From Prognosis to Possibility: Rewriting the Story of Lung Cancer Survivorship.
Arthur Dove, Landscape with Houses (1930)
This article is based on the keynote address given at LiveLung’s 2025 Lung Cancer Wellness & Survivorship Retreat held at The Ballantyne Hotel November 6–7.
The Changing Landscape of Survivorship.
For decades, a lung cancer diagnosis often carried a single story — one of finality. The prognosis was grim, the path forward narrow.
In 2023, I reflected on The Impact of Cancer on Personal Relationships:
When I was 15 years old, entering high school, my maternal grandfather, aka Moo Moo, died of lung cancer, which had metastasized to his brain. He and my grandmother lived down the country road from our home, and I would visit him after school and on the weekends. My jovial, witty, insightful grandfather disappeared in front of my adolescent eyes, as his body was ravaged by the crude cancer treatments of the mid-1980s. I remember then being struck by the fine and fuzzy hair, almost like wispy cotton candy, that started to grow back after his chemotherapy. At times he seemed ghost-like to me, and I found myself fearful of what his physical transformation meant to my grandfather’s destiny.
My grandfather’s diagnosis, treatment, and prognosis were the normative landscape of lung cancer; he lived it for less than 6 months; I was his witness.
Making Meaning, Connecting, Reclaiming.
Today, that story is changing. Advances in targeted therapies, immunotherapies, and early detection have opened new chapters in what it means to live with lung cancer. But as treatment evolves, so too must the way we understand survivorship. Beyond medical progress lies an equally vital conversation: How we make meaning, find connection, and reclaim identity after diagnosis.
This is the heart of the new narrative — the shift from prognosis to possibility.
Twenty years ago, the term lung cancer survivorship was rarely spoken. Today, it has become the heartbeat of the lung cancer community. With improved treatments, many individuals live years — even decades — beyond diagnosis. For some, lung cancer has become a chronic, manageable illness.
Yet living longer brings its own set of questions:
How do I make peace with uncertainty?
How do I find myself again after treatment?
What does it mean to live fully with a body that remembers trauma and a heart that still longs for normalcy?
The answers are not found in medical charts but in the stories survivors tell — stories of endurance, fear, humor, gratitude, and love.
Edvard Munch, The Heart (1898-99)
The Body Remembers. The Heart Remembers.
Cancer imprints itself on the body.
The nervous system learns to brace — for results, for symptoms, for what might come next.
The amygdala, a small almond-shaped structure in the brain’s limbic system, plays a key role in detecting threat and initiating the body’s stress response. For many survivors, the amygdala remains hypervigilant long after treatment ends, responding to triggers — a clinic smell, a date on the calendar, an unexpected cough — as if danger is still present.
As trauma theorists Alice Miller and Bessel van der Kolk and remind us, the body carries the residue of experience: pain unspoken, emotions suppressed, memories half-buried. Healing requires more than talking about trauma; it asks us to listen to the body’s truth.
But the heart keeps its own record, too — the memory of love, care, and those who walked alongside us. Healing begins when the body’s memory of fear meets the heart’s memory of love.
Pausing to breathe, to notice what remains steady, allows survivors and caregivers alike to reconnect body and soul — to find safety within again.
Existential Concerns and Meaning-Making.
Living with lung cancer invites a confrontation with what psychiatrist Irvin Yalom calls the “ultimate concerns” of human existence — death, freedom, isolation, and meaning.
Each patient, each care partner, faces them in their own way:
Death: Awareness of mortality can heighten anxiety but also deepen appreciation for life’s immediacy.
Freedom: Illness can limit physical freedom, yet emotional and spiritual freedom often expand when one embraces authenticity.
Isolation: Even when surrounded by others, the experience of illness can feel profoundly solitary — a reminder of our existential separateness.
Meaning: Survivorship asks, “What now?” It challenges us to find purpose amid change and to live consciously in the present.
The goal of existential work is not to remove anxiety, but to live meaningfully within it — to discover what still brings beauty, connection, and vitality.
Rewriting the Story.
Narrative therapists Michael White and David Epston believed that we are not the problem — the problem is the problem — and that by telling our stories differently, we uncover our agency and strength.
Every time we ask a question, we’re generating a possible version of a life.
– David Epston
In survivorship, this means re-authoring the story from one of loss to one of becoming.
Writing, advocacy, peer support, and creative expression all become forms of meaning-making — ways to integrate trauma, reclaim identity, and connect with others walking the same road.
Connection as Medicine.
Research shows that peer support and advocacy are powerful protective factors. Participation in survivor and caregiver networks has been linked to reduced distress, greater resilience, and improved quality of life (Giese-Davis et al., 2015; Hoey et al., 2008).
By contrast, loneliness increases mortality risk (Holt-Lunstad et al., 2015). Chronic loneliness impacts immune, cardiovascular, and inflammatory pathways — reminding us that connection is not a luxury but a biological necessity. The U.S. Surgeon General issued a report in 2023 detailing the loneliness epidemic and the risks to one’s emotional and physical health:
Our individual relationships are an untapped resource—a source of healing hiding in plain sight. They can help us live healthier, more productive, and more fulfilled lives. Answer that phone call from a friend. Make time to share a meal. Listen without the distraction of your phone. Perform an act of service. Express yourself authentically. The keys to human connection are simple, but extraordinarily powerful.
Survivor and caregiver stories shared aloud become bridges — healing both teller and listener — through authentic connection, fear softens, and belonging returns.
Neal Herbert, Bison, Norris Geyser Basin. (National Park Service)
Be the Buffalo.
The American Buffalo serves well as a metaphor for resilience.
While domesticated cattle try to outwit and outrun a storm, buffalo instinctually know that to outrun a storm is impossible. They face it head-on and are rewarded for their strength and ability to rebound.
Buffalo suffer less, conserve energy, and spend far less time in the freezing rain, drizzle, high winds, snow, and chaos than the cattle that turn away.
Human storms may take the form of a cancer diagnosis, the loss of a loved one, a broken relationship, depression, or existential doubt.
We cannot always choose the weather of our lives, but we can choose to face the storm — like the buffalo — with courage and heart.
Living Fully in Possibility.
To live fully in this new era of lung cancer survivorship means to balance medicine with meaning, information with imagination, and fear with freedom.
Every day is a sentence in a new chapter — one that survivors, caregivers, clinicians, and advocates are writing together.
“Survivorship isn’t the end of the story,” I often tell my clients.
“It’s the place where the story deepens.”
From prognosis to possibility — may we continue to write, breathe, and live into what is still becoming.
Selected References.
Giese-Davis, J., et al. (2015). The effect of peer counseling on quality of life following diagnosis of breast cancer: An observational study. Psycho-Oncology, 25(11), 1343–1351.
Hoey, L. M., et al. (2008). Systematic review of peer-support programs for people with cancer. Patient Education and Counseling, 70(3), 315–337.
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237.
Miller, A. (2005). The body never lies: The lingering effects of hurtful parenting. W. W. Norton & Company.
van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
White, M. (2007). Maps of narrative practice. W. W. Norton & Company.
Yalom, I. D. (1980). Existential psychotherapy. Basic Books.
