‘Thankful to Be Alive’: ‘Bachelorette’ Star Katie Thurston, 34, Reflects on a Year of Stage 4 Breast Cancer and a Holiday Filled With Joy

Katie Thurston, 34, the former Bachelorette star, has spent the past year openly sharing her journey with metastatic breast cancer. As the new year approaches, she’s looking back on everything she’s endured—and choosing to mark the moment with gratitude.

“Christmas feels a little extra special after the year I’ve had. Thankful to be alive and surrounded by love and joy,” she wrote on Instagram, alongside a carousel of festive photos featuring her family.

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Thurston was diagnosed with metastatic breast cancer in February. Also known as stage 4 breast cancer, the disease occurs when cancer cells spread beyond the breast to other parts of the body, such as the bones, liver, lungs, or brain.

Before beginning treatment, she confronted one of her earliest and most personal challenges: navigating fertility decisions in the midst of cancer.

“When first diagnosed with breast cancer, one of my early decisions was whether I wanted to pursue IVF before starting treatment. Decision-making when it comes to #oncofertility is complex,” she shared in another post.

“At the time of my diagnosis, I thought I was stage 3 and would eventually start chemotherapy. Because of this, we did one round of IVF…and successfully froze two embryos,” she explained.

 

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Thurston and fellow “The Bachelor” alum Jeff Acuri spent nearly two weeks in vitro fertilization (IVF), a process where the sperm and eggs are fertilized outside the body in a lab. They harvested 17 eggs, but after attempts at fertilization, only two were turned into embryos. The couple has the option to have the embryos transferred to a surrogate at a later date if needed.

“Now that I have stage 4 breast cancer, pregnancy would be a risk for me, especially as someone with hormone receptor-positive (HR+) breast cancer (meaning it feeds off of hormones). So, in the future, we will pursue #surrogacy in hopes of starting our family,” Thurston explained.

IVF’s Role In Family Planning For Cancer Patients

Fertility struggles are a genuine concern among cancer patients, as certain cancer treatments can cause infertility. Fortunately, in many cases, efforts can be made before beginning treatment to help preserve fertility.

Even without a diagnosis, many couples, at one point or another, experience infertility. The Centers for Disease Control and Prevention (CDC) says within the U.S., “about one in five” married women between the ages of 15 and 49 with no prior births are unable to get pregnant after trying for a year. Additionally, “one in four” of women in this group struggle to get pregnant or carry the pregnancy to term.

WATCH: How does chemotherapy affect fertility?

Infertility can be a side effect of cancer treatment due to how it impacts the body. Various cancer treatments, including chemotherapy and radiation, can affect both men’s and women’s fertility. Before undergoing cancer treatment, patients should speak to their doctors about fertility preservation if they wish to have a family in the future.

Patients should also recognize that infertility is a problem that affects so many people hoping to be parents, and nothing to be ashamed of.

The American Psychological Association said in its Monitor on Psychology Magazine, “A diagnosis of infertility — the inability to get pregnant after a year or more of trying — can lead to depression, anxiety, and other psychological problems, trigger feelings of shame and failure to live up to traditional gender expectations, and strain relationships.”

“The risk is greater the older you are,” reproductive endocrinologist Dr. Jaime Knopman told SurvivorNet.

“If you’re 39 and you get chemo that’s toxic to the ovaries, it’s most likely to make you menopausal. But, if you’re 29, your ovaries may recover because they have a higher baseline supply,” Dr. Knopman continued.

Radiation to the pelvis can also destroy eggs. It can damage the uterus, too.

Surgery to your ovaries or uterus can hurt fertility as well.

Meanwhile, endocrine or hormone therapy may block or suppress essential fertility hormones and may prevent a woman from getting pregnant. This infertility may be temporary or permanent, depending on the type and length of treatment. Thurston’s treatment includes hormone therapy.

Understanding Thurston’s Diagnosis

Thurston’s cancer is classified as hormone receptor-positive (HR+) and HER2-negative (HER2-), the most common subtype of breast cancer. According to Penn Medicine, about 70% of new breast cancer cases each year fall into this category.

Hormone receptors are proteins found on breast cells that respond to estrogen or progesterone. When cancer cells have these receptors, they can grow in response to these hormones—making them hormone receptor-positive. HER2, on the other hand, is a protein that can accelerate cancer cell growth. Tumors are labeled HER2-positive when they overexpress this protein, and HER2-negative when they don’t.

Traditionally, HER2 status has been viewed in binary terms—positive or negative—though many patients fall somewhere in between. These classifications are determined by how the tumor appears under a microscope and through additional testing by a pathologist.

Thurston’s current 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.

Planned Double Mastectomy, Delayed In the  Fall

Katie was mentally preparing to undergo a double mastectomy in November—a step she describes as “a whole other chapter” she’s still learning about. Radiation may follow, but for now, she’s focused on what’s working.

A double mastectomy is a procedure that removes both breasts. Some women choose this procedure to reduce their risk of cancer, especially if they have a family history of cancer or possess the BRCA1 and BRCA2 gene mutation, which also increases their risk.

WATCH: Dr. Elisa Port explains what happens during a double mastectomy.

