August 20, 2022

1400H - 1500H
Via Zoom

Empowerment
objective - for
Health Issue laypeople to have an
Course – understanding of
CANCER CANCER
INCURABILITY INCURABILITY &
& HOSPICE HOSPICE CARE in
CARE their health
management.
 Empowerment ROJoson PEP Talk
objective - for
Health Issue laypeople to have an I have a Patient
Course – Empowerment
understanding of
Program in which I
CANCER CANCER like to empower the
INCURABILITY INCURABILITY & lay people or
& HOSPICE HOSPICE CARE in patients to take
CARE their health control in the
management. management of
their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 My PEP TALK today
is entitled:
Empowerment
objective - for
Health Issue laypeople to have an CANCER
Course – understanding of INCURABILITY &
CANCER CANCER HOSPICE CARE.
INCURABILITY INCURABILITY &
& HOSPICE HOSPICE CARE in
CARE This is part of the
their health
Health Issue Course.
management.
 Health Issue Contents of CANCER INCURABILITY & HOSPICE
Course – CARE
• What is a cancer?
CANCER • What is the basic cause of cancer?
INCURABILITY • What is cancer incurability?
& HOSPICE • When do you stop cancer treatment because of
CARE incurability?
• What is hospice care?
• What are essential components and issues on
hospice care?
• What are ROJoson’s advocating statements and
advice on cancer incurability & hospice care?
 Health Issue • What is a cancer?
Course – Cancer is a disease.
CANCER Cancer is a medical disease when some of the
INCURABILITY body’s cells grow uncontrollably with a potential
& HOSPICE to invade the adjacent body tissues or organs and
CARE to spread to distant tissues or organs.
 • What is a cancer? Cancer is a medical
Health Issue
disease when some of
Course – the body’s cells grow
CANCER uncontrollably with a
INCURABILITY potential
& HOSPICE
CARE to invade the adjacent
body tissues or organs
and

to spread to distant
tissues or organs.
 • What is a cancer? Cancer is a medical
Health Issue
disease when some of
Course – the body’s cells grow
CANCER uncontrollably with a
INCURABILITY potential
& HOSPICE
CARE to invade the adjacent
body tissues or organs
and

to spread to distant
tissues or organs.
 Health Issue • What is the basic cause of cancer? Cancer is basically
Course – a genetic disease—
CANCER that is, it is caused
INCURABILITY by changes
& HOSPICE to genes that
CARE control the way
our cells function,
especially how
they grow and
divide.
 Health Issue • What is the basic cause of cancer? Cancer is basically
Course – Cancer covers a wide spectrum of diseases a genetic disease—
CANCER characterized by uncontrolled cell growth, which that is, it is caused
INCURABILITY is driven by down-regulation of tumour- by changes
& HOSPICE suppressing genes and/or up-regulation of to genes that
tumour-promoting genes. 
CARE control the way
our cells function,
Fail to stop uncontrolled cell growth!
especially how
Allow uncontrolled growth!  they grow and
divide.
 Health Issue • What is cancer incurability?
Course – The conventional definition of “medical cure”: a
CANCER medical condition or disease that’s completely
INCURABILITY gone and will never come back.
& HOSPICE
CARE Cancer incurability may either mean the
cancer cannot be cured anymore or there
is no cure for cancer to start with.

Is this true?

We have to qualify the answers and the context.

