February 4 is World Cancer Day, and this year’s theme is “Achieving the goal of cancer prevention and control is not that far away.” China is now facing a serious situation of “raging cancer”, with 1/5 of the world’s annual new tumor patients coming from China, and 1/4 of the annual deaths due to tumors occurring in China, but China’s tumor prevention and treatment work has shown an extremely unreasonable “date-core”-shaped situation: the two ends are However, China’s tumor prevention and treatment work presents an extremely unreasonable “jujube-nut”-shaped situation: at the two ends, prevention is light and end-of-life care is light; in the middle, overcrowding is found in specialized tumor hospitals, and patients are mostly in the middle and late stages of the disease with a limited period of survival. Experts call for an effective curb on the spread of cancer, the urgent need to change passive into active, strengthen cancer prevention, improve the quality of life of cancer patients, especially late-stage cancer patients Double rise in the number of morbidity and deaths Colorectal cancer, nicknamed “rich cancer”, has been rising in recent years in China at a rate of 4% to 5% per year. In Taiwan, Hong Kong, colorectal cancer has ranked first in the incidence of various types of malignant tumors. In Shanghai, Guangzhou, Harbin and other big cities, the incidence rate of colorectal cancer has risen to the second place in the incidence rate of various types of malignant tumors. The incidence rate of pancreatic cancer, the “king of cancer”, is also on the way up. According to the epidemiological survey in Tianjin, the growth rate of pancreatic cancer has been very fast during the past 20 years, and its growth rate ranks the first among female cancers and the fifth among male cancers, and its incidence rate is equal to the mortality rate. According to statistics, there are about 1 million newly diagnosed gastric cancer patients in the world every year, and China occupies 50% of them. In the past 30 years, stomach cancer in China is still on the rise, and its incidence rate ranks the 2nd among men and the 4th among women in all kinds of cancers. From the above data, we can see the whole picture of the incidence of cancer in China: “poor cancer” in developing countries represented by stomach cancer is still high, and “rich cancer” in developed countries represented by colorectal cancer is gradually appearing. “The superposition of ‘poor cancer’ and ‘rich cancer’ makes the cancer threat facing our country about to explode.” Chen Wanqing, deputy director of the National Tumor Prevention and Control Research Office, said that a recent analysis of the 20-year incidence trend of malignant tumors in China showed that the incidence rate of malignant tumors in registered areas of the country rose from 184.8 per 100,000 in 1989 to 286.7 per 100,000 in 2008. The urban incidence rate rose from 209.3/100,000 to 3.07/100,000; the rural incidence rate rose from 176.1/100,000 to 269.6/100,000. 20 years, depicting the tumor incidence rate graphs of different regions and genders of our country, the upward trend is obvious. What is even more serious is that in the next 20 years, the number of cancer incidence and deaths in China will continue to rise. According to the statistics of the World Cancer Report, in 2012, the number of cancer incidence in China was 3.065 million, and the number of cancer deaths was about 2.205 million. If effective measures are not taken, in 2020, the number of cancer incidence in China will reach 4 million and the number of deaths will reach 3 million; in 2030, the above figures will reach 5 million and 3.5 million, respectively. “Not only that, the incidence rate of cancer in China is close to the world level, and the mortality rate is higher than the world level.” Chen Wanqing had analyzed in an interview that objectively speaking, China’s ethnicity and cancer spectrum are quite different from Western countries. The most common in white Europeans and Americans are prostate cancer and breast cancer, whose 5-year survival rate exceeds more than 80%, while the common diseases in China are lung cancer, liver cancer, etc., whose 5-year survival rate is less than 30%. “However, subjectively speaking, cancer in China is mostly found in the middle and late stages, for example, among the pancreatic cancer patients received in the clinic, only 20% of all pancreatic cancer patients can still receive surgical treatment for Stage I and Stage II patients, and the remaining 80% of the patients can often only receive conservative treatments, such as chemotherapy, radiotherapy, immunotherapy, etc., which will inevitably result in a high mortality rate and a low 5-year survival rate. And this problem is prevalent in most cancers.” Hao Jihui, vice president of Tianjin Cancer Hospital and head of the pancreatic oncology department, said. Prevention is crucial “Although emerging treatment modalities including bioimmunotherapy, targeted drug therapy, and antibody drug therapy are currently emerging, there is still a long way to go to cure cancer.” Hao Jihui said, to the treatment of middle and advanced pancreatic cancer, for example, although the U.S. FDA has approved the targeted drug Trocar can be used for the treatment of the disease, but studies have shown that the drug can only prolong the life of the patient for an average of 15 days. Therefore, advocating a healthy lifestyle and actively promoting early cancer screening to prevent the disease before it occurs is crucial to reducing cancer incidence and mortality. In the interview, almost every expert repeatedly reiterated the importance of cancer prevention and control. Prof. Zhang Suzhan, director of Zhejiang Cancer Prevention and Control Institute, said that western countries have carried out early diagnosis and treatment of colorectal cancer earlier, and the effect is remarkable. For example, the United States in the eighties and nineties of the last century