Vibrant Life in the Face of Metastasis: The Human Side of Cancer as a Chronic Illness

When advanced disease becomes a long-term reality, the journey changes. It requires strength, not just to survive, but to grow deeply and find a Vibrant Life in the Face of Metastasis. 

This week, we talk about the incredible resilience of the human spirit that finds depth, clarity, and life's true priorities when cancer is treated as a chronic illness.

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#VibrantLife #ChronicCancer #Metastasis #Resilience #HumanSideOfCancer

In This Episode:

• 02:51 - South Dakota - Hot Springs and Kuchen
• 03:31 - Advice Hotline - Get Life Tips from Senior Adults
• 06:06 - Why Cancer is Now Considered a Chronic Disease
• 09:00 - How Cancer Care is Adapting to the Complexity of Longer Lives with Cancer
• 15:39 - Discussion with Charlie - What Are Early Cancer Symptoms; What About Secondary Cancers?
• 20:52 - "My Hands" by- Joseph Hawkins
• 22:02 - Outro

Fifty years ago, a cancer diagnosis often meant a short, intense battle. Today, thanks to incredible advancements in detection and treatments like immunotherapy, cancer is transforming into a chronic disease. We are seeing people with Stage IV, metastatic cancer living for ten years or more.

But this new reality—this longer life—comes with a profound and often unspoken human cost: the uncertainty of cycling on and off treatment, the relentless drain of financial toxicity, and the sheer exhaustion of staying engaged. How do you plan a life when the prognosis is always shifting?

In this episode, we explore what it truly means to manage advanced cancer as a chronic condition. We discuss the evolving, deeply personal relationship between the patient and their care team, the moment a diagnosis becomes a strange kind of gift that brings incredible clarity, and how we can all learn to focus on living well in the time we have.

Join us as we dive into the resilience of the human spirit when faced with the long game of chronic cancer care.

Chapters

• 0:00 Intro
• 2:51 South Dakota - Hot Springs and Kuchen
• 3:31 Advice Hotline - Get Life Tips from Senior Adults
• 6:06 Why Cancer is Now Considered a Chronic Disease
• 9:00 How Cancer Care is Adapting to the Complexity of Longer Lives with Cancer
• 15:39 Discussion with Charlie - What Are Early Cancer Symptoms; What About Secondary Cancers?
• 20:52 "My Hands" by- Joseph Hawkins
• 22:02 Outro

Transcript

Hello and welcome to Everyone Dies. This week's show is about how cancer care has evolved. 50 years ago, just 2% of Americans were cancer survivors.

Today, the number has tripled and continues to grow. Today we're going to explore how modern oncology is transforming cancer from a terminal diagnosis to a chronic condition and what that can mean for all of us. So relax and settle in for our podcast about serious illness, dying, death, and bereavement.

Because even though everyone dies, no one has to face it unprepared. I'm Marianne Matzo, a nurse practitioner, and I use my experience from working as a nurse for 47 years to help answer your questions about what happens at the end of life. And I'm Charlie Navarrette, an actor in New York City, and here to offer an every person viewpoint to our podcast.

We're both here because we believe that the more you know, the better prepared you are to make difficult decisions before a crisis hits. And remember, this podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording.

In the first half, Charlie has a report about an elder adult advice line and our recipe of the week. In the second half, I'll be talking about cancer as a Joseph Hawkins. So Charles, good to see your lovely little face.

I mean, yes, it's very lovely to see you. What's new? What's happening out in Okehomie? Well, the nice weather seems to be continuing. It's going to be like up in the low 80s.

Oh, geez. You'd never know it was November. Oh, yeah.

Oh, and my baby turned 28 the other day. Oh, your baby. What baby is that? My daughter, baby.

No. Yes. She's 28? Yes.

Holy smokes. Wow. We're exactly 40 years apart.

That's crazy. Yeah. Yeah.

Having a baby at 40 was a little crazy too. You have weathered the storm quite well. I'm like the picture of Dorian Gray, Charles.

Just don't go in my attic. Oh, dear. So for our first half, our travels this week took us to South Dakota, which is home to the world's largest naturally occurring indoor hot springs.