 Health Issue • What is cancer incurability? Before answering the
Course – question on cancer
The conventional definition of “medical cure”: a
incurability, allow me
CANCER medical condition or disease that’s completely
to discuss first the
INCURABILITY gone and will never come back.
concept of
& HOSPICE INCURABLE DISEASE.
A medical condition or disease that is persistently
CARE
present (does not disappear) or keeps on coming
back after some quiet or remission time, until
time of death of a person, is strictly speaking is
INCURABLE.
Examples: diabetes, hypertension, arthritis,
asthma, Alzheimer’s disease, and cancer.
 Health Issue • What is cancer incurability?
Course – INCURABLE diseases are usually chronic but may
CANCER be acute. Examples of diseases
INCURABILITY that are incurable and
Chronic diseases are defined broadly as chronic (at times,
& HOSPICE
conditions that last 1 year (some use 3 months) or acute: diabetes,
CARE more and require ongoing medical attention or hypertension,
limit activities of daily living or both. arthritis, asthma,
https://www.cdc.gov/chronicdisease/about/index.htm
Alzheimer’s disease,
and cancer.
Incurable disease may also be “acute” in the
sense it lasts for a short time and patient dies
soon (as long as it is classified as incurable).
 Health Issue • What is cancer incurability?
Course – INCURABLE diseases may be chronic terminal
CANCER illnesses or chronic non-terminal illness.
INCURABILITY
What is chronic terminal illness?
& HOSPICE
It is an end-stage disease that cannot be cured or
CARE adequately treated and controlled and is
reasonably expected to result in the death of the
patient within a short period of time.

This term is more commonly used for progressive

diseases such as cancer, dementia or advanced
heart disease than for injury.
 Health Issue • What is cancer incurability?
Course – INCURABLE diseases may be chronic terminal
CANCER illnesses or chronic non-terminal illness.
INCURABILITY What is chronic non-terminal illness?
It is a chronic disease, though cannot be cured or
& HOSPICE
adequately treated and controlled, but is
CARE reasonably not expected to result in the death of
the patient within a short period of time or
throughout life.
This term is more commonly used for non-
progressive or slow diseases such as arthritis and
hypertension that can be controlled and patients
can live with them all their life.
 Health Issue • What is cancer incurability?
Course – Looking and focusing on CANCER, if it is incurable
CANCER (which means, it will not disappear),
INCURABILITY it may be:
• chronic (long time) or acute (short time or
& HOSPICE
short lifespan)
CARE • chronic terminal disease (causing death soon)
or chronic non-terminal disease (not causing
death soon)
 Health Issue • What is cancer incurability?
Course – Going back ---
CANCER
INCURABILITY Cancer incurability may either mean the
& HOSPICE cancer cannot be cured anymore or there
CARE is no cure for cancer to start with.

Is this true? Cancer is incurable!

We have to qualify the answers and the context.

My answer is YES and NO.

 Health Issue • What is cancer incurability?
Course – YES, cancer is an incurable disease because:
CANCER - Physicians up to now do not know the exact
INCURABILITY cause of a particular cancer in a patient and most
of the treatment done are not directed towards
& HOSPICE
the triggering cause. Usual treatment modalities
CARE for cancer, such as surgery, radiotherapy and
chemotherapy, are just directed towards removal
or dissolution of the cancer tumors and
afterwards, doing surveillance and hoping for a
none recurrence.
 Health Issue • What is cancer incurability?
Course – YES, cancer is an incurable disease because:
CANCER Majority, if not all physicians, will
INCURABILITY - not guarantee cure for a cancer treatment.
- not commit to an assessment of “cure” after a
& HOSPICE
cancer treatment even if there are no evidence
CARE of residual or recurrence.
- just say “no evidence of recurrence.”
- just say a patient is in complete remission even
if there are no evidences of cancer recurrence.
- hope and pray of no recurrence, yet ready to
be confronted with one.
 Health Issue • What is cancer incurability?
Course – YES, cancer is an incurable disease because:
CANCER - Majority of cancers recur after some time, short
INCURABILITY time and even long duration after 10 to 15 years.
& HOSPICE
CARE
 Health Issue • What is cancer incurability?
Course – NO, cancer is NOT an incurable disease because:
CANCER - There are patients who have no cancer
INCURABILITY recurrence after treatment, in remission for a long
time, say 15 years or longer. They should
& HOSPICE
rightfully be considered as cured of cancer. They
CARE are the real cancer survivors.
- There are patients who have no cancer
recurrence after treatment, in remission for a long
time, say 10 years or longer, when they die of
non-cancer causes. They should also be rightfully
considered as cured of cancer.
 Health Issue • What is cancer incurability?
Course – My personal stand:
CANCER
INCURABILITY NO, not all cancers are incurable. Some are
& HOSPICE curable.
CARE
There is still a chance for “cure” if there is:
- Early treatment
- Evidence-based effective treatment
 Health Issue • What is cancer incurability?
Course – My other personal stand:
CANCER
INCURABILITY Cancer may not be incurable if:
& HOSPICE • There is no known effective curative treatment
in whatever stage of the cancer.
CARE • Current stage of cancer (advanced) at time of
first consultation is no longer curable. When the cancer has
grown too big for
treatment to work
and/or has spread to
other parts of the
body (metastasis).
 Health Issue • Importance of knowing concept of cancer
Course – incurability
CANCER Importance of knowing the concept of cancer
INCURABILITY incurability
& HOSPICE
One does NOT totally lose hope right away when
CARE one has cancer! Rather:

