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Survivorship research has historically centered on individuals treated for early-stage cancers, often overlooking those living with advanced and metastatic disease. As therapeutic advances extend survival, the population of people living with incurable cancers is growing, presenting unique clinical and psychosocial challenges. This perspective provides insights into: (i) the experience of living with advanced cancer from the perspective of a survivor and caregiver; (ii) recent advances in this research area, and (iii) strategies to address ongoing gaps within two key areas: the converging fields of survivorship and palliative care research and supporting people living with advanced and metastatic cancers who are experiencing significant prognostic uncertainty. Overall, we contend that survivorship research for people living with advanced and metastatic cancers must explicitly extend beyond survival outcomes to address the lived realities of long-term treatment, symptom burden, and uncertainty. We highlight the need for integrated survivorship and palliative care models that support quality of life throughout the illness trajectory and for clinical and research strategies that help survivors and caregivers navigate ongoing prognostic uncertainty. Prioritizing these areas in research and care delivery will better align cancer care with patient-centered outcomes across the illness trajectory for people living with advanced and metastatic cancers.