“The 3 things that matter most at the close of life”: Gerontology pioneer Dr Helen Ko, diagnosed with Stage 4 high grade cancer

Gerontologist, counsellor and educator Dr Helen Ko, 61, has spent more than three decades preparing Singapore for the realities of an ageing population.

Widely regarded as a pioneer in the sector, she was instrumental in establishing Singapore’s first gerontological counselling, day care and case management services for seniors.

Helen in 2018, speaking at a forum in Korea on skills and the future of work strategies for inclusive growth in Asia and the Pacific. Photos courtesy of Dr Helen Ko.

She was the first Director of the SAGE Counselling Centre, and the first CEO of St Luke’s Eldercare in her 30s (where she is currently an advisor). She later served as Executive Director of Centre For Seniors. She has also served on national platforms such as the Inter-Ministerial Committee on Ageing Population.

An Associate Professor at the Singapore University of Social Sciences, Helen teaches in the Master’s and PhD programmes in gerontology, focusing on the ageing workforce, gerontological counselling and “geragogy” (the science of teaching older adults).

For decades, Helen equipped others to face aging and mortality. In 2020, aging and mortality confronted her personally.

“I ‘boarded’ an operating theatre instead”

On February 18, 2020, she was meant to fly to Ethiopia. Instead, Helen who had turned 55 the month before, underwent urgent surgery.

“Instead of boarding an aircraft for Ethiopia for meetings of an international mission organisation in which I was serving, I ‘boarded’ an operating theatre instead,” she wrote in her book, Hope for Tomorrow: Navigating Illness and Ageing.

Just 10 days earlier, she had returned from a 10km brisk walk at MacRitchie Reservoir, a routine she had maintained up to six times a week for 15 years. That evening, she noticed a swelling in her groin area. Concerned, she alerted her husband, psychiatrist Dr Ko Soo Meng, and their eldest of four children – Moses, a doctor.

Helen walked or jogged around MacRitchie Reservoir several times a week for 15 years.

Within days, tests, a PET scan and a consult with a gynae-oncologist led to a devastating diagnosis: Stage Four High Grade Primary Peritoneal Cancer, a rare and aggressive cancer.

Her oncologist told her that the typical lifespan following such a diagnosis was about a year.

“I recall feeling dazed and quite numb because everything happened so suddenly and rapidly,” she wrote. “However, though unexpected, my overall reactions were not dramatic or extremely emotional.”

Reflections in her book written by her husband and her son show that it was more difficult for her family than it was for her.

Helen’s primary concern was not death itself, but coping with post-surgical pain, losing functional abilities and becoming dependent on her family, and she was concerned about her two youngest children, then aged 15 and 18.

Having lost her own father to cancer at age 14 – he was only 49 – she was not entirely shocked by the diagnosis.

“I was not too perturbed, as my spiritual beliefs have taught me that God is in control – He is a loving God who knows what He is doing. Therefore, I need not fear, as He will help me and enable me to weather this trial.”

Her primary concern was not death itself.

“I continue to believe that God will take care of my family if He should choose to take me home to His eternal Kingdom.”

Instead, she worried about coping with post-surgical pain, losing functional abilities and becoming dependent on her family, and she was concerned about her two youngest children, then aged 15 and 18.

A rollercoaster journey

Helen’s book is a compilation of spiritual reflections coupled with her academic knowledge, plus updates she wrote to family and friends over four-and-a-half years from early 2020 to mid-2024. These cover the diagnosis, major surgery, chemotherapy, nine months of stability, a recurrence in May 2021, another surgery and further chemotherapy.

Helen discontinued maintenance therapy in November 2023. After her book was released in December 2024, she had a recurrence of the cancer and resumed treatment in February 2026.

A particularly dark time was after the second surgery when the removal of lymph nodes left her vulnerable to cellulitis, a bacterial skin infection. In the space of four months, she contracted it seven times, five of which required hospitalisation where antibiotics were administered intravenously.

“It was so painful that at one point I asked God, maybe it is better to leave this world. But He sustained me,” she recalled.

In the midst of this, and not knowing if she would pull through, Helen’s beloved sister-in-law lost her fight with cancer.

Recalibrating but carrying on her calling

Six years after that grim prognosis, Helen lives on.

“Truly diagnosis and prognoses are utterly irrelevant to God,” she noted.

“I have lived past the typical lifespan for those with my kind of cancer. I am very thankful to God for extending my ‘lease’ here on earth.”

She said that even if given 10 or 20 more years, it would be “merely a drop in the bucket” compared to eternity.

Even as she went through cancer, she continued teaching “to fulfil my calling to raise another generation to serve seniors and the community”.

Helen moderating a session at the Asian Family Conference in 2024.

In a message in the book, Prof Aline Wong – former Senior Minister of State for Education and former SIM University chancellor – wrote: “Even in her suffering, she has carried on (and I would say heroically) with her teaching commitments.”

But Helen has taken the lead from God on how to recalibrate.

“In the months following the diagnosis, I felt God calling me to pause and to be still and listen to Him, to only do what He has assigned me to do,” she said. “We live in an activity-oriented ‘doing society’. It was not easy.”

She sensed God reminding her that her worth was not measured by productivity. “Importantly, I learned that I am precious and deeply loved by Him because I am His child, and not because of how much I have done for Him.