But also one has to accept that some cancers are TRY. TRY, TRY
incurable! GO ALL OUT

In some cancers, one may have to let nature take Even if realistically
its course. futile!
 Health Issue • What is cancer incurability?
Course – Importance of knowing the concept of cancer
CANCER incurability
INCURABILITY
& HOSPICE Promote sound decision-making by both patient-
relatives and physicians
CARE
• Formulating realistic goal of management
(palliative vs curative)
• Promoting quality of life
• Facilitating advance directive or end-of-life
preparedness
• Controlling unnecessary expenses
 • What is cancer incurability? Parameters to use:
Health Issue • Track record of the
Course – When does one declare a cancer to be: specific cancer
CANCER • curable?
INCURABILITY • not curable? • Stage of the cancer
& HOSPICE • terminally incurable already?
• not yet terminally incurable? • Behavior of the
CARE
cancer – growth
rate / recurring

• Presence or
absence of effective
curative treatment
 • What is cancer incurability? Parameters to use:
Health Issue • Track record of the
Course – When does one declare a cancer to be CURABLE: specific cancer
CANCER • Track record that it is curable
INCURABILITY • Early staged cancer • Stage of the cancer
& HOSPICE • Slow growth and not recurring
• Presence of effective curative treatment • Behavior of the
CARE
cancer – growth
rate / recurring

• Presence or
absence of effective
curative treatment
 • What is cancer incurability? Parameters to use:
Health Issue • Track record of the
Course – When does one declare a cancer to be specific cancer
CANCER INCURABLE:
INCURABILITY • Track record that it is incurable • Stage of the cancer
& HOSPICE • Advanced staged cancer
• Fast growth and recurring • Behavior of the
CARE • Absence of effective curative treatment cancer – growth
rate / recurring

• Presence or
absence of effective
curative treatment
 • What is cancer incurability? Parameters to use:
Health Issue • Track record of the
Course – When does one declare a cancer to be specific cancer
CANCER TERMINALLY INCURABLE:
INCURABILITY • Track record that it is incurable • Stage of the cancer
& HOSPICE • Advanced staged cancer
• Fast growth and recurring and progressive • Behavior of the
CARE • Absence of effective curative treatment cancer – growth
rate / recurring
• Patient is expected to die within 6 months to 1
year based on medical experience • Presence or
absence of effective
curative treatment
 • What is cancer incurability? Parameters to use:
Health Issue • Track record of the
Course – When does one declare a cancer to be NOT specific cancer
CANCER TERMINALLY INCURABLE:
INCURABILITY • Track record that it is incurable • Stage of the cancer
& HOSPICE • Advanced staged cancer
• Fast growth and recurring and progressive • Behavior of the
CARE • Absence of effective curative treatment cancer – growth
rate / recurring
• Patient is NOT expected to die within 6 months
to 1 year based on medical experience • Presence or
absence of effective
curative treatment
 • What is cancer incurability? Once a patient is
Health Issue
declared to have
Course – When does one declare a cancer to be terminally incurable
CANCER TERMINALLY INCURABLE: cancer, what should
INCURABILITY • Track record that it is incurable be done next?
& HOSPICE • Advanced stage cancer
• Fast growth and recurring and progressive
CARE • Absence of effective curative treatment

