Advanced cancer

In Canada, it is challenging to figure out how many people are dealing with advanced cancer due to inconsistent data collection. Data on the cancer stage at diagnosis is only available for certain types of cancer. Cancer stage is also not the only criteria for defining advanced cancer.

Everyone's experience with advanced cancer is different. When someone is diagnosed with advanced cancer, it can bring on feelings of grief and uncertainty for them and their families. Even though advanced cancer may not be curable, there are ways to help people with cancer and their families have a good quality of life for as long as possible. People that have advanced cancer and their caregivers and families often have physical, emotional and spiritual needs that aren't fully met. They also experience unique challenges and obstacles in accessing information and support that’s right for them.

No one should face a cancer diagnosis alone or lack access to the information and care they need. But for people facing an advanced cancer diagnosis and their loved ones, there can be unique challenges and barriers that make a cancer experience more difficult than it needs to be. The Canadian Cancer Society (CCS) acknowledges its responsibility to provide cancer information, support and practical services to people with advanced cancer, as well as advocate for healthy public policy and fund research focused on advancing health equity.

What is advanced cancer?

For CCS, advanced cancer is a cancer that is unlikely to be cured, and the focus of care changes in physical, emotional and practical ways. Advanced cancer is also known as metastatic, terminal, end-stage or stage 4 cancer. For some people, their cancer may already be advanced when it is diagnosed. For others, the cancer may not become advanced until years after it was first diagnosed.

CCS has released Advancing Health Equity Through Cancer Information and Support Services: Report on communities that are underserved. The report describes the gaps, barriers and challenges faced by 10 identified underserved communities, including people with advanced cancer. It offers insight on how to better engage with and improve supports for these communities who, like all people in Canada, deserve access to cancer care.

Our programs and services

All CCS staff are offered diversity, inclusion, belonging and equity training. This training helps us ensure that our physical spaces like lodges, camps and vehicles, as well as our services over the phone, chat and email, are safe, welcoming and inclusive.

Our cancer information, support and practical programs and services are for everyone in Canada, but here are ways that they support people with advanced cancer in particular.
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Cancer information

Understanding cancer can help ease the anxiety of a diagnosis. Find information on more than 100 cancer types, covering the entire cancer experience. Explore our wide range of resources in formats like publications, videos and webinars.
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Community Services Locator

Our Community Services Locator helps people with cancer and their loved ones find services and programs like support groups, wigs and prosthesis, financial help, places to stay and more. Use the “Services for” filter to find resources and support services for advanced or metastatic cancer.
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Cancer Information Helpline

The Cancer Information Helpline’s information specialists receive specialized training about the unique circumstances and challenges of advanced cancer. They can help people living with advanced cancer and their families and friends find support, information and helpful resources.
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Wheels of Hope

If you need to travel across town or across the province to receive cancer treatment, the Wheels of Hope team can help. Our transportation staff have received specialized, evidence-informed training in advanced cancer and they apply it to their daily work. This training allows our team of staff and volunteers to better support people with advanced cancer and their caregivers as they travel to their cancer appointments.
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Accommodations

Lodge teams regularly welcome people with advanced cancer during their treatment and understand their unique needs. The lodge provides a safe space and a home away from home where people can connect with others. Lodge staff have had specialized, evidence-informed training in advanced cancer to better support people with advanced cancer and their caregivers.
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Online cancer support community

CancerConnection.ca is a safe online community that provides connection, information and peer support to people with cancer and their families and friends. CancerConnection.ca has an active group of members who are living with advanced cancer, understand the unique challenges and share their experiences, questions and support with one another. Online moderators have had specialized, evidence-informed training in advanced cancer to better support people with advanced cancer and their caregivers.

Dauntless

When Dianne was finally ready to retire at age 66, she was diagnosed with stage 4 lung cancer. Hear about her treatment journey and how she found support through CCS and continued to move forward with living.

Dianne’s voice [music starts as she speaks]:

I was born October the 6th, 1951 in Twillingate, Newfoundland.

Carried to my home on Little Bay Islands on a schooner that was in Twillingate picking up freight. It was called the Dauntless. Little did I know that the captain would end up being my future father-in-law, and that Dauntless would forever be my username in the computer world.

Back then, being a nurse, teacher, secretary were about the only choices for young girls. But I enjoyed playing nurse, and I always thought it was glamorous. I graduated in 1972. It wasn't quite glamorous for sure, but I loved my work, and I cared about and for my patients. So much so that at the age of 60, when my friends were considering retirement, I was skydiving and starting a new position as a travel nurse in northern Labrador.

I always seemed to leap before I looked. The northern clinics in Labrador gave isolation a whole new meaning. Medevac planes that were dependent on the unpredictable weather, ambulances that couldn't get through to the clinics, and I knew so little about the supports available there for my patients, especially cancer patients.

