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For patients living with metastatic cancer, the journey is marked by uncertainty, shifting identities, and difficult questions about control and meaning. Drawing on lived conversations, PCC Senior Counsellor Chia Hui Erl explores how acceptance, hope, and connection help patients move toward living well.

In my work as a counsellor supporting patients living with metastatic cancer, I am constantly reminded that the cancer journey is much more than managing a medical condition. It is an ongoing emotional and existential journey, one in which patients live with the notion that there is no clear endpoint, yet continue to wake each day to relationships, responsibilities, hopes, and fears. Inherent in this experience is a confrontation with profound questions about time, identity, control, and meaning, often within a world where patients struggle to fully comprehend the complexity of their lived experience.

Living with metastatic cancer often means learning to adapt to ongoing uncertainty. Patients may grapple with not knowing whether treatment will work or when it stops working. Alongside are concerns about symptom severity, pain management, loss of control, and emotional fluctuations. There is also the exhaustion that comes from making difficult decisions without clear answers. Patient often asked, “Who am I when I can no longer do what I used to?” Changes in body and roles can deeply affect identity and independence while planning for an uncertain future becomes a painful task. Relying more on others may raise fears of being a burden while the patient is grieving anticipated losses, questioning meaning and purpose, and feeling unsure about what to hope for. These struggles are a normal part of adjusting and can be eased with time, support, and self-compassion.

Accepting begins when a patient makes an active choice to stop resisting the illness and to confront mortality. As one patient shared, “I had been hoping for a cure for the last two years. Now I have come to accept that I have to live with cancer.” In reality, “accepting” is an ongoing process rather than a fixed state. It can occur in different forms and across many facets of the patient’s experience—accepting the progression to the awareness of dying. I have observed that this awareness often leads patients to refocus on living well with metastatic cancer—moving toward living a life, rather than living an illness.

With this shift in mindset, patients often learn to focus on coping and to make adjustments that accommodate both the illness and its associated limitations. One patient shared that instead of dwelling on whether he could live for another ten years, he chose to focus on living now and living fully. This is what he could control. This psychological shift allows patients to live in the present, engaging in life rather than enduring it by constantly fighting the idea of death.

Social belonging is nurtured through shared emotional connections. Strong family bonds are closely linked to patients’ mental well-being and quality of life. We know how deeply we love is how deeply we grieve. Many patients fear not being around to love, guide, and protect their children or spouse. “I would scar them so much,” as one patient reflected. It was a real and painful concern. Open communication about illness though difficult, can ease this emotional burden, while some limits may help patients protect loved ones from suffering. This calls for a supportive balance between communicating and protecting, avoiding a conspiracy of silence while respecting differing levels of family readiness.

Patients often find themselves returning to struggle when significant challenges arise. This oscillating process can be emotionally exhausting. What many find helpful is maintaining a positive attitude—not through denial, but through positive reframing and identifying moments of meaning or gratitude.

As one patient shared, “While I know I am generally weaker, I feel grateful that I can still make choices about treatment options and how I want to live.” Normalising the experience can also be comforting: “Some days I’m okay, and other days I’m just tired of everything. I tell myself it’s okay—it’s normal to feel this way.”

Hope plays a central role in a patient’s journey. Being hopeful means remaining open to possibilities, especially when making sense of one’s experience becomes difficult. While hope evolves over time, patients can choose the form of hope that best supports them. When outcomes do not unfold as expected or hopes are labelled as unrealistic, the disappointment can be painful. Yet even when outcomes cannot be changed, patients can still decide how hope helps them cope. One mother, for example, found hope in believing that her children and husband would be resilient and find strength through adversity. This was the hope she chose to hold.

I recall a conversation with a patient who shared, “If this treatment does not work, there is the possibility that another one will. If there isn’t, at least I have tried.” When asked where she drew her courage and strength from, she replied, “Myself!” I was deeply moved by her response; it reminded me that patients themselves are often their greatest source of strength.

Living well with cancer is an ongoing process of adaptation. It is deeply personal, and there is no right or wrong way to navigate it. It is not about accepting everything, but about learning to live alongside uncertainty, redefining control, and finding anchors of meaning, comfort, and connection amid ongoing ambiguity. Through this process, patients reconstruct their lives with strength and resilience, prioritising a life that is personally meaningful rather than one defined by illness. This is what my patients have taught me.