• Patient is expected to die within 6 months to 1

year based on medical experience
 • What is cancer incurability? Once a patient is
Health Issue
declared to have
Course – Important in decision-making: terminally incurable
CANCER • Formulating realistic goal of management cancer, what should
INCURABILITY (PALLIATIVE - HOSPICE vs curative) be done next?
& HOSPICE • Promoting quality of life
• Facilitating advance directive or end-of-life
CARE
preparedness
• Controlling unnecessary expenses
 • What is cancer incurability? Once a patient is
Health Issue
declared to have
Course – The realistic goal of treatment should be one with terminally incurable
CANCER a palliative intent with hospice care (no longer a cancer, what should
INCURABILITY curative intent). be done next?
& HOSPICE The goal is just to promote of quality of life in
CARE whatever remaining years / months of life of the
patient.
NO more active anti-cancer treatment.
 • What is cancer incurability? Once a patient is
Health Issue
declared to have a
Course – When does one declare a cancer to be NOT non-terminally
CANCER TERMINALLY INCURABLE: incurable cancer, what
INCURABILITY • Track record that it is incurable should be done next?
& HOSPICE • Advanced stage cancer
• Fast growth and recurring and progressive
CARE • Absence of effective curative treatment

• Patient is NOT expected to die within 6 months

to 1 year based on medical experience
 • What is cancer incurability? Once a patient is
Health Issue
declared to have a
Course – The realistic goal of treatment should still be one non-terminally
CANCER with a palliative intent (no longer a curative incurable cancer, what
INCURABILITY intent). should be done next?
& HOSPICE The goal is just to control (not cure) the cancer
CARE with continued promotion of quality of life in
whatever remaining years / months of life of the
patient.

Active anti-cancer treatment may still be done to

control the cancer.
 Health Issue • What is cancer incurability?
Course – Approaches to treating incurable cancer:
CANCER
INCURABILITY • Palliative Intent
& HOSPICE • Palliative Care
CARE • Hospice Care
 Health Issue • What is PALLIATIVE intent and care?
Palliative care vs
Course – When you say palliative intent of treatment, you palliative intent
CANCER can still use any anti-cancer treatment modality
INCURABILITY as indicated and if still feasible (to control the Palliative care = care
& HOSPICE cancer and to promote quality of life). given with no
CARE curative intent
Anti-cancer treatment modalities include the (basically relieve
following: pain and promote
• Surgery quality of life).
• Radiation
• Chemotherapy Palliative intent – no
• Hormonal therapy more curative intent.
• Other anti-cancer treatment
 Who determines start
Health Issue • What is hospice care? of hospice care?
Course – Hospice care will come in if the patient with A physician – who
CANCER terminal incurable cancer has only about 6 with experience can
INCURABILITY months to one year left to live (based on reasonably say
& HOSPICE experience or track records). patient has 6 months
CARE to one year to live.
Hospice care is still part of the palliative intent of
treatment except that the anti-cancer treatment Then, patient and
is now withdrawn. Only measures or care to relatives decide on no
promote quality of life remain. anti-cancer treatment
anymore.
Hospice care can be done at home or at hospital
or a hospice center. JUST palliative care.
 Health Issue • What is hospice care?
Course – Short history of hospice care
CANCER
INCURABILITY The concept of providing specialized care for
& HOSPICE dying patients, linking pain and symptom control
CARE with compassionate care, began in England in the
1950's, when a pioneering physician named Dame
Cicely Saunders created the first modern hospice
there in 1967.
 Health Issue • What is hospice care?
Course – In general, particularly in the USA, hospice
CANCER care should be used when a person is expected
INCURABILITY to live about 6 months or less if the illness runs its
& HOSPICE usual course.
CARE
Personally, I would use 6 months to 12 months as
it is hard to predict exactly when a patient is going
to die or how long he is going to live.