began to appear colorectal cancer incidence rate and mortality rate of both downward trend. Research shows that, among the factors leading to the decline of incidence and mortality of colorectal cancer in the United States, moderate exercise, reduce fat intake and other healthy lifestyles contributed to 50%, early diagnosis and treatment contributed to 40%, and more than 60% of the population of the right age in the United States participated in colonoscopy screening more than once. It is understood that China has carried out the pilot work of early diagnosis and treatment of colorectal cancer in Haining and Jiashan areas of Zhejiang Province, which are the only two areas where the incidence and mortality rates of colorectal cancer have not increased in all the tumor registry sites in the country. “Happily, universal coverage of early diagnosis and treatment of colorectal cancer has been realized in Shanghai and Tianjin, and it can be expected that the incidence and mortality rates of colorectal cancer in these places will drop after several years.” Zhang Suzhan pointed out that at present, China’s public compliance with colonoscopy is still not high, and health education needs to be strengthened. “Cancer prevention and control system construction and strategy research need to be further strengthened, and we can’t rely on the health planning system alone.” Some experts pointed out that in 2002, WHO published the book “National Cancer Control Planning: Policy and Management Guidelines”, which called on all countries to establish national cancer control planning, set up a set of rigorously-designed, implementable, supervisory, and evaluable systems, and rationally utilize limited resources through the implementation of evidence-based strategies regarding primary prevention, early detection, diagnosis, and treatment of tumors, ultimately lowering the incidence of tumors and mortality rates, and improve the quality of life of tumor patients. Xu Runlong, deputy director of Zhejiang Provincial Health and Family Planning Commission, proposed that administrative, economic, social and other aspects should be integrated to further strengthen China’s comprehensive cancer prevention and control work. According to experts, in view of the medical expenditure caused by tobacco is higher than the tax revenue from tobacco sales, Australia has implemented strict tobacco control initiatives; the British government has intervened in the population obesity; the United States of America’s health insurance, commercial insurance has been covered by the colorectal cancer early screening, these international experiences for China’s comprehensive cancer prevention and control provides a good example. Healthy Lifestyle is Easy to Know and Difficult to Do In the interpretation of the theme of this year’s World Cancer Day, the International Union Against Cancer (IUAC) proposes that advocating people to choose healthy lifestyles and reducing social and environmental cancer-causing factors is the key to realizing the goals of the World Declaration Against Cancer. Individuals and societies need to recognize that at least 1/3 of all cancers can be prevented by reducing alcohol consumption, eating a healthy diet and increasing physical activity. Fifty percent of cancers can be prevented if smoking is reduced; ultraviolet protection is the key to preventing skin cancer; and occupational and environmental exposures, such as asbestos, are also important cancer-causing factors. The term healthy lifestyle is not unfamiliar to the public, but what kind of lifestyle is healthy, most people may know little, and even more people know that it is easy to do. In 2012, Professor Qiao Youlin, Director of the Epidemiology Research Department of Cancer Hospital, Chinese Academy of Medical Sciences, in cooperation with the World Health Organization, made the first systematic evaluation of the impact of environmental and behavioral risk factors on cancer deaths in China. The analysis of this study, published in the Annals of Oncology, the top international journal of oncology, showed that 29.4% of cancer deaths in China’s population were attributed to chronic infections, 23% to smoking, 13% to insufficient fruit intake, and about 7% to alcohol consumption, occupational exposure to cancer-causing factors, overweight, obesity and lack of physical activity. “These figures mean that nearly 60 percent of cancer patients in China can be prevented and avoided by promoting healthy behaviors and creating a healthy living environment.” Qiao Youlin said. Some members of the public, based on the mentality that “disease is still far away from me,” do not take healthy lifestyles seriously, and some patients do not return to healthy lifestyles even when they are sick. “Healthy lifestyles are not deeply rooted in people’s hearts,” said Qiang Wanmin, chairman of the Cancer Nursing Professional Committee of the Chinese Anti-Cancer Association and director of the nursing department of Tianjin Medical University Cancer Hospital. “To take a simple example, despite nurses repeatedly instructing patients on their diet, many patients still like to eat fried products such as fried cakes and doughnuts and pickled salted vegetables for breakfast. These kinds of food should be eliminated for patients with digestive tract tumors and chemotherapy.” Qiang Wanmin said that in recent years there has been more and more publicity about healthy lifestyles, but the effect on changing patients’ lifestyles is not obvious. “Only intuitive stakes and demonstration role, in order to deepen the patient’s understanding of a healthy lifestyle and consciously comply with, medical personnel have the obligation and responsibility to seek ways and means to solve the problem, choose the patients are happy to participate, and simple and intuitive way to guide. Doing so may cost us a lot, but the effect is remarkable.” Qiang Wanmin said, for example, many patients have a personal experience, who will not