“Bachelorette Star Katie Thurston, 34, Says Despite Positive Progress With Stage 4 Breast Cancer Treatments, She Says, ‘I’ve Been Struggling’ as Emotional Impact Takes Its Toll
“Bachelorette Star Katie Thurston, 34, Says Despite Positive Progress With Stage 4 Breast Cancer Treatments, She Says, ‘I’ve Been Struggling’ as Emotional Impact Takes Its Toll
How to Cope With the Emotional Toll of a Breast Cancer Diagnosis
Katie Thurston, 34, of “The Bachelorette,” says she’s been “struggling” with her health as she continues metastatic breast cancer treatment, despite recent encouraging cancer scans indicating her tumor is shrinking.
Stage 4 cancer often brings emotional strain; research published in Epidemiology and Psychiatric Sciences found that “35 to 40 percent of cancer patients have a diagnosable psychiatric disorder,” and the number of people experiencing mental health challenges is “higher among cancer patients with advanced stages of cancer and in palliative care settings.”
Psychiatrist Dr. Asher Aladjem emphasizes that anxiety is a normal protective response but urges patients to advocate for mental health support alongside physical treatment.
Recently, Thurston shared that her tumor is shrinking, leading her to postpone a double mastectomy (removal of both breasts). She was first diagnosed in February 2025 with rare triple-positive breast cancer requiring multi-pronged therapy.
Thurston previously shared that her treatment regimen includes ribociclib, a targeted therapy taken with endocrine therapy. Lleuprolide, a hormone therapy, and Letrozole, which is an aromatase inhibitor that reduces the body’s estrogen production, are commonly used in postmenopausal women with hormone-sensitive breast cancer.
Katie Thurston, 34, best known from “The Bachelorette,” says even encouraging cancer scans can’t erase the weight of living with metastatic breast cancer. In a recent Instagram story, she admitted, “I’ve been struggling with my health lately,” opening up about the ongoing burden beyond the spotlight.
“Slow to recover,” she added while speculating if her ventilation within her home contributed to her ongoing health struggles.
Understandably, Thurston’s mental health is likely to be impacted by living with a cancer that can be managed, but given that it is in stage 4, it may not be curable. While millions of people have unmet mental health needs, the need for mental health resources is even greater among cancer patients and their families.
Research published in Epidemiology and Psychiatric Sciences found that “35 to 40 percent of cancer patients have a diagnosable psychiatric disorder,” and the number of people experiencing mental health challenges is “higher among cancer patients with advanced stages of cancer and in palliative care settings.”
WATCH: How Genetic Testing Can Help Determine the Right Form of Mental Health Treatment.
Dr. Asher Aladjem, a board-certified psychiatrist at NYU Langone, tells SurvivorNet, “Anxiety is a protective and normal kind of symptom.”
“Sometimes the anxiety gets to the point that things stand in the way of the scan or whatever the test is, and people avoid it and run away from it. Treating the anxiety allows for the completion of the workup or the treatment or whatever the situation may be in a much more effective way,” Dr. Aladjem said.
Dr. Alagjem encourages patients to advocate for their mental health. He reminds us that even if mental health services are not offered while undergoing physical treatment for a diagnosis, patients can still ask their care team about them.
“We are trying to advocate for patients to be able to get the services that they need with whatever support they may need – whether it’s medications or therapy or nursing staff,” Dr. Alagjem added.
Last month, Thurston shared with supporters on Instagram that her tumor is “still shrinking.”
“It is my hope that one day those scans can’t detect the cancer anymore, but for a six-month check-in, this is really good news,” Thurston said.
Thurston had been preparing for a double mastectomy in November, but the encouraging results have led her to postpone the procedure. After consulting with her medical team, she explained, “Major surgery requires pausing medication for an extended period of time.”
Katie Thurston at the Breast Cancer Research Foundation event on May 13, 2025 (Photo by Stephanie Augello/Variety via Getty Images)
Thurston first revealed her diagnosis in February 2025, announcing she had stage 3 triple-positive ductal carcinoma—a rare and aggressive subtype of luminal breast cancer. According to Cancer Cell International, “Triple-positive breast cancer (TPBC), a unique subtype of luminal breast cancer, is characterized by concurrent positivity for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2).”
This subtype accounts for only 5–10% of all breast cancer cases and typically requires a multi-pronged treatment approach, including chemotherapy, HER2-targeted therapy, and hormone (endocrine) therapy.
Although Thurston’s double mastectomy (removal of both breasts) is delayed, eventually she expects to have it. When it comes to breast cancer surgery, there’s no one-size-fits-all approach. Choosing between a lumpectomy and a mastectomy is a deeply personal decision—one that depends on a range of medical and emotional factors.
“As a breast surgeon, my job is to help patients understand that their long-term survival with mastectomy is equivalent to that with lumpectomy and radiation,” says Dr. Sarah Cate, Chief of Breast Surgery at Stamford Hospital.