The other prerequisite for hospice is the decision

to withhold direct anti-cancer treatment.
 Health Issue Palliative and Hospice Care
Course – Basically, what are done in palliative and hospice
CANCER care:
INCURABILITY
& HOSPICE Pain management
CARE • Physical
• Mental
• Spiritual

Quality of life promotion

Until the end-of-life moment!

 Health Issue • Advance Health Care Directive Issue in Hospice Care
Course – Ideally, there must be an advance directive by the
CANCER patient in hospice care.
INCURABILITY
& HOSPICE An advance health care directive or
CARE living will is an advance health care
planning in which the author or
person who makes this explains how
he wants medical decisions to be
made in case he cannot make
decisions already. 
 Health Issue Advance Health Care Directive Issue in Hospice Care
Course –
or Advance Directive
CANCER
INCURABILITY By setting the contents of an advance
& HOSPICE health care directive,
CARE the author is exercising his right of
patient autonomy as what are usually
placed in the directive are
what medical measures he will allow to
done and
what he does not want to be done to his
body.
 Health Issue Advance Health Care Directive Issue in Hospice Care
Course –
or Advance Directive
CANCER
INCURABILITY
This document serves as a guide to the
& HOSPICE
immediate relatives and significant others
CARE
when the time comes to implement the
contents as well as to the health care
professionals who may eventually be
called to manage him. 
 Health Issue • DIET and FLUIDS in Hospice Care Issue in Hospice Care
Course – Helpful Things to Consider in DIET and FLUIDS https://
CANCER • Decreasing food and fluid intake is a common, victoriahospice.org/wp-
INCURABILITY natural part of the dying process. content/uploads/
• Most dying people do not experience thirst or 2019/07/
& HOSPICE food_and_fluids_brochur
CARE hunger as death approaches. e_2017.pdf
• Giving food and fluids by artificial means (e.g.,
intravenously) does not usually prolong life or
improve its quality.
 Health Issue • DIET and FLUIDS in Hospice Care Issue in Hospice Care
Course – Helpful Things to Consider in FOOD and FLUIDS https://
CANCER • Providing food and fluids by artificial means victoriahospice.org/wp-
INCURABILITY may, in fact, increase distressing symptoms content/uploads/
2019/07/
& HOSPICE such as shortness of breath, respiratory
food_and_fluids_brochur
CARE congestion, restlessness, nausea and vomiting. e_2017.pdf
• When people have difficulty swallowing, eating
and drinking may put them at risk for choking.
• Artificial hydration does not provide nutrition.
• Artificial hydration does not usually prevent or
improve thirst or relieve a dry mouth.
• Frequent mouth care can help relieve a dry
mouth.
 Health Issue • PLACE of Hospice Care Issue in Hospice Care
Course – Decide where to have hospice care:
CANCER at home, at hospital, or at a hospice center.
INCURABILITY
& HOSPICE Decide whether to die at home, hospital or
hospice center.
CARE
Use the advance directive to guide everybody.
 Health Issue • ROJoson advocating statements and advice on
Course – cancer incurability & hospice care
CANCER
INCURABILITY
& HOSPICE
CARE
 Health Issue • ROJoson advocating statements and advice on
Course – cancer incurability & hospice care
CANCER All laypeople must know the basic concepts,
INCURABILITY principles and processes of cancer incurability and
& HOSPICE hospice care.
Part of PATIENT EMPOWERMENT.
CARE Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in medical
management of oneself and relatives by knowing
the basic concepts and principles and processes in
CANCER INCURABILITY & HOSPICE CARE.
 Health Issue • ROJoson advocating statements and advice on
Course – cancer incurability & hospice care
CANCER All laypeople must know the basic concepts,
INCURABILITY principles and processes of cancer incurability and
& HOSPICE hospice care.
CARE The 4Ks promote sound decision-making by both
patient-relatives and physicians in the realms of:
• Formulating realistic goal of management
(palliative vs curative)
• Promoting quality of life
• Controlling unnecessary expenses
 Health Issue • ROJoson advocating statements and advice on
Course – cancer incurability & hospice care
CANCER One does NOT totally lose hope right away when
INCURABILITY one has cancer!
& HOSPICE
It all depends on the situation – the type of
CARE cancer; the stage; the presence or absence of
effective treatment; etc.