Located in hot springs, Evans Plunge is a natural hot springs pool that has been a popular tourist attraction since the late 19th century. Designated as the state dessert, Kuchin is a South Dakota favorite. This pie-like pastry features rich custard poured over your choice of fruit.

How perfect for your next funeral lunch. Bon Appetit. Artists in residence at an elder care home in Canada became interested in the conversations the older adults would have during their visual art sessions.

They eventually launched an advice hotline so that the elder residents could share what they had learned in their decades of living. You can call, and this phone number will be in our show notes, 204-788-8060 to reach the Misery Cordia Place life advice line and hear pre-recorded messages from the residents on various topics. Press one for Carl's advice on following your dreams.

Press three for Randy's wisdom on how to grow in new ways. He joined some clubs and got a girlfriend. Press four for guidance on surviving Winnipeg winters.

If possible, don't be there. Press zero for Cheryl's tips on being true to yourself. You who has to live with yourself later.

A woman who is 97 years old advises to brush your teeth. Maurice does his best moose calls, and Geraldine recalls the tips she got as a girl. Don't wear a sleeveless blouse.

Men can look down your armpit. Continuing to grow as you age was a recurring theme in the advice from residents. Randy talks about learning the value of paying attention and listening to people, especially children.

One nugget of wisdom, a gem Bill recalled from his father, goes back decades, perhaps centuries, but is just as relevant today. Don't waste your time. Don't have a schoolyard fight.

That doesn't get you anywhere. You can find the phone number, again, in our show notes. Please go to our webpage for this week's recipe for coochin and additional resources for this program.

This is the part where we ask you for financial support. Your tax-deductible gift will go directly to supporting our non-profit journalism so that we can remain accessible to everyone. You can donate at www.everyonedies.org. That's every, the number one, dies.org, or at our site on Patreon under Everyone Dies.

Marianne? Thanks, Charlie. The model of cancer care has been changing over the last 20 years, with oncology centers also offering survivorship and supportive care, along with chemotherapy and radiation. 50 years ago, in 1975, 2% of the population were cancer survivors, and we now have 6% of the population surviving.

Put it another way, one out of every 18 Americans, that's 18.6 million people, were a cancer survivor in January 1st of 2025. By 2035, that number is projected to exceed 22 million. The reasons for this change are the advancements in cancer treatment, early detection methods, and improved follow-ups.

So even in the case of stage 4 metastatic disease, the cancer course lasts many years. It's not considered a curable disease, but the focus is on management of the cancer growth to increase survival as long as possible. So cancer is now considered to be a chronic disease.

You might be wondering what is meant by chronic disease. A chronic disease is a health condition that lasts for an extended period, typically more than six months, and it's characterized by first, long duration, so chronic diseases persist for months or even years. Second, it requires ongoing medical care.

They require regular monitoring, treatment, and management by healthcare professionals. Three, there's an impact on daily life. Chronic diseases can affect daily activities, work, and overall quality of life.

Four, there are multiple risk factors. They often have complex causes involving multiple factors such as lifestyle, genetics, and environmental exposure. And lastly, there's a potential for complications.

Chronic diseases can lead to other health problems and complications over time. Those who are diagnosed with stage 4 metastatic cancer, which is the most advanced form of cancer, are typically not broken out in studies of cancer survivors. But a study by Gallachio and colleagues did just this.

Utilizing surveillance, epidemiology, and end results, the SEER program registries to estimate the occurrence of metastatic cancer by cancer type and survival. They document that 19% of people with metastatic breast cancer and 20% of those with colon cancer were estimated to live with metastatic disease for 10 or more years. And there's a table in the show notes that says different types of cancer and survival.

So if you are living with cancer, you can look at that and have a sense of what the research says. Almost all cancers are now chronic diseases, and our approach to care has needed to pivot. People diagnosed with early stage cancer, and if you need information on cancer staging, see our podcast about cancer staging.

It explains it all. So people with early stage cancer are treated with an intent to cure. People living with advanced or metastatic cancer may cycle on and off treatments to prolong life, but without an expectation of cure.

