Most survivorship articles focus on finishing treatment and learning to ease into the new norm. But for women living with metastatic (stage IV) breast cancer, the journey looks different. Treatment continues, emotions shift, and “normal” evolves into a new routine with its own challenges. This article is written specifically for those living with ongoing Stage IV disease, where cancer remains a part of daily life – not as a setback, but as a reality that requires strength, adaptability, and purpose.  Understanding Advanced Breast Cancer “What does it mean to be Stage IV?” Advanced breast cancer, also known as metastatic breast cancer or Stage IV breast cancer, is cancer that has spread beyond the breast to other parts of the body like bones, lung, liver, brain, or other organs [1] [2]. Sometimes it may be found at first diagnosis, or it can develop as a recurrence [2].  While it is not curable, advancements in treatments have made it possible to relieve symptoms, slow cancer progression and improve quality of life.  Receiving this diagnosis can feel like the ground has shifted beneath you. You may experience disbelief, anger, fear, sadness or helplessness. Even small physical sensations can suddenly carry more weight, leading to heightened vigilance and worry [3]. These feelings are normal. Give yourself compassion and time to process everything before looking ahead. When Survivorship Takes a Different Shape “What does ongoing treatment mean for my life ahead?” For early-stage breast cancer, survivorship often means transitioning from active treatment to surveillance and the gradual rebuilding of daily life . There can be pressure, both spoken and unspoken, to “bounce back”, return to routine, and leave cancer behind.  However, metastatic breast cancer brings a different kind of survivorship: Treatment is ongoing, not completed You may navigate cycles of stability and progression Discussions may include symptom management, palliative or supportive care and long-term planning [4][5] Living meaningfully “right now” becomes just as important as preparing for the future You may not always consider yourself a “survivor” in the traditional sense, but you are – in the way you adapt, carry on, and remain present every day.  Finding Your Voice and Embracing Support “How can I learn to let others in?” Honest communication with your care team can help you understand what lies ahead and manage common side effects such as fatigue, neuropathy, pain, hair loss, insomnia and vaginal dryness [2].Viewing this condition as a chronic but not life-limiting illness may may also help [6]. Asking about sensitive topics, including end-of-life concerns, can help reduce uncertainty and help you make confident, informed decisions. Without this clarity, you may feel anxious and turn to less reliable sources on social media or experience a flood of well-meaning but overwhelming advice from loved ones, which can worsen distress [2]. Support from loved ones can make a world of a difference. Family and friends may not always understand your experience or know how to help. This can make you feel drained and you may feel tempted to withdraw. But, isolation can magnify your symptoms and emotions.  It’s common to hesitate asking for help, worrying about being a burden or feeling pressured to stay positive. However, needing support doesn’t mean showing weakness, and asking for help is a form of strength.  Loved ones can support you by: Driving you to appointments and sitting in with you Helping to research questions about the disease and management to clarify with your healthcare providers Assisting with daily household tasks or errands  Helping with child care, pet care or care of elderly dependents Offering quiet companionship and a listening ear or positive encouragement Support groups and peer communities can be especially meaningful [7]. Many women find comfort in speaking with others who truly understand the journey of uncertainty, emotional complexity and resilience required to live with metastatic disease. Quality-of-life concerns including physical and emotional distress, body image struggles, disruption of daily routine, and an awareness of life’s brevity can cause distress and open communication with loved ones can improve psychological adjustment [3][8]. You may need to take the lead in expressing your needs, but remember that advocating for yourself doesn’t mean you’re responsible for others’ emotions.  Living for Yourself in the Face of Metastatic Cancer “Each day holds moments to cherish, even with cancer as part of my story.” Cancer can disrupt routines and create instability. Rebuilding pockets of predictability in your life can help you feel grounded and in control.  Here are some strategies that many women find helpful :  Keep Yourself Engaged Continuing work, hobbies or daily routine – when you are able - can bring stability and reduce the focus on cancer. Set Attainable Goals Small goals, such as short walks or trying a new recipe, and long-term goals, like completing a course or project, can bring purpose and help you celebrate wins as they come. Engage in Hobbies and Practise Mindfulness Diving into new passions such as art, journaling, music, yoga, or meditation, or rekindling joy in existing ones can help reduce stress, ease anxiety and strengthen emotional resilience. Honour Your Energy Some days will be better than others. Adjust your expectations and routines based on how you feel. What matters is not productivity – it’s honouring your needs. Consider Long-Term Planning as Empowerment For many, long-term planning can bring comfort and peace of mind. This may include: Setting practical arrangements Discussing future goals with loved ones Clarifying preferences around medical care Identifying meaningful “life projects”, such as photo albums, letters or personal legacy work Long-term planning is not about giving up – it is a way to create stability and ensure that your voice remains central in all decisions. A lifelong illness can sharpen your appreciation for meaningful moments: shared laughter, a nice meal, or time with loved ones. These moments matter. They are not small–they are anchors. Hope isn’t Gone, it Persists “I’ll take things one step at a time.” Hope for women with metastatic breast cancer often shifts away from cure and toward living fully and meaningfully, despite the uncertainty.  It can be difficult when others see only “the cancer patient” instead of the whole person. Staying connected with your identity – your interests, values, quirks, dreams – can help you reclaim the space cancer often tries to occupy.  You remain a whole and beautiful person. You deserve care, dignity and joy – not because of your diagnosis, but because of who you are. You Are Not Alone At Solis and Luma, we recognise that every woman’s journey is uniquely hers. Survivorship is defined by the quiet strength it takes to live each day with intention, no matter your stage.  *Article reviewed by Dr Tan Sing Huang, Senior Medical Oncologist at OncoCare Cancer Centre. Dr Tan Sing Huang is also a contributing author of The Breast Years of Your Life: Living Well After Cancer, a compassionate guide on healing emotionally, navigating advanced breast cancer, and living with purpose.  Learn more or get your copy at: https://www.solis.sg/the-breast-years-of-your-life/  References [1] Cleveland Clinic, Metastatic Breast Cancer [2] Solis Breast Care & Surgery Centre, The Breast Years of Your Life: Living Well After Cancer [3] The Breast Journal, Living with Metastatic Breast Cancer: A Qualitative Analysis of Physical, Psychological, and Social Sequelae [4] Journal of Surgical Oncology, Breast cancer survivorship [5] ASCO Educational Book, Survivorship Care for People Affected by Advanced or Metastatic Cancer: Building on the Recent Multinational Association of Supportive Care in Cancer-ASCO Standards and Practice Recommendations [6] PLOS One, Exploring the experiences of women living with metastatic breast cancer [MBC]: A systematic review of qualitative evidence [7] European Society for Medical Oncology, The Guide for Patients on Survivorship [8] National Library of Medicine, Metastatic breast cancer: Learn More - Living with metastatic breast cancer