Stage 4 lung cancer is the most advanced stage of lung cancer. In stage 4, the cancer has spread (metastasized) to both lungs, the area around the lungs, or distant organs.

According to the National Cancer Institute (NCI), 57 percent of lung and bronchus cancer is diagnosed at this late stage.

Lung and bronchus cancer is the second most commonly diagnosed cancer, behind breast cancer. It represents about 13.5 percent of all new cancer cases, with an estimate of about 234,000 new cases in the United States in 2018.

If you or a loved one has received a stage 4 lung cancer diagnosis, you’ll want to know what to expect so you can get the best possible treatment.

Expect a rush of emotions

Along with communicating with family and friends, consider joining a support group or seeking out a therapist or counselor.

Expect to take charge of your healthcare decisions

Many people are motivated to research from trusted resources and then discuss findings with their healthcare team.

One area to research could be available clinical trials. These might give you access to new treatments that could improve your prognosis.

Expect to make lifestyle changes

Many people support their treatment by stopping unhealthy habits like smoking and adopting healthy habits like staying physically active and eating a proper diet.

Expect some relationships to change

You might find that people start treating you differently than you hoped or predicted. Or you might find yourself needing something different from certain relationships. Be honest about your needs and seek the support of friends and family you trust.

Expect palliative care

Many lung cancer treatments have uncomfortable or concerning side effects. Sometimes treatment can be adjusted. Typically, your healthcare team can recommend a palliative care specialist who focuses on the management of side effects.

Expect checkups

Even when you are done with initial treatment, there will be follow up visits, including testing to monitor your recovery.

A five-year lung cancer survival rate measures how many people are living five years after they were diagnosed with lung cancer. The five-year relative survival rate for stage 4 lung cancer is 4.7 percent.

However, relative survival rates don’t take into account recent improvements in treatment. They’re based on diagnosis and treatment for at least 5 years earlier.

Remember that survival rates are only estimates, and everyone’s body responds to the disease and its treatment differently.

If you have been diagnosed with stage 4 lung cancer, many factors will affect your outlook, including:

  • Overall health. Commonly, if you’re healthy when diagnosed with stage 4 lung cancer, it’s an indication that you might have a better ability to tolerate life-extending treatments.
  • Age. Although data regarding the outcome of older people with lung cancer is limited, a small 2013 study found older age was associated with poorer lung cancer survival.
  • Gender. According to the American Cancer Society (ACS), the chances of a woman developing lung cancer sometime in her life is about 1 in 17, while for a man the risk is about 1 in 15.
  • Race. The ACS also indicates that while black women are 10 percent less likely to develop lung cancer than white women, black men are about 20 percent more likely to develop lung cancer than white men.
  • Response to treatment. If your body responds well to cancer treatment, you will likely have a higher chance of survival.

Often at this stage, your healthcare team is focused on palliative care as opposed to curative care. Late stage lung cancer can cause symptoms such as:

  • Fatigue. This can include extreme physical, emotional, and mental tiredness.
  • Emotional changes. Some people find that they become less interested in things that used to interest them.
  • Pain. Severe pain and discomfort can occur, but your healthcare team can help you manage the pain to improve your quality of life.
  • Difficulty breathing. Shortness of breath and trouble breathing are not uncommon. You can learn positions and techniques that help breathing, and your healthcare team can recommend medication to relax your breathing and reduce anxiety.
  • Coughing. A persistent cough can be caused by a tumor blocking an airway. Your healthcare team can create a treatment plan to alleviate and control the coughing.
  • Bleeding. If a tumor spreads into a major airway, it may cause bleeding. Your doctor may suggest treatment with radiation or another procedure.
  • Changes in appetite. Fatigue, discomfort, and certain medications can reduce appetite. You may find that food is no longer as appetizing and that you seem to become full more quickly.

As a caregiver, you can expect to see your loved one experiencing many of the symptoms and changes listed above, from reduced appetite to difficulty breathing to emotional changes.

Your loved one might also experience spiritual changes, whether they’re religious or not. According to a 2012 article in Annals of Oncology, the person you’re caring for might face spiritual issues that may cause distress or may help them reframe their current situation and find greater meaning in life.

The article concludes that caregivers are responsible for spiritual as well as physical and psychosocial dimensions of their loved one’s situation. The goal is to deliver person-centered, compassionate care that delivers an improved quality of life along with best possible health outcomes.

Caregiving is often emotionally and physically exhausting. This can lead to feeling overwhelmed and overburdened, a condition referred to as caregiver burnout.

Physical signs and symptoms of burnout can include:

Emotional signs and symptoms of burnout can include:

It’s important for caregivers to take care of their own health as well, and ask for support and guidance when needed.

By understanding stage 4 lung cancer prognosis, you can anticipate what you will experience as you navigate the treatment process.

With preparation, you can be ready to make decisions that will maximize your treatment options and comfort.