For advanced cancer patients with little hope for radical treatment, the question of whether to give aggressive anti-cancer treatment with a view to prolonging life (which sometimes may not be possible) or palliative treatment to alleviate pain and improve the quality of life is a question often faced by oncologists. It is true that cancer patients should strive for radical treatment as much as possible in order to gain the most survival time. However, if the current treatment cannot achieve radical cure, or the patient’s physical condition does not allow it, or if it is certain that anticancer treatment will cause more harm than good, clinicians should be aware of the “current situation” and settle for the second best, with the improvement of the patient’s quality of life as the main goal. As a special form of clinical care, palliative care is mainly about symptom control and pain relief. Through symptom relief, active pain relief, nutritional support, etc., supplemented by spiritual and psychological treatment, the quality of patients’ survival can be improved; through the cooperation with family members, patients can face difficulties with a more comfortable, calm state of mind and stronger perseverance, and at the same time, the disturbances to the family and the society can be alleviated. Palliative care is relatively simple and not expensive. Palliative care emphasizes the importance of treating life well. The role and importance of palliative care, with its focus on pain relief, has been increasingly emphasized, and the WHO has introduced a ‘three-step’ pain relief programme to find ways to reduce the suffering of cancer patients, and has proposed the elimination of cancer pain globally by the year 2000. According to some data, more than 70% of cancer patients will eventually suffer from moderate to severe pain, and many patients are more afraid of pain than of death itself. The consumption of coffee-based painkillers used for tumor patients in China is much lower than that in developed countries, indicating that there are still many cancer patients who do not receive effective pain relief. It is best to deal with patients with malignant tumors in a way that both prolongs survival time and improves the quality of survival. Therefore, when cancer is impossible to be cured, palliative care should be properly done, and the financial situation of the patients and their families should also be taken into consideration, so as to avoid ending up with the loss of both human and financial resources. Of course, before the implementation of palliative care, the situation should be fully explained to the patient’s family to gain understanding and avoid unnecessary misunderstanding. Consideration of all alternatives is one of the elements of decision-making in the clinical decision-making process. For very advanced patients, palliation should also be one of the options. Anti-cancer treatment or palliative care? Clinicians can only make decisions based on their personal knowledge and experience. Some doctors who are faced with a cancer patient and do not provide active anti-cancer treatment seem to be reluctant, believing that they cannot watch the patient die from the tumor, and thus attach great importance to anti-cancer treatment, without giving a comprehensive assessment of the pros and cons of anti-cancer methods and the overall management of the patient. Due to the over-emphasis on tumor treatment, the reasonable use of palliative care is often neglected, and anti-cancer effects are pursued, as a result, due to the side effects of anti-cancer treatment, not only the quality of survival of these patients is lowered, but also the medical cost is increased, and even the survival time is shortened. In fact, for advanced patients with no hope for radical treatment, palliative care can also have more advantages than disadvantages. This situation can be seen in the clinic, certain cancer patients can survive for a long time with tumor after treatment. When the effect of the existing anticancer treatment is very little and the side effects or sequelae are large, or when the disease develops very slowly, it can be considered that no special treatment is needed for the time being, and clinical observation or palliative treatment is given instead. Palliative care may be the only right choice for some cancer patients who have no hope of a radical cure. Decision-making is necessary when faced with more than two options to achieve the same goal. When faced with a clinical problem, it is rare that there is only one option to choose from, and it is often necessary to choose from more than one. Clinical trials are one of the better ways to help physicians make decisions, but they still have shortcomings: 1. Often, they only compare two similar regimens (e.g., two drugs); 2. There may not be enough attention paid to adverse effects, costs, and so on; and 3. There is not yet an ideal way to deal with soft metrics (e.g., pain, quality of survival). In addition, there are many clinical issues that do not all allow for clinical trials at this time. Quantitative evaluation of various outcomes of alternatives (including various different types of programs), estimating the probability of their occurrence, calculating the term value, and helping physicians to make the best choice through sensitivity analysis and threshold analysis. However, due to the existence of many intricate clinical phenomena, uncertainties (e.g., pain, malaise, etc.), and individual differences, which in turn make clinical trials and decision-making also rely on experience and subjective judgment, confusion and inconsistency commonly exist in the clinical decision-making process. Despite the complexity of clinical problems and the uncomplicated nature of correct decision-making, it is still possible to make correct decisions based on the evaluation of various therapeutic measures (including palliative care) on the basis of a variety of factors such as effectiveness, side effects, cost, feasibility, etc., through a number of decision-analysis methods and by combining clinical experience. Of course, when implementing the selected program, the decision should be tracked according to the new specific situation, and the program should be constantly revised and improved to achieve the best results.