They live with the uncertainty of active cancer treatment and periods of stable disease, not in need of treatment for many years. My patients would talk to me about this uncertainty and how it makes it difficult to plan for anything because they don't know when there will be a further metastasis, whether there will be another drug available to them, and how long they'll be able to do the things that are important to them. Newer therapies are available such as immunotherapy and targeted therapies that have offered people an extended positive response to treatment and longer periods of disease stability.

But this comes with greater uncertainty and the need to cycle on and off treatment for the rest of their lives. And they then learn to live with immune-related side effects, endocrine disorders, joint and muscle pain, and even secondary cancers. People with advanced cancer have to learn to live with the daily knowledge that the cancer can bring them to the end of their lives at any time, when in fact this is really a daily possibility for everyone that this could be their last day on earth.

The rest of us could pretend that this is not a reality of life while these people face their mortality daily. In studies that I've conducted with female cancer survivors, I've been told numerous times that they found cancer to be a gift that helped them focus on the things that were important in life. One woman said it was not a gift that she would want to give anybody, but for her it changed her life for the better.

The healthcare practitioner-patient relationship has also evolved as metastatic cancer has shifted toward long-term management. It becomes more complex. I remember when women would come into clinic diagnosed with stage 4 breast cancer and there were few drugs available, plus surgery and radiation.

Now we can stanger the drugs and women can get three or even four types of drug treatment, each one offering months or years of progression-free survival. That survival though comes at a high burden in terms of psychosocial and physical symptoms, expense, complex healthcare needs, and amplified caregiver support needs. In the past we would take care of these people for a few years until they died.

Now we have a much longer relationship with them and this is not without our getting attached to them and greater grief when they die. We get to know their families, their parents, and other family members who come with them to appointments whom we get to know as well. They may bring their kids with them and want to talk about their children and how they manage the unpredictability of their disease.

The extra time that they have is truly a gift for the healthcare practitioner though and the extra time is time that we get to know them, care about them, and ultimately grieve more when they die. When the time comes for them to move to hospice care, the oncologist relationship ends and their care is transferred to another practitioner in hospice. There have been many times when I've written the hospice referral and I'm saying goodbye to them and it's so hard to watch them walk out of the clinic for the last time after all we've gone through with them over the years.

It's just so very sad and heartbreaking. We go in knowing that they have stage 4 disease and so do they and yet as the years roll by and we are treating the cancer and the symptoms and what is a chronic disease model, a part of us forgets the cancer stage and we roll with whatever happens and deal with the disease progression when it occurs. When it comes to treatment options, oncologists tend to focus on effectiveness and physical side effects of the treatments but people living with cancer have so many more responsibilities and competing demands in their lives that treatment decisions require consideration of factors such as logistics of treatment, personal and family responsibility, and the ability to attend important events.

They have a wide range of priorities that they consider in treatment decisions and as a practitioner I have to respect that, offer risk versus benefit analysis of the choices that are before them and respect and support the decisions that they make. People living with metastatic cancer and their care practitioners need to stay engaged and proactive in their care over time. There's also a financial aspect because cancer treatment and surveillance is expensive even for people with insurance.

In oncology this is called financial toxicity and this includes the cost of treatment and the loss of income. Issues like psychological distress, like anxiety or depression is common in chronic disease. When clinicians ask about those symptoms, normalize them, and treat the symptoms, information, support, and communication are vital to helping people and their caregivers stay in the game, attentive, and engaged.

They get exhausted with the appointments, the blood draws, the scans, and all that goes with ongoing cancer treatment. Involvement in peer support and advocacy are ways that women can engage with and support others while participating in their own care. What I've learned from years of working with people living with cancer is this, life doesn't stop after a diagnosis.

It changes, it deepens. There's grief, yes, but there's also gratitude, courage, and clarity about what life really means. Cancer has become a chronic disease, but the human spirit remains anything but chronic.

It's vibrant, resilient, and deeply alive. For those living with advanced disease and for those whose care partners are involved, the work isn't only about surviving. It's about living well in the time that we have.

