An old article has been reposted continuously for two years, first on Weibo and then on WeChat’s circle of friends, and the attention has never diminished. The author of the article, Chen Zuobing, M.D., an emergency medicine specialist for more than 20 years, respected his father’s wishes and chose palliative care after his father suffered from advanced cancer and metastasis throughout his body, and let him pass away peacefully without active resuscitation when he was dying. The reason for the controversy of this article is that China is entering an aging society and many people have to start thinking about how to make choices when their parents have cancer. Deng Yanhong, associate professor of medical oncology at the Sixth Hospital of Sun Yat-sen University, said that the choice of palliative care or active intervention for the elderly with cancer cannot be based on age alone, but also on the condition and physical status of the elderly. The title of this long microblog is “A doctor’s dying choice for a father with cancer”. Chen Zuobing, a medical doctor and emergency specialist at Zhejiang Medical College, learned that his 78-year-old father had an advanced malignant tumor that had metastasized throughout his body and was inoperable, informed him of his condition and respected his father’s wishes by not doing radiotherapy and chemotherapy and sending him home to Zhuji from Hangzhou to live out his last life in peace. He also explained to his mother that in case his father fell into a coma or his breathing and heart stopped, do not take any resuscitation measures, and if allowed, do some sedation and hypnosis to let him pass away peacefully. Six months after returning to Zhuji, Chen Zuobing’s father passed away peacefully. Chen Zuobing wrote in his handwritten note: “Due to the advanced tumor, the whole body metastasis, inoperable. Colleagues and friends have proposed a series of treatment plans, including chemotherapy, radiotherapy, heat therapy and so on. In the past, I was the one who picked the options for others, but now it was my turn to decide the treatment plan for my own father, and I was at my wits’ end.” His father asked how much time could be extended after chemotherapy and radiotherapy. Chen Zuobing said, not necessarily, the effect is good maybe a few months. The father asked again, how much, what is bad for the body? Chen Zuobing replied, all publicly funded, the side effects are hair loss, weakness, poor appetite, etc.. The old father thought about it overnight and decided to go back home the next day. This article has caused a fierce reaction among netizens, the vast majority of them are praise, but also can see that some people’s hearts are torn. The reason for the netizens’ praise is mainly that the old man is old, his own poor health, simply can not stand the side effects of radiotherapy, in the end, people and money, but also suffered a lot for nothing. Those who feel torn are mainly because they feel guilty if they don’t treat the disease; if they treat it, the elderly will suffer more! Doctor’s view: Whether to actively treat cancer in the elderly varies from person to person Deng Yanhong, associate professor of medical oncology at the Sixth Hospital of Zhongshan University, believes that whether to give up treatment or actively intervene in cancer in the elderly should not simply be based on “age” as the standard, thinking that as long as they are elderly, their bodies must not be able to tolerate treatment, and even if they are actively treated, they will not live much longer. In fact, this is a misunderstanding. She said that with the continuous development of society, the public’s awareness of health care is getting stronger and stronger, and some elderly people are still in good health when cancer is discovered. It’s not that there’s no value in aggressive treatment – their bodies can tolerate aggressive treatment, surgery or chemotherapy, and they may still have a long life expectancy after aggressive treatment. Yanhong Deng says that in her chemotherapy department, for example, 10% of the senior citizens over the age of 75 who are currently receiving chemotherapy in the ward do not tolerate chemotherapy differently than patients under the age of 70. In addition, from the perspective of survival quality of the elderly, some cancers, such as colorectal cancer, if not actively intervened, with the development of the disease patients will soon develop digestive tract obstruction, pain, abdominal distension, inability to eat and other problems, the quality of life will be very poor, so we can not simply just give up treatment, but the specific situation should be analyzed. Special reminder: Comprehensive assessment is important before treatment for elderly people of advanced age Deng Yanhong added that more prudent assessment is needed when formulating treatment plans for elderly people with cancer. More emphasis is placed on multidisciplinary judgment, which usually requires consultation by senior doctors from multiple disciplines, such as surgery, oncology, cardiovascular medicine and anesthesiology. The choice of chemotherapy regimens will also be relatively more modest, with those that can be treated with single drugs not choosing a combination, and those that can have fewer side effects not choosing drugs with more side effects. As long as they are evaluated and qualified, senior citizens with early to mid-stage cancer have equal benefit to younger people after surgery, and age is not a high risk factor for their cancer to recur or develop complications in the future, she said. The International Society of Geriatric Oncology (SIOG) also recently published its latest consensus for the treatment of elderly colorectal cancer patients, which actually places the most emphasis on comprehensive assessment and individualized treatment responses as well.