gasp, but how to gasp in order to achieve full exchange of gas, increase the oxygen content of the lungs, many patients are not clear. Through the nurse’s demonstration of guidance, patients know that the original breathing there is so much to learn, and then give him the relevant health knowledge he will be very willing to accept. The implementation of effective cancer prevention and control strategies, change people’s behavior, the need for the government in the use of vaccines, tobacco control, occupational protection and health education and other aspects of more responsibility. Experts also suggest that China is currently not doing enough in this area. For example, taking chronic infections as an example, research shows that Helicobacter pylori (HP) is one of the most common infectious cancer-causing factors in China’s population, and the domestic HP vaccine, although it has successfully obtained the certificate of a class of new drugs in 2008, has not yet been put into industrialized production. For human papillomavirus (HPV), another common infectious cancer-causing factor in China, a preventive vaccine has been successfully developed internationally and approved for marketing in 2006. However, because the phase 3 clinical study in China has not yet been completed, the HPV vaccine is still outside the country. Some researchers have estimated the additional burden of disease that may be caused by the lack of introduction of HPV vaccine in China, and concluded that without other effective interventions, the delay in HPV vaccination may result in 380,000 new cervical cancer cases and 210,000 cervical cancer deaths in the future in China from 2006 to 2012. Improve the survival years more to the quality of life Nowadays, there are many treatment methods for tumors, the effect is remarkable, the survival years of patients are prolonging, but how about the quality of life? “The incidence of cancer in China is increasing year by year, and cancer survivors have become a huge group. How to let cancer survivors return to society smoothly and have a good quality of life has become a social issue.” Liu Wei, director-designate of the Tumor Psychology Professional Committee of the Chinese Anti-Cancer Association and standing committee member of the Cancer Rehabilitation and Palliative Professional Committee, pointed out that giving cancer survivors all-around care for their body and mind is also an important aspect of the cancer prevention and control system. “Through decades of clinical observation and practice, I have the experience that protection from the outside world and a firm belief in overcoming cancer is the key to improving the quality of patients’ survival. The whole society, medical workers and their caregivers should give all aspects of protection to tumor patients and fully respect them in order to strengthen patients’ beliefs and truly improve their quality of life.” Qiang Wanmin said that external guarantees include economic basis, family support, and social roles. Tumor patients may cause the lack of body organs and image defects after treatment, which is far more harmful to patients than the disease itself. After the basic recovery of the body by the community refused to accept the situation occurs from time to time, the patient’s human dignity and sense of belonging is greatly reduced; in the late stage of patient care, the reality of the body care more than the spiritual care prevails, which is prone to make the tumor patients feel that life has lost its meaning, although the life is prolonged, but the quality of life is declining. Liu Wei proposed that both medical staff and patients’ families should strengthen their awareness and concern about the psychological pain of cancer patients and caregivers, and help patients alleviate their psychological pain. According to Qiang Wanmin, the “20 minutes of listening per month” activity carried out by the psychological support group of Cancer Hospital of Tianjin Medical University in each ward has made many patients willing to talk to nurses about the words and wishes buried in their hearts. Some wards have also set up special “patient reception rooms” to allow hospitalized patients to have a private communication space with visiting relatives and friends, thus protecting the patients’ right to privacy. In response to the burden brought about by the patient’s lack of physical condition, the Breast Unit of the hospital has set up an award for the best caregiver for the patient’s husband and a classroom for family members, so that the patient can receive the warmth of the family and at the same time, feel that he or she is still an important member of the family and has an irreplaceable role to play. After discharge, the nurses also organize regular networking activities for patients and display activities such as costume shows, which also boost patients’ confidence to a large extent. In addition, Liu Duanqi, deputy secretary-general of the China Anti-Cancer Association and director of the oncology department of the General Hospital of the Beijing Military Region, admits that end-of-life care and palliative care for advanced cancers have not yet received enough attention. “Understanding and coping with the emotional, spiritual as well as physical trauma that cancer inflicts on human beings will maximize the quality of survival for cancer patients and their families.” Wang Changli, chairman of the Lung Cancer Professional Committee of the Chinese Anti-Cancer Association and director of the Department of Lung Oncology at Tianjin Medical University Cancer Hospital, pointed out that cancer seriously affects patients’ emotional, physical and mental states, and that the quality of life of cancer patients decreases drastically in the years after diagnosis. Physical side effects of advanced cancer treatment, such as impaired fertility, sexual dysfunction, hair loss and weight gain, can cause patients to feel ashamed and be discriminated against, and in some cases