PREFACE When a person suffers from a disease, when he sees a doctor and the doctor and the patient discuss the treatment plan, the first thing to understand is: what is the goal of our treatment? Medicine is not omnipotent, it is impossible to cure all diseases, there are too many unknown things in the field of medicine, so sometimes the doctor will helplessly send out the sigh of “sometimes curing, often helping, always comforting”. Therefore, the three main goals of modern medicine are: to cure diseases, to prolong life and to improve the quality of life. Unfortunately, in our country and most parts of the world, cancer patients are already in advanced stages when they first seek medical treatment, and most of them have lost the opportunity of radical surgery, chemotherapy or radiotherapy. In the face of incurable diseases, how to let patients live a wonderful and dignified life in their limited life is the problem of palliative care that we must face. He Zhen, Department of Internal Medicine, Henan Cancer Hospital Palliative care, that is, by relieving pain and controlling symptoms, as well as providing spiritual and psychological support to enable patients to achieve the best quality of life, is an essential element of cancer control. In the 1980s, the World Health Organization changed the three tasks of tumor prevention and control from “tumor prevention, early diagnosis and early treatment” to four tasks of “tumor prevention, early diagnosis, comprehensive treatment and palliative care”, included palliative care as one of the four key tasks in solving the problem of cancer, and took the control of pain in cancer as the entry point for promoting palliative care. In November last year, the death of a post-80s girl aroused widespread attention from the Internet and the media. She was Xiong Dun, the author of the comic book , who recounted her more than one-year experience of fighting cancer in the form of a comic book with a strong and optimistic mindset. Though she eventually regretted her death, she lived a wonderful life in her limited life, which powerfully illustrated the essence of modern palliative care. The concept of modern palliative care began in the West, in 1940, British doctors began to try to use painkillers to treat patients, giving humanitarian medical care, and achieved better medical effects and social effects. 1964, the world’s first hospice was established in the United Kingdom, combining traditional medicine and modern medical treatment to treat patients with advanced disease (mainly advanced cancer patients), and since then countries around the world have followed suit. Since 1982, the World Health Organization (WHO) has been promoting the principle of three-step pain relief for cancer worldwide, and promoting the understanding of improving patients’ quality of life in the comprehensive treatment of cancer in various countries. On October 8, 2005, the first World Hospice and Palliative Care Day was born under the joint advocacy of Hospice Voices and the Hospice and Palliative Care Societies around the world, calling on all sectors of the society to understand and support palliative care and end-of-life care for cancer patients. Comparatively speaking, China’s cancer palliative care career started relatively late. Prof. Li Tongdu, a famous oncologist from Anhui Provincial Cancer Hospital, first put forward the idea that “the admission and treatment of late-stage cancer patients is a social problem” in 1985, and then raised his own funds to build Anhui Tumor Rehabilitation Hospital in 1987, which admits and treats patients with late-stage cancer and promotes the concept of palliative care for cancer patients. The concept of palliative cancer treatment was promoted. Subsequently, Shanghai, Beijing, Guangzhou, Tianjin and other places have also set up care and treatment institutions for terminal cancer patients, and in August 1994, the Professional Committee of Cancer Rehabilitation and Palliative Care of the Chinese Anti-Cancer Association was formally established. Subsequently, provincial and municipal cancer rehabilitation and palliative care professional committees and cancer pain relief committees were also established, and the cause of palliative medicine in China has had a vigorous development. Palliative care considerations One: early treatment. That is, palliative care should be used as early as possible in the treatment of cancer. If treatment to control cancer progression is ineffective or does not achieve the desired goal, then palliative care should become the primary treatment. Palliative care should be integrated into comprehensive oncologic care as part of conventional treatment for every patient with palliative care needs. According to the development of malignant tumors, palliative care can be roughly divided into three stages. Stage 1: The patient’s general condition is better and treatment has just been started; anticancer treatment should be combined with palliative care. Stage 2: When anticancer treatment may no longer be of benefit, palliative care should be the mainstay. Stage 3: when the expected survival time is only a few weeks to a few days and the cancer is in the terminal stage, hospice care treatment and hospice services should be provided for cancer patients. Doctors and patients should work together to guarantee palliative care throughout the whole process of cancer treatment and ensure that anti-cancer treatment is reasonable and beneficial. Second: Combined treatment. Palliative care is combined with other tumor treatments. Surgery, chemotherapy, radiotherapy, etc., which are mainly aimed at tumor treatment, will bring some related health problems, which are called complications or side effects in medicine. In clinically advanced tumor patients, these treatments do not make it possible to achieve a cure, nor do they necessarily prolong the survival period. At this point, doctors and patients should weigh the pros and cons, consider the possible benefits and pains they may bring, and should decide on the treatment strategy with the primary goal of improving the quality of life. Combined Chinese and Western medicine palliative care for tumors is guided by an individualized comprehensive treatment model, scientifically integrating the holistic concepts of motherland medicine and the concept of evidence-based treatment, and integrating Chinese and Western medicine to control pain and other symptoms. For example, severe nausea and vomiting and diarrhea may occur in chemotherapy, Chinese medicine can alleviate these adverse reactions so that chemotherapy can be