Malignant tumor, commonly known as cancer, has always been a common enemy faced by human beings. When cancer is mentioned, people naturally associate it with death, pain, nausea and vomiting after chemotherapy, hair loss, anorexia, weight loss and other scenes that are fearful, painful and worrying, which in fact truly reflects the current situation of tumor treatment in the past years. However, with the rapid progress of oncology research and treatment in the past 20 years or so, the clinical treatment effect of tumors has improved significantly. Many previously incurable tumors can now achieve long-term control through reasonable treatment, and even for advanced tumors, doctors can use effective treatments to prolong life and alleviate various pains of patients. Cancer is gradually becoming a chronic disease, which requires long-term joint efforts of both doctors and patients to face. In the process of receiving anti-cancer treatment, it would be helpful for patients and their relatives and friends to know more information about it, so that they can cooperate with medical staff to implement appropriate treatment and maintain a relatively high quality of life while obtaining long-term disease control. Therefore, in addition to introducing knowledge about anti-tumor treatment, we introduce some information and concepts about supportive cancer treatment, which we hope will help to reduce patients’ pain and improve their quality of life. 1.What are the main components of tumor treatment? The treatment of tumor includes two main components, one of which is indispensable. Firstly, anti-tumor treatment, also called etiological treatment, mainly through surgery, radiotherapy, chemotherapy, endocrine therapy and molecular targeted therapy to achieve the purpose of curing tumor or obtaining long-term survival; secondly, supportive treatment, also called symptomatic treatment, aims at relieving patients’ various symptoms and psychological pain, making them as comfortable as possible, helping them to receive anti-tumor treatment smoothly and maintain a better quality of life. In the process of tumor treatment, only by taking into account these two aspects mentioned above, can we obtain satisfactory results. Neglecting either aspect cannot be called a qualified treatment. In the past, the focus of both doctors and patients in cancer treatment was mainly on anti-tumor treatment, and not enough attention was paid to supportive treatment, and patients’ various symptoms and pains were not paid attention to and effectively treated, resulting in anti-tumor treatment leaving patients with mostly painful, unbearable and even unbearable memories. A few patients also interrupted or refused further treatment due to unbearable treatment-related side effects, which affected the overall effect of tumor treatment. These painful experiences are witnessed by patients’ family and friends, and then become public impression and consensus, which invariably increase people’s fear and avoidance of cancer, and gradually form a vicious circle, which is very unfavorable to cancer patients’ cooperation with treatment. The rapid development of modern medicine is not only reflected in many specific research results and treatment methods, but also in the respect and care for patients’ personality. Supportive treatment for cancer is a vivid interpretation of this advanced medical humanistic concept, a sign of returning to rationality in cancer treatment, and a concrete embodiment of medical humanitarianism. We believe that through the joint efforts of doctors and patients, the level of supportive treatment for cancer patients can be improved, so that patients can actually enjoy the fruits of medical progress and gradually reverse the public’s painful memories of cancer and anti-cancer treatment. 2.How to carry out targeted supportive treatment? Cancer not only threatens patients’ lives, but also brings them various uncomfortable symptoms and pains. The medical community has reached a consensus on relieving these pains and agreed that it is the basic right of patients. Therefore, for cancer patients, communicating with their doctors at all times and actively informing them of their symptoms will help them to carry out timely treatment, and we do not advocate patients to endure pain and other symptoms. The main purpose of supportive treatment is to relieve patients of various uncomfortable symptoms and make them as comfortable as possible to face the disease and life with a positive attitude. Supportive therapy should be started as early as possible, and the earlier the patient receives supportive therapy, the more benefit the patient will have. The main tasks and contents of supportive therapy are different for tumor patients in different stages and phases (Figure 1). According to different stages of tumor, supportive treatment mainly includes two stages: one is the best supportive care stage; the other is the palliative care stage. 3.What is the best supportive treatment for tumor? Early stage tumor patients can obtain curative efficacy through comprehensive treatments such as surgery and postoperative adjuvant therapy, and doctors often call this stage of supportive therapy as best supportive therapy. Its purpose is to help patients receive various treatments smoothly and eventually cure the cancer. The main components of optimal supportive treatment include control of tumor-related symptoms, management of comorbidities of anti-tumor treatment, and rehabilitation after the end of overall treatment. For example, patients with early-stage lung cancer cannot eat normally for a few days after surgery, and will suffer from postoperative pain, possible combination of cough and constipation during bed rest; patients receiving postoperative adjuvant chemotherapy are often combined with anorexia, nausea and vomiting, leukocytopenia, anemia and weakness. Therefore, necessary nutritional support, effective analgesic treatment, prevention and control of infection, relief of constipation, correction of anemia and leukocytopenia are the main elements of supportive treatment during this period. In western developed countries, the negative psychological impact of cancer diagnosis and treatment on patients is highly valued, and psychological counseling throughout the overall treatment process is also a component of supportive treatment. Thus, supportive treatment is not only limited to symptom control, but also includes psychological counseling and meeting spiritual needs of patients. 4.What is palliative care? Middle and late stage tumors make up the majority of cancer patients. In addition to the necessary surgery, they often need to receive radiotherapy to control cancer progression, prolong life expectancy and achieve long-term survival. This stage is often long and can last for months or even years. The supportive treatment during this stage is called palliative care. Palliative care is the main treatment for patients with advanced tumors and the only treatment for patients with end-stage tumors. It aims not only to improve symptoms, but also to prolong survival through palliative antitumor treatment, such as palliative radiotherapy or chemotherapy. According to the information published by the World Health Organization (WH0) in the 1990s, the main elements of palliative care include: pain and other symptom control is the first priority of palliative care; paying attention to the psychological and spiritual aspects of patients’ needs; and helping patients to face life with a positive mindset. Palliative care not only improves patients’ quality of life, but also may have a positive impact on the treatment of their diseases, so it should be carried out as early as possible and combined with other treatments that prolong patients’ lives. 