.
And while receiving support is necessary, giving back to others can be just as healing.
“So many people living with mBC find deep purpose in showing up for someone who is a few months or years behind them on the same path,” Rocha-Cadman says. “It creates a sense of agency at a time when so much feels out of your control.”
Give Yourself Grace
Alice Santurri, a 58-year-old who's been living with mBC for a decade and organizes for the nonprofit cancer support center The Gather Place, says one of the hardest parts has been losing friends facing the same disease.
“There is a particular kind of heartbreak in watching someone whose cancer mirrors your own — same subtype, same drugs, same treatment path — suddenly run out of options,” Santurri says. “One day the medication works, and the next it doesn’t, and then she’s gone. I call it survivor's guilt, and it’s a weight I feel every single day.”
Rocha-Cadman says that struggling emotionally isn't a sign of weakness or failure. It's an extremely human response to an extraordinarily difficult experience, and professional help is out there if you need it.
In Santurri’s case, learning to feel her difficult emotions temporarily has been a helpful approach. She lets herself cry or feel rage when she needs to, and then she continues to move through her life with purpose and love.
“I’ve learned to allow myself to ‘feel all the feels,’ but not to live in that space permanently,” Santurri says. “I give myself the hour, or the day, and then I remind myself to keep on keepin’ on.”
When living with mBC, Rocha-Cadman says the goal isn’t getting back to who you were before—the focus shifts to figuring out how to live a new version of your life alongside your diagnosis.
“That mindset shift is incredibly hard, but it can also be really helpful,” she says. “Instead of waiting for life to feel ‘normal’ again, you start to realize you’re living now, on your own terms.”
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