'I Have Metastatic Disease. How Long Will I Live?'

Believe it or not, I receive about 30 e-mails a day from patients or their loved ones asking me this question. These are individuals I have never met, seeking very profound and honest answers about their clinical situation and longevity. Unfortunately, there is no easy answer, no crystal ball to consult.

Sure, there are some family members who write me and describe a seriously ill mother on her deathbed, but this is the unusual situation.

Stage IV breast cancer is a serious situation. No question. However, the patient's physical condition and other factors, such as where the disease has spread and whether it is responding to treatment, directly influence how well she is going to do. This means that although most women with metastatic disease will die from it, not all will. I've seen women swept away swiftly within months of being diagnosed and I've seen women live more than two decades with a good quality of life. So there is no one specific answer for this situation.

It is important, however, for the patient to know that her situation is serious and to make sure her affairs are in order. This is wise advice for individuals who don't have metastasis -- or even breast cancer, for that matter. Life is unpredictable. Before you see this posting I could be killed in a car wreck. Do I have an advance directive and a will? You bet. I took those steps when I was pregnant with my daughter 27 years ago. It just seemed the prudent thing to do.

You'll find that doctors are hesitant to put timetables on longevity, too. They don't have a crystal ball, either. Some doctors will continue treating the patient until the very end. I'm not sure this is always the wisest course; I sometimes wonder what role the patient had in making this decision. For me, quality of life is more important than quantity of life. Knowing when to discontinue treatment and prepare for the end of life is a complicated and emotionally charged situation that oncologists face every day. When a patient dies, it doesn't mean the doctors or the patient failed. It simply means that the disease was more powerful than will, desire, and medicine combined.

I have a sign on my desk at home that says "Live each day as if it were your last and one day you will be right." These are wise words, worth thinking about whether you have metastatic disease, have a loved one in this situation, or fear that one day you'll face such news.


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