The everyday reality of living with Stage IV (also known as

metastatic or advanced) cancer is not something you will hear about on

the evening news. Nor will it make the front page of the New York

Times. Instead, you will hear or read about the latest medical

"breakthrough," regardless of whether there is any significant scientific

evidence of efficacy, of benefit over a similar drug. What those of us

who read the fine print of such articles, work in the cancer field, or

participate in a drug trial learn is that these therapies generally carry an

enormous price, both personal and financial, affecting most intimately the

person receiving treatment and their loved ones, but also society at large.

Indeed, conventional cancer treatments and trials are trials to patients and

families, not only physically, but also psychologically and emotionally.

This is not something many doctors talk about or care to hear about from

patients. Descriptions of emotional and existential pain, and the

unpleasant, intrusive side-effects of personal and familial suffering, such

as fear, anger, and uncertainty, does not make it into the patient's clinical

chart. One person, in a recent cancer support group, compared the long

term impact of living with metastatic breast cancer to the symptoms of

PTSD (post-traumatic stress disorder). The term survivor, applied to

anyone who has ever had a cancer diagnosis and is still living, is apropos

to people surviving the extreme ups and downs of treatment. In this

sense, family members and significant others are survivors too. As with

other crises that threaten our sense of safety and security, bonds either

strengthen or break. For individuals and relationships that survive

cancer, as not all do, it is a shared journey.