Charlie, any questions or thoughts? I love how you ended that. It's about surviving and living well. Which is what we're all just trying to do, right? Yeah, exactly, but under these conditions, that's, yeah, it's really difficult.

So, okay. So, back to you. Yeah, yeah.

Let's get back to me. So, symptoms, I mean, like what? Well, if you're having a certain kind of chemotherapy, you could nausea and vomiting, you could have... No, I'm sorry, I mean beforehand. I mean, if... What do people start to feel? Because, you know, people don't always, you know, take, you know, good care of themselves and, you know, other folks don't have insurance or... So, what... If someone's coming down with cancer, what symptoms would appear? Well, it depends on the type of cancer.

I did a lot of work with women with ovarian cancers, and I can remember one woman who had ovarian cancer, had treatment, got involved in support groups, and then as time went on, she started having symptoms similar to when she was first diagnosed, and she ignored them, and she ignored them because she was afraid that it might be progression of her cancer. Well, it was progression of her cancer and, you know, necessitated her, you know, going back for more treatments, but she knew what the symptoms were, and it frightened her to think, maybe my cancer's back. Now, some people in that situation would make like an emergency call to their doctor and get in immediately.

Some people say, I don't want to deal with this and ignore it. So, as we've talked about different kinds of cancers and different symptoms, one of the messages that we try to say to everyone is don't ignore these things. You know your body.

If your body is doing something different than what it normally does, or if it hurts, or if you're starting to lose weight, or you've lost your appetite, and, you know, there's, you're not taking medicine to adjust your appetite, then you need to call your healthcare practitioner and say, this is different. I don't know, you know, could be nothing, and it could be something, but on our own, we don't have any way of knowing which one of those it is. So, we need to go to the healthcare practitioner and say, here's what's going on.

Yeah, what was that old, it was a campaign, advertising campaign, Know in Advance, or from years ago now, I don't remember. Was that the duck and cover? Pardon? Was that duck and cover? No, not that far back. No, this is about, covered, no, not duck and cover, geez.

No, it was something from the Cancer Society about being aware. Well, it could just be, be aware. Know your body, and if something's Yeah, out of whack, exactly, yeah, yeah.

Don't ignore it. You know, you also mentioned secondary cancer. So, is this common, someone comes, has cancer, and then another type of cancer arises? I don't know, I don't know off the top of my head what the statistics are for the percent of secondary cancers, but I do know that they happen, and they can happen just as, you know, a zig instead of a zag, like the original cancer, or it could be as a result of the treatment, like if you're getting radiation treatment, that can cause other kinds of cancers, like you can get a skin cancer, something like that.

So, secondary cancers can be a result of the treatment, or it could be just because some people have like a genetic predisposition to cancer, and they get multiple types of cancer because of their genetics. So, there's a lot of reasons, but it can happen. The thing is, is that for our listeners, is that you need to know it can happen, and so you pay attention to all of your symptoms and be aware.

Yeah, yeah. Okay, thanks. Well, you're welcome.

In our third half, a poem written by Joseph Hawkins titled, My Hands. So many tools have I held, syringes and catheters, blood samples and pens, so many pens that I wonder that there are more yet to write with. My hands should have grooves from hands tenderly held, dry fingers and sweaty palms, cold digits gently grasped and firmly held.

Yet the grooves are in my mind, my soul perhaps. I look down and see their invisible mark upon me, the hands of others in their last days, their last hours and minutes. I held each, no fear, small comfort that requires no other tool, the kindest touch at the end, to hold another and to be there at the end.

And that's it for this week's episode. Please stay tuned for the continuing saga of Everyone Dies, and thank you for listening. You can find more episodes from our series about cancer on Spotify, Apple Podcasts, or your favorite podcast app.

Follow and subscribe to the show, share it with someone who needs a little hope today, and join us again next week. This is Charlie Navarette, and from comedian Susan Rice about caregiving, I took care of my mom and dad for many years. I wasn't good at it.

They died. And I'm Marian Matzo, and we'll see you next week. Remember, every day is a gift.

This podcast does not provide medical advice. All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only, and are not a substitute for professional medical advice or treatment. Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health.

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