5.What are the public’s misconceptions about palliative care? Although palliative care includes the concept and means of active symptom control and anti-tumor treatment, there have been different degrees of misconceptions about palliative care in both western developed countries and China, which can be partly attributed to the derogatory meaning of the term “palliative care” itself. The term “palliative care” itself has a pejorative connotation. In English, the word palliative is a derivative of pallium, which means “large shawl” and means “to cover up, to conceal”. Therefore, during the period of underdeveloped medical science, palliative care used to mean “negative” and “helpless”. However, the progress of modern medical treatment concept has made the medical service represented by this term be incorporated with more positive contents, especially become an indispensable part of oncology treatment, so some foreign scholars also try to use the term supportive care (supportive care) to avoid patients’ misunderstanding of palliative care. In China, the term “palliative” contains many derogatory meanings, which has led many patients and even some doctors to misunderstand palliative care, thinking that palliative care means adopting a negative attitude and letting the tumor progress, or even being misunderstood as “backward”, “incompetent” or “backward”. It is even misunderstood as “backward”, “incompetent” or “giving up” treatment. Therefore, scholars in China have been trying to replace it with other more appropriate terms, and in Hong Kong and Taiwan, palliative care is gradually replaced by “hospice” or “palliative” treatment. After understanding the above information, the reader will have a preliminary understanding of the main purpose and tasks of palliative care. The pragmatic strategy is that content is far more important than form. It is not a medical inevitability, but a realistic and positive behavior based on the current level of human cognition. What we give up is the ineffective treatment that is not beneficial or even harmful to patients, and replace it with comfortable treatment and care that is in the best interest of patients, their families and society. 6.What is the significance of palliative care for lung cancer patients? In 2010, oncologists from Massachusetts General Hospital published the results of their clinical study on lung cancer patients, which confirmed that palliative care can prolong the survival of lung cancer patients. Their study randomized patients with advanced lung cancer into two groups, one receiving only antineoplastic therapy and the other receiving palliative care in combination with antineoplastic therapy, and found that patients in the combined palliative care group lived longer. The results of this study have received widespread attention from oncologists around the world and have prompted doctors and patients to update the concept of oncology treatment and better integrate palliative care into the overall anti-tumor treatment so that more patients can benefit. 7.Why is pain relief the first priority of palliative care? The symptoms of patients with mid- to late-stage cancer are complex and diverse, and pain is the most common symptom. Continuous pain brings great suffering to patients and their relatives and seriously affects patients’ quality of life and even survival. Therefore, WH0 has made pain relief treatment the top priority of palliative care for oncology and issued the “Three Step Analgesic Guidelines for Cancer Pain” to the world in the 1980s, with the aim of promoting the concept of positive pain relief and alleviating the suffering of cancer patients worldwide. Valuing patients’ pain and actively giving analgesic treatment is a concrete manifestation of medical humanitarianism. The basic principle of WH0 analgesic guideline is pain relief by step, that is, before pain relief treatment, doctors should assess the patient’s pain and then give appropriate pain relief treatment according to this, about 80% or more of cancer pain can be satisfactorily relieved by medication. Opioid drugs are commonly used by cancer patients for pain relief, and the commonly used opioids in China include morphine, oxycodone and fentanyl. The fear of addiction to these drugs has been one of the main reasons that hinder effective pain relief treatment. Here we would like to tell you that cancer pain patients will not become addicted to these drugs when they use them for pain relief under the guidance of doctors. The concept of cancer pain relief in China is still relatively backward, and the concept of pain tolerance is still common. The public can often see reports in film and media about cancer patients who endure severe pain and continue to work or live tenaciously. Although the strong will of cancer patients is touching, the media ignore the fact that the great pain they endure is not well controlled, and even praise such endurance intentionally or unintentionally. In any case, such praise is inappropriate. Because making cancer patients pain-free is something that modern medicine can already do, and it is the duty of doctors. More importantly, it is the most basic right of every cancer patient to ask for pain-free. 8.What is hospice care? With the increasing incidence of cancer, about 7 million people die from cancer every year worldwide, and the number of deaths from cancer in China has risen to about 1.5 million every year. When cancer patients are dying, the main task of palliative care is to help them pass away painlessly and with dignity, and this stage of palliative care is called “end-of-life care” or “terminal care”. During this phase, all invasive treatments should be avoided and the patient’s symptoms should be relieved mainly by medication. When the patient is dying, invasive ventilation (such as tracheotomy), ventilator-assisted breathing, cardiopulmonary resuscitation and other unhelpful “rescue” measures should be avoided, but anti-pain, anti-emetic, secretion-suppressing and even sedative medications can be actively administered. The patient can pass away with dignity and without pain. In order to fully realize the treatment goal of hospice care, first of all, the patient and his relatives should be informed of his condition in a timely and objective manner, and the common symptoms of terminal patients and the main strategies of hospice care should be introduced step by step. 9.What is death with dignity? Death with dignity is to help patients with advanced cancer to get rid of unnecessary life support systems such as cardiopulmonary resuscitation, tracheal intubation and ventilator-assisted breathing before death by signing a “living will” to help patients realize their personal wishes and pass away with dignity. In western developed countries, hospice care has generally become the basic work of palliative care. In China, palliative care is still in its infancy, and many medical institutions are not yet able to provide hospice care services. However, we believe that with the continuous development of palliative medicine in China, this service will be gradually improved.