There are still some cancers which can be “cured!”

NOT all cancers are incurable!
 Health Issue • ROJoson advocating statements and advice on
Course – cancer incurability & hospice care
CANCER However, one has to accept that some cancers are
INCURABILITY really incurable or already incurable! Rather than:
& HOSPICE
In some cancers, one may just have to let nature TRY. TRY, TRY
CARE take its course. GO ALL OUT

In cancer treatment

Even if it is
realistically futile!
 Health Issue • ROJoson advocating statements and advice on
Course – cancer incurability & hospice care
CANCER If the cancer is deemed curable – choose the best,
INCURABILITY the most cost-effective treatment to promote Rather than:
& HOSPICE cure.
TRY. TRY, TRY
CARE If the cancer is deemed incurable already – GO ALL OUT
choose the most practical and the most cost-
effective treatment to promote palliation. In cancer treatment
If the cancer is deemed terminally incurable
already – choose the most practical and most Even if it is
cost-effective treatment to promote a peaceful realistically futile!
death.
 • ROJoson advocating statements and advice on Parameters to use:
Health Issue • Track record of the
Course – cancer incurability & hospice care
specific cancer
CANCER Know the bases of declaring a cancer to be:
INCURABILITY • curable? • Stage of the cancer
& HOSPICE • not curable?
CARE • terminally incurable already? • Behavior of the
• not yet terminally incurable? cancer – growth
rate / recurring

• Presence or
absence of effective
curative treatment
 Health Issue • ROJoson advocating statements and advice on
Course – cancer incurability & hospice care
CANCER Then, decide on the realistic goal of treatment.
INCURABILITY
& HOSPICE • Curative
CARE • Palliative
• With anti-cancer treatment
• Without anti-cancer treatment
 Health Issue • ROJoson advocating statements and advice on
Course – cancer incurability & hospice care
CANCER For terminally incurable cancer:
INCURABILITY Let nature take its
& HOSPICE Have an advance health care directive. course!
CARE
Give details on how the terminally-ill patient will Palliate to promote a
be managed up to his last breath. peaceful death!
• Place of care – home / hospital / hospice
center Palliate to promote a
• Diet and nutrition quality of life!
• Procedures (diagnostic tests / treatment)
• Etc.
 Health Issue • ROJoson advocating statements and advice on
Course – cancer incurability & hospice care
CANCER Hattie Bryant’s four steps to a peaceful
INCURABILITY death are as follows: Let nature take its
& HOSPICE course!
• Acknowledge the inevitability of death
CARE • Understand the limits of medicine Palliate to promote a
• Educate yourself about your health care peaceful death!
choices
• Communicate your wishes and choose a Palliate to promote a
proxy quality of life!
 Health Issue Contents of CANCER INCURABILITY & HOSPICE Summary
Course – CARE Take Away
• What is a cancer?
CANCER • What is the basic cause of cancer?
INCURABILITY • What is cancer incurability?
& HOSPICE • When do you stop cancer treatment because of
CARE incurability?
• What is hospice care?
• What are essential components and issues on
hospice care?
• What are ROJoson’s advocating statements and
advice on cancer incurability & hospice care?
 Health Issue Be always in touch with reliable medical Take Away in
Course – information on CANCER INCURABILITY & HOSPICE relation to
CARE.
CANCER Patient
INCURABILITY Knowledge is power; it gives power. Empowerment
& HOSPICE Use the 4Ks of Patient Empowerment:
CARE Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of oneself by
knowing the basic principles and processes
in CANCER INCURABILITY & HOSPICE CARE.
 Empowerment
objective - for
Health Issue laypeople to have an
Course – understanding of
CANCER CANCER
INCURABILITY INCURABILITY &
& HOSPICE HOSPICE CARE in
CARE their health
management.