At the age of 66, I was finally ready to retire. Plans of travelling the world were waiting for me, including a trip to Disney World with my grandson, and doing some of the things that I had been doing throughout my life, I guess, skydiving, zip lining, white water rafting, and parasailing were all calling my name. But life had other plans for me.

A mass was found in my lung. Cancer had shown up unannounced to my retirement party. Didn't seem quite fair, since I was a non-smoker all my life. But I didn't let it slow me down. I kept on living the way I always had. I did all the scans and tests required, and my surgery was scheduled for March the 18th, and I thought I had the luck of the Irish with me, as it was the day after St Patty's Day.

Two days before my scheduled surgery, I was admitted to the hospital. I spent the next 30 days in the hospital, with 10 of those in ICU. Just when I started to feel better, that's when everything changed.

The doctor came into my room and closed the door. I wondered why he closed the door. But he closed the door to hope, to my future adventures, and to the surgery itself. Stage 4 lung cancer, my only option to see an oncologist, and start the lines of treatment. For me, this is when my cancer journey really began.

Line one, line two, line three. You never go back, only forwards. I was surprised to learn that there was actually no me, there were just the lines. Chemotherapy, targeted drugs, radiation, a never-ending cycle with horrible side effects, and still the cancer continued to spread. I had to fight for my life, telling a roomful of doctors please look outside the line. Look at me.

After a lot of tears and pleading, my oncologist agreed to go back to a treatment that worked for me in the past. I went backwards in treatment protocols, but forward with living. My travel plans and adventures with my grandson have not completely gone, they have just changed.

I get to watch from the sidelines now, watch him play, slide, and grow. I still get to be his Nana. That door has come slightly ajar for me from time to time, but it is never fully opened. After being diagnosed with cancer, I asked myself, who do I call? Where do I go for support? What information is available?

I thought back to those hard times working as a northern travel nurse and how difficult it was for people with cancer in Newfoundland and Labrador that lived out around the bays or in those small communities. Through the Canadian Cancer Society, I was able to find support, support that I wish I knew about back then, support that my patients needed.

I used to pray for me. But now, I pray for more research, treatment options, and awareness so that soon, that door can swing wide open and stay open for not just me, but for others in the same situation.

The plan to live

When cancer came back after she was cancer-free for 4 and a half years, Laura created a new plan for living with stage 4 breast cancer. She keeps shorter work hours and found support through the CancerConnection.ca community. To her, “living is the ultimate plan.”

[Music playing]

Laura’s voice:
My sister and I celebrated the end of cancer 1.0 treatment with champagne in the chemo room. I completed the treatment plan and was cancer-free. I got a tattoo and went back to the plan of living my life. I am a wife, a mother, and a manager, and I have always been a planner. I also have stage 4 breast cancer, and cancer isn't in anyone's plan.

The cancer 1.0 plan was to pass the magic five-year cancer-free mark. But at 4 and 1/2 years, I was diagnosed with cancer 2.0. Breast cancer was back in my liver. I had been tired. I planned to go to the doctor, but one evening, I had a lot of abdominal pain. My sister convinced me to go to emergency the next morning. Probably your gallbladder, she said. The emergency doc was also positive it was my gallbladder.

I said, can you please check my liver? I want to make sure my cancer isn't back. He said, why do you think your cancer is back? I told them, my friend's cancer came back in her liver. The ultrasound confirmed it. My gallbladder was unremarkable, but my liver was fully involved with metastatic cancer. I was alone, and I drove myself home to tell the family.

A few days later, I was admitted to hospital to start chemo. My oncologist said we had days to turn the car around, or I would have no treatment options. How could I be dying? I was just tired.

My daughter, who was living in Australia, booked a flight home. I thought, she thinks I'm going to die. My son was terrified, but he hid it well. My husband said his cave was not deep enough for this. He was going to have to shave his wife's head for the second time. My sister took family photos while I still had hair. I was thinking, good. We'll have a recent family photo for the memorial, already creating a new plan.

If I wanted to live, the fight was going to be hard, and the cancer 2.0 treatment plan was going to be endless. A big part of my life is my career and my team. My boss was on vacation, and I was frantically texting him to call me. I broke the news to my team that I was going to be away for a while and put someone in my place.

Within a month, my liver enzymes started to improve. Chemo was working. I might live after all. So I created a new plan. My new plan adjusts around treatments and scans. I am back at work and constantly have to remind people that I have cancer and can't work 10-hour days. I also have a new team on CancerConnection. I comment on posts about my experience, and it also allows me to share my fears. I joked with a fellow chemo patient that I had bought the lifetime package. It was a deal because these treatments, they will continue forever.

Today, I am stable. Scans are checkpoints against the new plan. I hope I don't have to adjust this plan any time soon, but if I do, I will because living is the ultimate plan.

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Advanced Cancer
This booklet is for people who have been diagnosed with advanced cancer and their caregivers. It offers practical information and support to help you get started in caring for yourself and each other as you learn to live with advanced cancer.
To learn more about other communities that are underserved, explore our health equity work.