Living Well with Metastatic Breast Cancer: A Practical Guide to Facing Each Day with Strength

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 
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From Communication to Connection: Rebuilding Intimacy and Sexual Wellness After Breast Cancer

For many women, intimacy after breast cancer can feel like unfamiliar ground. Your body has changed, emotions have shifted, and the idea of pleasure may feel distant. Yet intimacy isn’t lost, it’s transformed. Rebuilding closeness begins with understanding these changes, communicating openly, and learning to define pleasure on your own terms—in new, meaningful ways. Listening to Your Body’s New Language Breast cancer surgery may alter the look and feel of your breasts [1]. Treatments like chemotherapy and hormone therapy can cause vaginal dryness, fatigue or reduced desire [1] [2]. These physical shifts can affect how you relate to your body, and how confident you feel about resuming intimacy. It’s common to wonder: “Will my partner still find me attractive?” “Will sex feel the same?” [3] [4] Partners may also hesitate, afraid of causing pain or not knowing what’s “okay” [4] [5] [6]. Over time, silence and assumptions can create distance—even when love remains strong [7] [8].  Acknowledging these changes—in your body, your sense of self and your relationships—is a vital step in healing. Your body has carried you through cancer. Listening to it, with kindness instead of judgement, is an act of self-compassion. Boundaries as Bridges, Not Barriers Rebuilding intimacy begins with open communication. After treatment, your needs and comfort levels may have changed, and sharing them honestly helps strengthen trust and deepen connection [9].  Boundaries aren’t walls. They’re bridges that help you and your partner meet each other where you are.  Research shows that couples who communicate openly about fears, desires and limitations experience greater satisfaction and less distress [10].  You can also speak with your doctor about symptoms like pain, dryness or loss of sensation [1]. Your care team can suggest ways to manage these and make intimacy more comfortable for you.  It’s normal to feel shy about discussing sexuality. But remember: talking about sex is a natural, healthy part of reclaiming yourself [11]. The first conversation may feel awkward—but it opens the door to healing closeness.  Redefining What Closeness Means When you think of sexuality, you may first think of intercourse. But pleasure can be found in small acts of connection—holding hands, gentle touch, laughter or emotional intimacy [1] [7] [9]. Exploring touch gradually and broadening your idea of connection beyond penetrative sex can reduce anxiety and help you rediscover comfort in your body in new ways [7] [9]. Studies show that couples who approach intimacy with openness, flexibility and acceptance rebuild stronger connections [12].  If pain or numbness occurs, try different positions that take the pressure off your chest, or take breaks [7] [13].  Remember: pleasure is about comfort and connection, not performance.  Moving Forward and Finding Your Rhythm Again Desire may not feel as spontaneous, but closeness is always within reach. Whether through gentle touch, warm conversation or shared laughter, intimacy begins when you feel safe, seen and loved.  Be patient with yourself. Some days, you will crave closeness; others, rest will be what you need most. Both are forms of healing.  At Solis and Luma, we believe that living well after breast cancer means nurturing joy, confidence, and intimacy—in a way that works for you. Every journey is unique. Don’t be discouraged if something that works for others doesn’t feel right for you [14]. Let this new chapter be where you redefine intimacy—not as something lost, but as something newly yours.   Article reviewed by Ms Dian Handayani, Sexologist and Certified Sex Coach at Nambani. Dian is also a contributing author of The Breast Years of Your Life: Living Well After Cancer. From emotional resilience and fertility to nutrition and exercise, the book offers compassionate, practical guidance for survivors rediscovering wellness and confidence after treatment. To learn more or grab a copy, visit https://www.solis.sg/the-breast-years-of-your-life/ References: [1] Solis Breast Care & Surgery Centre, The Breast Years of Your Life: Living Well After Cancer [2] American Cancer Society, Body Image and Sexuality After Breast Cancer  [3] Breastcancer.org, Sexual Health During and After Breast Cancer  [4] Current Opinion in Supportive and Palliative Care, Sexual identity after breast cancer: sexuality, body image, and relationship repercussions [5] MD Anderson Cancer Center, Sexuality and Cancer: A Guide for Patients and Their Partners [6] Women's Health, Care for breast cancer survivors in Asian countries: A review of sexual dysfunction [7] Breast Cancer Now, Your Body, Intimacy and Sex [8] Psychooncology, Everyday Protective Buffering Predicts Intimacy and Fear of Cancer Recurrence in Couples Coping with Early-Stage Breast Cancer [9] BMC Cancer, Constructions of sex and intimacy after cancer: Q methodology study of people with cancer, their partners, and health professionals [10] European Journal of Oncology Nursing, Factors contributing to sexual dissatisfaction in women with breast cancer: The specific role of conjugal relationship quality [11] American Cancer Society, How Cancer Can Affect Sex and Intimacy [12] Frontiers in Psychology, Coping With Changes to Sex and Intimacy After a Diagnosis of Metastatic Breast Cancer: Results From a Qualitative Investigation With Patients and Partners [13] The Oncologist, From diagnosis to survivorship addressing the sexuality of women during cancer [14] Psycho-Oncology, Wearing my heart on my chest: dating, new relationships, and the reconfiguration of self-esteem after breast cancer
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Good Nutrition for Living with and Beyond Breast Cancer

