• Shared decision-making with your oncologist and care team can lead to better treatment outcomes and satisfaction.
• Planning and organization can reduce the stress and anxiety that come with a cancer diagnosis.
• Emotional and mental health are important to successful cancer care.

A cancer diagnosis can be distressing, but advanced non-small cell lung cancer (NSCLC) brings unique challenges and uncertainty. NSCLC is considered advanced when it has metastasized — that is, spread beyond its original location to other areas of the body.

Knowing what to expect as treatment begins, understanding your prognosis, and communicating openly with your doctor can help manage the anxiety and emotions of an advanced NSCLC diagnosis.

What Is NSCLC?

Non-small cell lung cancer is the most common type of lung cancer, accounting for 80 percent to 85 percent of all lung cancer diagnoses. Its subtypes include:

• Large cell carcinoma — Developing in any part of the lung, this subtype tends to grow and spread quickly, which can make it more difficult to treat.
• Squamous cell carcinoma — Originating in the flat cells that line the airways, this type is typically found in the central parts of the lungs near a major bronchus.
• Adenocarcinoma — Arising from cells that produce mucus, adenocarcinoma usually occurs in the outer regions of the lungs.

While the prognosis and treatment options for these subtypes are generally similar, there can be differences in the specific treatments that work best for each.

Learn more about advanced NSCLC.

1. Understand Your Treatment Options

As with many kinds of cancer, NSCLC has a variety of treatment options. These include:

• Radiation therapy
• Chemotherapy
• Targeted drug therapy
• Immunotherapy
• Surgery

Your oncologist will work with you to determine the best treatment based on how advanced the cancer is at diagnosis, along with your overall health and immune system strength. Clinical trials — research studies testing new medications — may also be an option.

Palliative therapies may help improve the quality of life for people with advanced lung cancer. Palliative therapies focus on:

• Relieving pain
• Addressing breathing difficulties
• Removing blockages from airways
• Reducing buildup of fluid in the lungs
• Treating buildup of fluid around the heart

2. Engage in Shared Decision-Making With Your Doctor

In today’s world of oncology, shared decision-making is increasingly important. Patient advocates recommend this approach, which encourages open, two-way communication between patients and their health care teams. Rather than simply asking people with cancer to listen and follow instructions, shared decision-making emphasizes collaboration. The treatment team discusses the available treatments with the person with NSCLC and their family, explaining the pros and cons of each option. They also consider the person’s treatment goals before recommending a plan. This approach puts the individual at the center of their care.

Why is this approach so important? Shared decision-making can lead to better outcomes for anyone undergoing medical treatment. People are more comfortable with the care they get when they fully understand the options and feel their concerns and preferences have been taken into account. They feel like they have greater control in a challenging situation and report more satisfaction with the treatment plans they choose. This communication builds trust between doctors and those undergoing treatment.

Advocating for yourself is key to the shared decision-making process. The process only works when people understand how important it is that they ask questions and express their concerns to their oncologists and treatment teams.

Stay engaged throughout your cancer treatment. Learn about your condition from your health care team and from reputable sources like the American Cancer Society and the American Lung Association. Ask questions at your doctor’s appointments. You may also look into seeking a second opinion.

3. Reduce Stress Through Planning and Organizing

A diagnosis of advanced NSCLC can feel overwhelming, with a flood of information and decisions to process in a short time. Organizing your thoughts and plans on paper can help reduce stress and make managing cancer treatment easier. In general, staying organized can improve sleep and reduce anxiety, which boosts overall well-being.

Financial and Medical Paperwork

What can you organize to make life a little easier after a cancer diagnosis?

• Treatment plans — Keeping track of medications, therapies, and any adjustments to your care can help you stay on top of your treatment.
• Consultation schedules — Recording appointments with oncologists, surgeons, and other specialists helps avoid missing important visits.
• Medical bills — Organizing billing statements and receipts makes it easier to monitor expenses and prepare for insurance claims.
• Insurance paperwork (home, health, life, or others) — Maintaining up-to-date records of all insurance policies ensures coverage and simplifies the claims process.
• Power of attorney — Designating a trusted person to make legal or financial decisions can ensure your wishes are respected if you are unable to make decisions yourself.
• A living will or advance directive — Documenting your preferences for medical care, such as end-of-life treatments or resuscitation orders, can guide your care team in honoring your wishes.
• A will — Outlining your wishes regarding your assets and the care of dependents can help provide peace of mind for you and your family.
• Other financial paperwork — Getting a handle on bank statements, retirement accounts, and any outstanding debts helps maintain a clear view of your finances.