“Rather, it is to highlight the need to ‘let go’ of the unnecessary, the non-essentials, and focus on what truly matters – loving Him and loving my neighbours.”

What matters most at the end

As a gerontologist, Helen has long studied what people need in the final stage of life. Now she is living it.

“For me, at the close of my life, a sense of having achieved peace is most important – especially spiritual peace,” she wrote.

She described three interrelated dimensions: Spiritual peace, relational peace and psychological or emotional peace.

1. Spiritual peace

“Spiritual peace is peace with God, and the peace of God. Our spiritual pain is a sign of failure to achieve it on some level,” she wrote.

“As a Christian, I have peace with God and eternal salvation because of Jesus Christ. Even through challenges of cancer, I can continue to enjoy the transcendent peace of God as His beloved child.”

While she and others have prayed for healing, Helen has also prepared her heart for the possibility of death. “Should this happen, I believe I can take leave from this world with my heart at peace, celebrating with thankfulness the life which I have lived on earth.”

She added: “Of course, my gratitude doesn’t imply the absence of sorrow arising from current and/or anticipated future losses, for example, the hope of seeing all my children grow up to be mature, God-fearing adults … I will grieve deeply particularly over the physical separation from my loved ones.

“But I am comforted by the hope of resurrection, knowing that I will see them again someday, and that I will be in the presence of Jesus Christ, my Lord.”

2. Relational peace

Drawing from research and her professional training, she noted that reconciliation and forgiveness are crucial for those nearing death. Otherwise, the dying may struggle to “let go”.

Helen was well enough to travel with her family to New Zealand in December 2022.

“Therefore as much as possible, I devote a significant amount of time to cultivating good, harmonious relationships, particularly with family and friends.”

Her diagnosis has sharpened her awareness of time.

“My cancer diagnosis has engendered an acute awareness of my limited time horizon on earth, propelling me to be even more focused and intentional about spending quality time with my significant others, to build and leave behind positive memories for them.”

3. Psychological and emotional peace

Helen references German developmental psychologist Erik Erikson’s theory of the final stage in life (typically late in adulthood for the rest of one’s life): Those who feel they have accomplished what they set out to do experience satisfaction; those burdened by regret may sink into depression and despair.

“At the end of my life, I do not wish to be plagued by feelings of regret,” she wrote.

Unfinished responsibilities or unfulfilled callings would weigh heavily. Completing her book was part of fulfilling what she believed God had assigned her.

How spirituality sustains her

Helen cited a study by Yale University School of Medicine that suggested that people who believe in a higher power, the importance of prayer and finding meaning in times of hardship are less likely to be depressed.

Studies overseas and in Singapore have found that spirituality is one of the main coping mechanisms amongst older adults.

Helen noted that according to research, spirituality helps older adults cope with loss and impending death through meaning-making, social support, belief in an afterlife and spiritual rituals.

For her, meaning-making meant learning to slow down. “I felt God calling me to pause … and to only do what He has assigned me to do.” In relinquishing non-essentials, she discovered deeper intimacy with Him.

The “bane” of lymphedema became a blessing when Helen slowed down and became attentive to what was still going on well in her life. For instance, noticing wildlife like the colugo (pictured) – and the sighting of the critically endangered Sunda pangolin, her first during her 20 years of walking at MacRitchie.

Her faith community – family, church members, colleagues and students – became a tangible source of strength. “Their prayers and practical support have been a tremendous source of comfort and strength for me and my family.”

In August 2023, Helen prayed to see stingrays again at MacRitchie and the Lord answered her prayer almost immediately. “To me, sightings of these creatures at MacRitchie speak to me of God’s love and providential care,” Helen told Salt&Light.

Her belief in an afterlife also shapes her acceptance of mortality. “Indeed for me, I know that someday, I will see the people I love again in heaven. This has certainly helped me cope by bringing much comfort and peace to me.”

Spiritual rituals provided avenues for grief. On Good Friday following her diagnosis, reflecting on Christ’s suffering gave her language for her own.

“Additionally, the opportunities to ‘complain’ about my distress to God through prayers certainly helped to facilitate my grieving process.”

Making peace with death

In her book, Helen wrote:” While I and others continue to pray and are hopeful for a miraculous healing of my advanced cancer, we acknowledge that in God’s perfect wisdom and sovereign will, He may choose to take me to my eternal home in the near future.

“Should this happen, I believe I can take leave from this world with my heart at peace, celebrating with thankfulness the life which I have lived on earth. I have tasted His goodness, unfailing love and faithfulness in a very personal way throughout my life.”

The above was adapted from Hope for Tomorrow: Navigating Illness and Ageing by Dr Helen Ko.

The book is published by Armour Publishing and can be purchased here.

Join us in praying for Helen and her family

Helen discontinued maintenance therapy in November 2023. After the book was released in December 2024, she had a recurrence of the cancer and resumed treatment in February 2026.

The 18-session chemotherapy regime is expected to last till end July.

Helen told Salt&Light: “Praise God that I continue to experience His transcendent peace and indwelling presence. However, I would appreciate prayers for:

1. Minimal adverse effects from chemotherapy, particularly peripheral neuropathy i.e. numbness of hands and feet
2. Full remission, God willing
3. Strength, grace and wisdom to fulfil whatever assignments the Lord has for me in this season of my life, for His glory
4. My family will continue to love the Lord and love others, and be salt and light for Jesus always.”

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