Breast cancer treatments have become more and more successful, with a huge number of women studied beyond breast cancer, discovering what lifestyle factors may reduce the risk of recurrence.   The current recommendations supported by research are:  Maintain a normal body weight, but if you are overweight, losing just 5%-10% of your weight is beneficial.  Do not drink alcohol. Alcohol is one of the greatest risk factors for breast cancer and there is no safe limit as far as breast cancer is concerned. If you do choose to drink alcohol, limit your intake to no more than 7 units a week. Of note, 1 unit is not the same as 1 drink.   175ml wine 13% ABV is 2.3 units  125ml champagne 12% AVB is 1.5 units  330ml beer 5% ABV is 1.7 units  25ml spirit 40% ABV is 1 unit  Limit saturated fat by avoiding or rarely eating fast food and highly processed convenience foods.   Do eat foods that contain healthy unsaturated fat, and this includes nuts, seeds, nut butter, olives, avocado, oily fish such as salmon, sardines and mackerel and use extra virgin olive oil.   Limit red meat (beef, lamb, pork) to no more than 500g per week, which in practice is about 3  times a week, and avoid or rarely eat processed meat such as bacon, ham and salami. These  foods do not directly increase breast cancer risk but do tend to be high in saturated fat and are linked with increased colon cancer risk.  Eat a high fibre diet. Foods high in fibre include beans and lentils, nuts and seeds, fruit and vegetables, wholemeal bread and flour, brown, red and wild rice, barley, spelt, quinoa, freekeh, kamut and other wholegrains. If you are not used to a high fibre diet, you may notice some bloating and more wind than usual, this is nothing to worry about and is a normal process that shows that your gut microbes are active and keeping your gut healthy, but if it’s uncomfortable, gradually increase your fibre intake over a period of a few weeks. Beans and lentils are especially high in fibre, so try to eat meals containing them at least 4 times a week. Eat dairy and high calcium foods. Dairy foods are often a cause of controversy, and many people mistakenly believe they are linked with increased breast cancer risk, however, research  shows the opposite to be true and that women who include dairy and high calcium foods in their diet have a reduced breast cancer risk. If you dislike dairy foods or are intolerant to them, ensure  your diet is rich in high calcium non-dairy foods.  Include soy in your diet. As with dairy, this group of foods can be controversial, but research does show that women who eat soy have a reduced breast cancer risk and reduced risk of recurrence compared to women who do not eat soy. This is the same for both hormone receptor negative and positive breast cancer. You may have heard that soy contains a group of  compounds called phyto-oestrogens, and this is where much of the fear arises, however, phyto oestrogens are not the same as the oestrogen that your body makes, they have a different chemical structure and attach to different receptors in the body.   You may choose not to eat soy, maybe because you dislike it, are intolerant or don’t feel comfortable eating it, and that is fine, it is still possible to eat a healthy diet that reduces breast cancer risk by following some of the other guidelines included in this article.  Be physically active. Whilst this is not in the realm of healthy eating, being physically active has clearly been shown to reduce breast cancer risk. Aim to be moderately active for a minimum of 150 minutes a week, so approximately 30 minutes a day, or vigorously active for at least 75 minutes a week. Moderate and vigorous will be different for everyone, so be your own guide as far as effort goes.   The final and very important piece of advice is do not fear food. Eating should be enjoyable and free from stress. A healthy diet can look different from one person to the next. Your friend, relative or fellow breast cancer friend may feel great eating one way and eating certain foods, but that doesn’t mean you have to do the same. Make adaptations to your diet gradually and enjoy the process, this is much more likely to lead to sustainable change.  *Article contributed by Jackie Green, Dietitian & Nutritionist at The Family Dietitian   Jackie is also a contributing author of The Breast Years of Your Life: Living Well After Cancer. To  learn more about this empowering book for breast cancer survivors, or to get your copy, visit https://www.solis.sg/the-breast-years-of-your-life/ Recipes https://www.wcrf-uk.org/healthy-eating/recipes/  References and further reading WCRF: Continuous Update Project 2018: Survivors of breast and other cancers  Messina M et al Neither soy foods nor isoflavones warrant classification as endocrine disruptors:  a technical review of the observational and clinical data. Crit Rev Food Sci Nutr. 2022;62(21):5824-5885. doi: 10.1080/10408398.2021.1895054. Epub 2021 Mar 27. PMID:  33775173.  Arafat HM et al The association between breast cancer and consumption of dairy products: a  systematic review. Ann Med. 2023 Dec;55(1):2198256. doi: 10.1080/07853890.2023.2198256. PMID: 37078247; PMCID: PMC10120447  Bodai B et al Breast Cancer: Lifestyle, the Human Gut Microbiota/Microbiome, and Survivorship. Perm J. 2020; 24:19.129. doi: 10.7812/TPP/19.129. PMID: 32589577; PMCID: PMC7319098. 
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