You just learned that your small-cell lung cancer (SCLC) has spread. Now you're cycling through a range of emotions:
- Shock: You can't believe you have metastatic cancer.
- Anger: How could this happen to you?
- Fear: It's scary to think about cancer and dying.
- Worry: How will your partner or children manage?
- Anxiety: What will happen in the future?
- Guilt: Did you cause your cancer?
- Loneliness: No one knows how you feel.
- Hopelessness: Your cancer isn't curable.
Everyone reacts differently to the news. Some people try to learn all they can about their cancer and its treatments. Others seek help from their doctor, therapist, or friends and family. A few hide at home because they don't want to face late-stage cancer.
Whatever you feel right now, it's a normal and healthy response to a serious diagnosis. "Sit with those emotions. Allow yourself to feel them, to recognize them, to label them. Be able to experience the emotion that is happening for you," says Tyler Evans, PhD, a clinical associate professor who specializes in psycho-oncology at UT Southwestern Medical Center in Dallas.
The first few days after a late-stage SCLC diagnosis can be hard. Though well-meaning friends and family might tell you to "stay positive," that's not easy to do. But there are ways to deal with the fear and hopelessness you feel right now. And there are people to lean on for support.
Ways to Deal With Your Diagnosis
Take a deep breath. Center yourself. Then try these methods to come to terms with your diagnosis.
Give yourself space
Take all the time you need to process the news. Rest and regroup. Give yourself space from other people and responsibilities until you can get a grip on your new reality.
Let yourself grieve
It's very common after a late-stage cancer diagnosis to go through the five stages of grief: denial, anger, bargaining, depression, and acceptance. But the grief process doesn't always move in a straight line from grief to acceptance.
"Sometimes you go from one to four, then you're back at two, and then you get to five," Evans says. Expect a rollercoaster of emotions. Your moods will swing up and down with each update you get from your doctor. Don't expect the grief you feel to go away quickly.
Learn what to expect
The unknown is scary. One way to calm your fears is to learn about metastatic SCLC. Ask a lot of questions at doctor visits. Find out where your cancer has spread. Ask how your doctor plans to treat it, how the treatment might help, and whether you can join a clinical trial of a new cancer drug.
Don't blame yourself
A lot of stigma still surrounds lung cancer. Sometimes people blame themselves for their diagnosis, especially if they smoked. "These thoughts, even if they are true, are not helpful," Evans says.
Self-blame only adds to anxiety, depression, and anger. Try to manage these emotions with the help of a therapist or other mental health providers.
Be present
It's easy to get caught up in fear and anxiety right now. Late-stage cancer can feel overwhelming. When anxiety creeps in and you have scary thoughts, pause. "Bring yourself back to the present moment," Evans suggests.
Mindfulness makes you aware of your negative thoughts without judgment, fear, or anger. Meditation and deep breathing are ways to keep yourself rooted in the present moment. A therapist can teach you other mindfulness techniques.
Control what you can
So many parts of a cancer diagnosis are out of your control. Focus on the things you can control. Take care of your body with healthy food, exercise, and sleep. Do things you enjoy. Spend time with the people you love.
Find new meaning in your life
Cancer has changed the course of your life, but you're still in charge. You get to decide what you want your future to look like.
How can you make the most of every moment you have? Do you want to spend more time with friends and family? Pick up an old hobby you put aside? Try a new hobby? Life might look different from what it did before cancer, but it can still be filled with moments of joy.
Where to Find Support
All kinds of support are available to help you manage your diagnosis. You just need to ask.
Family and friends
The people who love you want to help, but they don't always know what you need. Tell them. Be specific. Ask a friend to prepare meals, help with chores, or pick up your kids at school. Have your partner hold you while you cry or watch a funny movie and laugh together.
A psychologist, therapist, or social worker
These mental health professionals help you deal with the emotions of a late-stage SCLC diagnosis. Psycho-oncologists work with patients who have cancer. Your hospital might have one or more of these providers on staff. Or your cancer doctor can recommend someone in your area.
A lung cancer support group
Friends and family may not understand what it's like to have late-stage SCLC. A lung cancer support group is filled with people who know what you're going through. They can offer advice and answer your questions about what to expect.
Lung cancer support groups are held in person or online. Find a group at your cancer center, or through organizations such as LUNGevity, the American Lung Association, or GO2 for Lung Cancer.
The Journey Ahead
It's very common for SCLC to spread. Though it grows quickly, there are still many reasons to have hope.
SCLC responds well to treatments like chemotherapy and radiation therapy. Research has moved at a fast pace. Newly approved immunotherapies have improved survival and quality of life in people with late-stage SCLC.
One recently approved drug combo is lurbinectedin (Zepzelca) plus atezolizumab (Tecentriq). Together, these medicines damage the cancer cells' DNA and help your immune system fight the cancer. Tarlatamab (Imdelltra) is a new immunotherapy that brings your immune cells straight to the cancer cells. These new treatments keep lung cancer under control longer and improve survival.
Clinical trials
Ther are more treatment options for SCLC available now than ever before, thanks to clinical trials. These studies test new treatments to see if they're safe and effective. Every new SCLC drug started in a clinical trial.
When you join a study, you get a chance to try a new drug that might work better than approved medicines. You also help cancer research move forward. Ask your doctor if you're a good candidate for any SCLC studies.
Palliative care
This type of treatment is often misunderstood. "Some people are a little hesitant when we mention palliative care because they often associate it with hospice, dying, or end of life," Evans says.
Palliative care isn't the same as hospice care. Its goal is to improve your symptoms, relieve stress, and make you more comfortable during cancer treatment. If your hospital doesn't offer palliative care, ask about it.
Reframe your mindset
Once SCLC spreads, life looks different. The focus shifts from getting a cure to improving the quality of life.
Remember that you are still you. "The version of yourself precancer might have been version 1.0, and now you're at version 2.0," Evans says. "It's not that 1.0 was better or worse than 2.0. They're just different versions."
Cancer might have taken some control away from you, but not all of it. Find the parts of your new life you still own. Decide how you want to spend your time, what you want the rest of your life to look like, and how to make the most of every precious moment you have.