Still, many women request a double mastectomy (removal of both breasts), believing it offers the best protection against recurrence. But that’s not always the case. The size of the tumor, its genetic profile, and a patient’s family history all play a role in determining the most appropriate surgical path.
WATCH: Should I Have a Lumpectomy or Mastectomy?
“Mastectomy has very specific indications,” Dr. Cate explains.
“Some of the things that would predict a mastectomy are things like a large tumor size to breast ratio, or having cancer in more than one area of the breast, or having a genetic mutation.”
Katie Thurston, who recently shared her breast cancer journey publicly, is preparing for a double mastectomy. While this procedure is often part of treatment, it’s also used preventatively for women at high risk of developing breast cancer.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removal of the tissue,” says Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System.
“The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
WATCH: What Goes Into a Double Mastectomy
Today, most women choose to undergo some form of reconstruction, which can significantly extend the duration of surgery—especially when tissue is transferred from another part of the body.
“When you take tissue from another part of the body and transfer it to fill in the empty space where the breasts are, this is a very long operation,” Dr. Port says.
“It can take anywhere from six to 12 hours because it’s really like having a tummy tuck and then transferring the tissue and grafting the tissue, connecting the vessels, so those tissues have blood flow to live in,” Dr. Port adds.
For women with a strong family history or a known genetic mutation—such as BRCA1 or BRCA2—the decision to undergo a preventative mastectomy may be the most effective way to reduce their risk.
“Risk-reducing mastectomies are an operation where we take women at, usually, very high risk for getting breast cancer,” Dr. Port explains. “For genetic mutation carriers, who are the ones at the highest risk, there’s unfortunately only one way to actually prevent breast cancer.”
WATCH: Getting a Preventive Mastectomy
Women who test positive for a BRCA mutation typically face two options.
“One is what’s called high-risk surveillance, which means we check them every six months or so—mammograms, MRIs—with the hope that if, God forbid, they develop breast cancer, we pick it up early,” Dr. Port says. “But that’s not prevention, that’s early detection.”
“Early detection is a goal, it’s not a guarantee. For the woman who wants to be more proactive about actually preventing breast cancer, or as we say, reducing her risk, unfortunately, the only way to do that is to remove the actual tissue at risk, and that is the breast tissue,” she adds.
Katie’s Ongoing Treatment
Thurston previously shared that her treatment regimen includes three key medications:
Kisqali (ribociclib): Approved by the FDA in 2017, this targeted therapy is used in combination with endocrine therapy to treat HR+/HER2- breast cancer. It works by slowing the progression of cancer, offering a more tolerable alternative to traditional chemotherapy.
Lupron (leuprolide): A hormone therapy injection that lowers estrogen levels in the body, helping to prevent the cancer from growing.
Letrozole: An aromatase inhibitor that reduces the body’s estrogen production, commonly used in postmenopausal women with hormone-sensitive breast cancer.
Treatment Options for Advanced Breast Cancer
Metastatic breast cancer (also called stage 4) means cancer cells have spread from the breast to other parts of the body, which may include the bones, liver, lungs, brain, and beyond.
Breast cancer spreads through the bloodstream or lymphatic system. The blood carries cancer cells to different body parts, where they grow as new tumors.
As the cancer spreads to other body parts, patients may experience additional symptoms depending on where the cancer has spread. Examples include:
Bones: Severe bone pain or fractures
Lungs: Difficulty breathing, chest pain, new cough
Liver: Yellowing of the skin (jaundice), abdominal pain, nausea, and/or vomiting
Brain: Headaches, memory loss, changes in vision, seizures
WATCH: Treatment options for metastatic breast cancer.
Although stage 4 breast cancer is not curable, several treatment options exist that can extend the life of patients. Treatment options depend on the stage, type of primary breast cancer, and whether hormone receptors are positive.
Treatment can include a combination of:
Chemotherapy: Oral or IV medications that are toxic to tumor cells
Hormonal therapies: Drugs that lower estrogen levels or block estrogen receptors from allowing the cancer cells to grow
Targeted therapies: Drugs that target your tumor’s specific gene mutations
Immunotherapy: Medications that stimulate your immune system to recognize and attack cancer cells
Radiation: The use of high-energy rays to kill tumor cells and shrink tumors
Surgery: To remove a cancerous tumor or lymph nodes (uncommon with stage IV; more common in stages I, II, and III)
Clinical trials: Studies of new medications, treatments, and other therapies offer hope for better outcomes.
Questions to Ask Your Doctor
If you’re facing the option of having a mastectomy, here are some questions to consider asking your doctor:
What can I do to prepare for a double mastectomy?
What happens before and after the procedure?
For reconstruction, what are the benefits of using implants over my own tissue and vice versa?