Find a system that works for you. Whether that means an accordion file for paperwork, a shared cloud drive with scans of everything important, or both, devising a system can help you sort and group documents clearly.

Don’t be afraid to ask for help planning and organizing all the details that will come into the process; it’s a lot to manage alone. Make sure your spouse, partner, or other trusted friend or family member is aware of the location of all important information — and of your wishes. Making as many decisions ahead of time as possible will make treatment and any potential end-of-life care easier for everyone involved, including family and caretakers.

End-of-Life Planning

Life expectancy with lung cancer can be unpredictable, with many factors affecting individual outcomes. It’s essential to prepare for different possibilities. The American Lung Association has a downloadable life planning worksheet that may be helpful in clarifying your priorities.

Having conversations about living wills, funeral plans, end-of-life care, and other details can be difficult. Start with your doctor. (Even doctors have a difficult time beginning these conversations with the people they treat, so let your health care team know when you are ready to discuss cancer plans or end-of-life issues.) It may be hard to do, but it can help to make your loved ones aware of your wishes and plans early on.

4. Focus on Your Emotional Health Alongside Your Physical Health

Any diagnosis of cancer is a lot for most people to deal with. Advanced non-small cell lung cancer is no different. Anxiety, stress, depression, hopelessness, lack of control, anger — all of these are entirely natural reactions to being diagnosed with advanced cancer.

Approximately one-third of people diagnosed with advanced NSCLC show symptoms of moderate to severe depression shortly after diagnosis. Some research shows that those diagnosed with advanced non-small cell lung cancer experience more intense symptoms of depression than people with other types of cancers. This is because of the complexity and difficulty of the disease in advanced stages.

Strategies for Improving Emotional Health

Acknowledging difficult emotions as real and normal, then addressing and managing them, can help improve your quality of life with advanced NSCLC. The following strategies can help.

Maintain Social Connections

It’s tempting to close yourself off during times of intense stress, but maintaining social connections is important to treating any illness. Let your friends and family know what’s going on so they can support you. It’s normal to feel like no one will understand, and some of your relationships may change, but most people will want to be there for you in whatever ways they can.

Keep a Journal

Journaling can help with managing the emotional response to a lung cancer diagnosis and treatment. The simple act of putting your emotions into words on paper (or a screen) can help you reduce stress, manage anxiety, and cope with depression. It can also help you assess priorities and track your physical and emotional symptoms. Try to journal for a few minutes every day. Make it easy to do, with pens you love or a cozy nook for your laptop.

Find a Support Group

Your cancer treatment center may have support groups you can join. Conversations with people going through the same things you are can ease the burden of a stressful experience. While support groups are traditionally in-person experiences, in the era of COVID-19, online options are more widely available. The American Lung Association and the American Cancer Society offer information about support groups for people with lung cancer. You can also lean on MyLungCancerTeam members for support.

Consider Therapy

More cancer treatment centers are recognizing that improving the psychological well-being of people with lung cancer can positively impact treatment. Although not all centers have on-site therapy services for the people they treat, they may be able to provide referrals to appropriate providers. Ask your doctor or health care provider for more information.

Seek Religious or Spiritual Guidance

If you are spiritual, support from a religious or spiritual advisor may also be a source of comfort during this time. A clergy member from your faith community or a hospital chaplain can be helpful to you and your family as you navigate advanced NSCLC.

A diagnosis of advanced non-small cell lung cancer profoundly affects both you and your loved ones. Engaging in shared decision-making with your care team, staying organized, and protecting your mental and emotional health can help you navigate this journey with greater ease.

You Are Not Alone

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 13,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

How are you managing your lung cancer diagnosis? Have you found ways to improve your symptoms? How are you feeling day-to-day? Share your experience in the comments below, or start a conversation by posting on your Activities page.