Accepting the Reality of a Metastatic Diagnosis

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Another challenge that plagues this specific population is the need to accept the reality of a metastatic diagnosis. Many lack an understanding of what the term metastatic implies. Although it does not have the same negative connotation as a few years ago (we are seeing more and more people live longer with stage IV illness), it does mean that remission is not an option. Young adults must factor this idea into their life goals and plans for the future.

Accepting this reality is challenging and often requires additional support from an oncology professional, a licensed therapist, peer support, or group therapy. “The most challenging part so far has just been assimilating the fact that the metastatic diagnosis meant my life was not going to continue how I envisioned. I think it took me a long time simply to adjust to that and then start to find ways to still pursue my interests and find meaning in my everyday life,” explains a young adult patient.

The Role of Grief and Creating a Legacy

Young adults with metastatic illness may experience grieve milestones associated with normal adult life events. They may have to adjust their life goals to find continued meaning, even if this means grieving the loss of a dream job, planning for a family, or the ability to travel freely. Young adults are prone to comparing themselves with their peers, and finding dissatisfaction in their daily life. Those with metastatic illness may feel pressure to accomplish certain life tasks such as finding a partner or starting a family. They may feel conflicted as others urge them to follow their dreams because their life may be cut short. 

Similarly, many find themselves faced with their sudden mortality and the idea that they must create something to leave behind. This idea of constructing a legacy can cause emotional distress, as this idea is new to many young adults. It is important that this population finds emotional support to process what a personal legacy may signify and how they can find meaning in their situation.

Creating a Supportive Network

Once the challenges are identified, how do you help? Young adult specific support is often hard to come by; however, specialized support through individual telephone counseling, in-person counseling, as well as online and in-person support groups is available through CancerCare. Young adults have identified that having a supportive space to process these challenges has allowed them to further explore their experience and come to terms with their personal reality.3 Peer support has been acknowledged as an important part of the process; speaking to other young adults with metastatic disease can decrease isolation and emotional distress. Encourage young adults to reach out for support and to extend their network beyond primary means.

Sarah Paul is the Child and AYA Program coordinator at CancerCare. 


1. Cancer Facts & Figures 2017. Atlanta, GA: American Cancer Society; 2017.

2. Bolte S. Young adults (20 to 39) with cancer. In: Christ G, Messner C, Behar L, eds. Handbook of Oncology Social Work: Psychosocial Care for People with Cancer. New York, NY: Oxford University Press; 2015:507-513.

3. Closing the gap: Research and Care Imperatives for Adolescents and Young Adults With Cancer. Report of the Adolescent and Young Adult Oncology Progress Review Group. Bethesda, MD: National Cancer Institute; 2006. NIH Publication No. 06-6067. Accessed December 13, 2017.