even lead to family breakup. At the same time, family members of cancer patients also suffer from tremendous psychological pressure, and their physical and mental health are also affected. Currently, palliative care is receiving much attention worldwide. The 67th World Health Assembly made a resolution to strengthen the emphasis on palliative care, incorporating palliative care into government health care policies and budgets, as well as into the curricula of health care professionals, advocating that governments should pay attention to palliative care for cancer, and carry out a holistic, patient-centered, and multidisciplinary implementation of the cancer prevention and control system, so as to improve the quality of life of cancer patients, their families and caregivers. Strengthening the integration of palliative care, psychotherapy and anti-cancer treatment is also becoming popular. At present, China’s psychosocial oncology is still in its infancy, and it is imperative to create Chinese palliative and psychological diagnosis and treatment guidelines, and to explore a Chinese palliative and psychological rehabilitation treatment model. It is understood that Tianjin Medical University Cancer Hospital set up a hospice ward as early as in the 1990s to provide all-around physical and mental care for patients in advanced stages, and the treatment and care are in line with patients’ wishes, focusing on patients’ feelings, so that the patients can live with dignity and leave with dignity. The Family Care Center also provides nursing services especially for homebound patients, and conducts home visits and consultations, so that patients who are willing to complete their entire life at home can also enjoy the same care as inpatient treatment. Viewpoints Practicing healthy living and not bowing down to cancer Statistics show that 60% of cancers can be prevented, but many people do not take seriously the prevention and control of cancer by changing their lifestyles and dietary habits, are we compromising with bad habits and bowing down to cancer? What should the government, medical practitioners and the general public do in the face of the onslaught of cancer? It has become an important proposition that requires careful consideration. In recent years, the government has stepped up publicity on cancer prevention and control, and the words “cancer is preventable and controllable” can be found everywhere in the government’s red-title documents, the media’s popularization of science and technology, and on the bulletin boards in the community, including newspapers, magazines, microblogs, microblogs, television, radio, and other forms of all-media health education can be said to be in full swing, but a careful reading of the contents makes it easy to find out that more and more people are willing to give in to bad habits and bow to cancer. However, it is not difficult to find that more publicity focuses on the close correlation between cancer and lifestyle by listing data, while there is a lack of specific guidance on how to change lifestyle and what constitutes a healthy diet. These “common” suggestions of “balanced diet, oil control and salt restriction” are actually difficult to implement. What is even more unacceptable is that in this era of information explosion, different media, different experts, and even the same media at different stages, give different advice on healthy diet and lifestyle, leaving the public confused. Epidemiological studies have confirmed that smoking is an independent risk factor for cancer. However, the country has been hesitant to move forward on the issue of tobacco control. The revision of the Advertising Law, which has been the focus of attention, has passed the second trial of the Standing Committee of the National People’s Congress, but it still leaves room for the posting of advertisements by tobacco specialty stores, which makes all sectors of the society sigh with regret. What needs to be recognized is that nowadays there are more and more medical experts who devote themselves to popularization of science and make it an important part of their work, but compared with the public’s demand for health science knowledge, the work done by these experts is still a drop in the bucket. Admittedly, the current doctors in large hospitals “medical, teaching, research” three heavy responsibilities on the shoulders of busy and breathless, and popular science education is not a mandatory requirement, there is no economic return, only by interest and enthusiasm is difficult to adhere to. Undeniably, medical workers are the main force of health education, the need to bear the social responsibility can not be shirked, but we should also see that the current technical support and policy support for these clinical medical experts is far from enough. Popularization of science is a systematic project, the need for top-level design and evidence-based medical data support, but also need to have professionals to conduct research, to reach the hands of clinical experts should be detailed and specific, operational and even individualized use of healthy lifestyle recommendations. Finally, it comes down to us. A lot of Chicken Soup for the Soul says, “No one has the obligation to love yourself more than you do,” and how to love yourself is understood differently by everyone: some people live with indifference to their health and do as they please, while some people live a healthy life for themselves and their families. There is no doubt that we respect the latter. The United States insurance system is sound, obese people to buy health insurance spending significantly higher than the normal weight of the population, which gives us a revelation: their own health to pay the bill. Cancer is preventable and controllable in the early stage, with optimistic long-term effects, while late-stage patients have high medical costs and poor prognosis, so adopting a healthy lifestyle should be everyone’s pursuit of life.