Either 1 or 2 or 3 should be met.

1. Disease with metastases at presentation (a must be met)
a. Has the Cancer metastasized and is untreatable at presentation?

OR

2. Progression of cancer from an earlier state of disease to metastatic disease (a or b must be met)
a. Has the Cancer metastasized regardless of therapy?
b. Has patient been ruled out as a candidate or declines further curative therapy?

OR

3. Certain cancers with poor prognosis (all must be met)
a. Patient has suspicious large tumor and refuses definitive diagnosis?
b. Patient has declined in functional status?
c. Patient has significant, unintentional weight loss?