Making the decision to undergo a mastectomy can be an emotional experience for many women facing breast cancer. While the surgery itself may only take a few hours, the changes can be difficult to adjust to mentally.

“A double mastectomy typically takes about two hours for the cancer part of the operation, the removal of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”

A Delayed Mastectomy

During the Fall, Thurston received confirmation that her current treatment plan is working. She took to Instagram to share the encouraging news with her followers.

“Three months ago, I was finally put on a plan for my HR+ HER2- breast cancer. Kisqali + Lupron + Letrozole. And today, the scans confirmed the tumors are SHRINKING!!”

Thurston explained that her decision to delay treatment wasn’t made lightly. She postponed care to transfer her medical team, pursue fertility preservation, and explore participation in a clinical trial.

“I delayed treatment to transfer my care to @columbia. I delayed treatment to pursue IVF — I delayed treatment because I attempted to join a clinical trial, only to be denied after discovering I had #metastaticbreastcancer, meaning stage IV, for life,” she said.

Staying Positive and Holding Onto Hope

As Thurston learned how to rejigger her daily life as a metastatic breast cancer patient, she’s also found ways to cope with the anxieties and stay positive. Finding support was among the most impactful things that she did.

“Moving to New York City shortly after my breast cancer diagnosis was hard,” she reflected on Instagram. “But slowly I’ve met amazing sisters who picked me up off the floor as I learned what my new life would look like.”

 

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In an Instagram video, Thurston and her friend gleefully show off their cute pill cases while on a New York subway.

“Things are different, but I do my best to keep living and enjoying whatever moments I have,” Thurston added and topped off her social media post by thanking one of her fellow breast cancer warriors she’s befriended in New York.

A cancer diagnosis can unleash a flood of emotions, often making the early days of the journey the hardest to navigate. During this time, having a strong support system can make all the difference. That support may come from close family and friends—or, for some, from professionals outside their inner circle.

“Some people don’t need to go outside their family and friends circle. They feel like they have enough support there,” explains New York-based psychiatrist Dr. Lori Plutchik. “But for people who feel like they need a little bit more, it is important to reach out to a mental health professional.”

WATCH: Seeking Support: The First 3 Things to Do After a Cancer Diagnosis

Supporters can help ease stress and anxiety after diagnosis and even advocate for you during treatment.

For patients who may not have a group of friends or family close by to support them, a mental health professional may be equally as helpful.

“Make sure that the mental health professional you work with is reaching out—with your consent—to the rest of your team, including your oncologist, surgeon, family, friends, and any caretakers involved in your treatment,” Dr. Plutchik advises.

She recommends cancer patients take three key steps to strengthen their support system:

• Step 1: Seek additional support if you need it—whether through a therapist or a support group.
• Step 2: Choose a mental health professional experienced in helping people facing cancer.
• Step 3: Keep your care team connected, from loved ones to doctors to your therapist.

Katie’s Continued Treatment

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.

What Is Kisqali and How Does It Work?

Kisqali (ribociclib) is a type of targeted cancer medicine known as a CDK4/6 inhibitor, a class of drugs that blocks specific proteins that help cancer cells grow and divide. By inhibiting these proteins, Kisqali helps slow the progression of certain breast cancers.

It is taken once daily as an oral pill, typically alongside hormone‑blocking therapy such as an aromatase inhibitor.

Before starting treatment, doctors confirm the cancer type through a biopsy, which involves removing a small sample of tumor tissue for laboratory testing.

For people with metastatic, hormone receptor–positive, HER2‑negative breast cancer, Kisqali combined with endocrine therapy is often used as a first‑line treatment, meaning it may be the first recommended therapy option.

How Does Kisqali Work?

Cancer cells multiply by moving through a tightly regulated process called the cell cycle. Two key proteins—CDK4 and CDK6—help drive this process. Kisqali works by blocking these proteins, stopping cancer cells from moving forward in the cycle and preventing them from dividing.

However, cancer cells can sometimes activate other growth pathways to compensate. That’s why Kisqali is paired with endocrine (hormone) therapy, which blocks estrogen or progesterone from fueling hormone‑receptor‑positive breast cancer cells.

Together, the two treatments create a dual attack:

• Kisqali slows cancer cell division.
• Endocrine therapy starves cancer cells of the hormones they rely on.

This combination makes it harder for cancer cells to adapt or continue growing.

Dr. Eleonora Teplinsky, a board-certified medical oncologist specializing in breast and gynecologic cancer at Valley Health System in New Jersey, stresses that patients should understand some of the potential side effects of Kisqali.

Possible side effects may include:

• Low white blood cell counts, such as neutropenia (which can cause fever, chills, cough, and more)
• Nausea or vomiting
• Diarrhea
• Fatigue

The NATALEE phase III clinical trial, which helped lead to Kisqali’s approval by the Food and Drug Administration, “In the group that received Ribociclib and endocrine therapy … at three years their disease-free survival was 90.4% compared to 87.1% in the group that received endocrine therapy alone,” Dr. Teplinsky said. This translates to a 3.3% “absolute improvement.”

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?
• What should I know about implants?
• What will recovery look like after the procedure?

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