A cancer diagnosis can be distressing, but stage 4 (stage IV) non-small cell lung cancer (NSCLC) brings unique challenges and uncertainty. Stage 4 NSCLC is considered advanced cancer that has metastasized. This means it has spread beyond its original location to the other lung, the mediastinum (the space between the lungs), the heart, or other parts of the body outside of the chest, even if it hasn’t spread to the lymph nodes.

Knowing what to expect as lung cancer treatment begins, understanding your prognosis, and communicating openly with your doctor can help manage the anxiety and emotions of a stage 4 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. A specific kind of large cell carcinoma, called large cell neuroendocrine carcinoma (LCNEC), is a fast-growing cancer that acts a lot like small cell lung cancer.
• 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 (chemo)
• Targeted drug therapy
• Immunotherapy
• Surgery

Your oncologist (cancer doctor) will work with you to determine the types of treatment that are appropriate for you based on how advanced the cancer is at diagnosis, along with your overall health and immune system strength. NSCLC advanced cancer staging is classified as stage 4A and stage 4B. Stage 4B is more widely spread. People with stage 4B NSCLC may be tested for certain gene mutations (changes) in cancer cells that would make them good candidates for targeted therapy as a first treatment option.

Advances in the treatment of NSCLC continue to develop. Be sure to talk to your doctor about new treatment options and always discuss potential side effects of treatment before you try it. Clinical trials — research studies testing new medications — may also be an option.

Palliative therapies, which focus on comfort, may help improve the quality of life for people with stage 4 lung cancer. Palliative care focuses on:

• Relieving chest pain
• Addressing shortness of breath
• Removing blockages from airways
• Reducing pleural effusion (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. Health advocates recommend this approach, which encourages open, two-way communication between people with NSCLC and their healthcare teams.

Acknowledging difficult emotions as real and normal, then addressing and managing them, can improve your quality of life with stage 4 NSCLC.

Rather than doctors 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 and priorities before recommending a treatment plan. This approach puts the individual at the center of their care.

Why is this approach so important? There’s good evidence that 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. A friend, family member, or caregiver can help you write down your questions and take notes at your doctor’s appointments. Some cancer centers also have nurse navigators that can assist you in finding the resources you need for your cancer care.

Stay engaged throughout your cancer treatment. Learn about your condition from your healthcare 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 stage 4 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 helps ensure 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 become 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 property 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 can help you 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.

Approximately one-third of people newly diagnosed with stage 4 NSCLC show symptoms of moderate or severe depression shortly after diagnosis.

Don’t be afraid to ask for help planning and organizing all the details that will come into the process, because 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 metastatic lung cancer can be unpredictable, with many factors affecting individual outcomes. It’s essential to prepare for different possibilities when living with stage 4 non-small cell lung cancer. 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 loved ones. It may be hard to do, but it can help to make close family members aware of your wishes and plans early on.

It can also be helpful to talk to your doctor. (Even doctors have a difficult time beginning these conversations with the people they treat.) Let your healthcare team know when you are ready to discuss your prognosis as NSCLD progresses, potential care needs, or end-of-life issues.

4. Focus On Your Emotional Health Alongside Your Physical Health

Any diagnosis of cancer is a lot for most people to deal with emotionally. Advanced stage 4 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 newly diagnosed with stage 4 NSCLC show symptoms of moderate or severe depression shortly after diagnosis. Some research shows that those diagnosed with advanced lung cancer experience more intense symptoms of depression than people with other types of cancers. This is often because of the complexity and uncertainty 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 stage 4 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 when managing an 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 the anxiety that may come with 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, 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 psychological therapy services for the people they treat, they may be able to provide referrals to appropriate providers. Ask your doctor or healthcare 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 stage 4 NSCLC.

A diagnosis of stage 4 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 14,000 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.