carried out smoothly. If the tumor patients are elderly and have serious comorbidities such as diabetes mellitus, hypertension, coronary heart disease or sequelae of stroke, their treatment is very different from that of patients with simple tumors in terms of the overall treatment principle, which is not only treating the disease of “tumor”, but also treating a “person”. “The choice of treatment plan for elderly patients should fully consider the risk and benefit of the patients, and give appropriate and necessary treatment to the concomitant diseases of the patients, which requires multidisciplinary cooperation, not only oncologists, but also cardiologists, neurologists, diabetics, respiratory physicians, etc., to form a comprehensive treatment team with multidisciplinary collaboration. The Department of Geriatrics of Zhengzhou People’s Hospital has initially formed a successful model that is rarely seen in China. It provides one-stop service to elderly patients with multiple coexisting diseases, especially elderly tumor patients. Its third: pain relief. Relief of pain and other distressing symptoms. Physical problems faced by cancer patients include pain, nausea, vomiting, difficulty in breathing, loss of appetite, wound ulcers, bloating, edema, constipation, and insomnia. They are either disease-related or treatment-related. Clinical practice has demonstrated that patients benefit more from timely control of these painful symptoms at the beginning of treatment, and both doctors and patients should be concerned. Pain is an unpleasant sensation and emotional feeling, and doctors should relieve pain for cancer pain patients as soon as possible. Patients and their families also have the right to ask their doctors to provide adequate pain relief. The “three-step” treatment of pain advocated by the World Health Organization (WHO) is based on the three degrees of cancer pain, namely, mild, moderate and severe, and different medication plans are adopted for their treatment. Currently, the internationally recognized drug of choice for cancer pain relief is opioids. However, due to the misplaced awareness and division of labor among many doctors and health administrators, China is one of the countries in the world with the strictest management of narcotic prescription and use; it is also one of the few countries with the lowest per capita use of narcotics and the most irrational medication structure among the more than 100 countries with statistics; and it also dares not prescribe strong opioid medications for fear of being held accountable when a patient needs them. with the joint efforts of all sectors of the society, China’s The consumption of medical morphine increased from 4kg in 1984 to 971kg in 2010. By standardizing the use of medication, 75% to 80% of patients with cancer pain can be relieved of their pain. For the remaining patients whose pain cannot be relieved by oral drugs, doctors can also design individualized treatment plans according to the different parts of pain, nature of pain, degree of pain and condition of cancer pain patients, such as cooperating with chemotherapy, radiotherapy, surgery, intrathecal and intracerebroventricular drug injection technology, nerve blocking technology, patient self-control analgesia technology, subcutaneous implantation pump technology, etc. Patients and their families should understand the importance of pain relief. Patients and their families should understand that pain relief treatment will not aggravate the condition, and pain relief treatment is the first choice of treatment for cancer pain patients. We can’t imagine how a patient with excruciating cancer pain can calmly accept radiotherapy and other treatments. Only when the pain is controlled and the patient feels comfortable will the patient be in a position to receive adequate anti-cancer treatment. Doctors have the experience that a cancer patient with adequate pain relief tends to have a slower progression of the disease. Fourth: psychological support. Pay attention to the psychosocial problems of cancer patients. Cancer treatment is different from other disease treatment. The complexity of the causes and treatment mechanisms of cancer makes it impossible to predict the duration of your treatment and the amount of expenditure. All inputs are uncertain. Even if comprehensive conventional treatment is implemented, there is no guarantee that a cancer patient will be cured or get better. It is undoubtedly essential for patients to receive timely and reasonable conventional treatment (surgery, chemotherapy, radiotherapy, Chinese medicine, immunization) at the early stage of the disease. However, we must realize that this is only the beginning of the long and complicated process of cancer treatment and recovery. Much more needs to be done. Any attempt to rely solely on conventional treatment to solve all the problems of cancer is naïve and risky. In palliative care for advanced cancer patients, the first step is to effectively control pain and other symptoms, so that the patient’s body is comfortable, and the care from relatives, friends and the community can make the patient feel that life is worth living, and have confidence and courage; and then help the patient to discover his or her own responsibility, mission and value, and to find the meaning of life, so that the patient will have the strength to face all the suffering or even death, and to live positively and optimistically. This kind of comprehensive care for the body and mind allows patients to achieve physical and mental peace, which can significantly improve the quality of life of patients. Fifth: end-of-life care. Correctly recognize death and regard death as a normal process. Death is an inevitable process that everyone has to face sooner or later. With the development of society and people’s concern for the quality of life, more and more people are willing to accept hospice care as a special service of complete care. People advocate for a better life and emphasize on a better life, but neglect a better death. Through death education, people can face death objectively, consciously improve the quality of the final stage of their life journey, and bid farewell to their lives with openness and without regrets. All human beings unanimously hope that they can end their lives in a painless and peaceful atmosphere, and that they can live a more fulfilling and dignified life in their years of struggle against illness. Hospice care not only alleviates the extreme physical pain of patients, but most importantly, it gives them spiritual comfort and support, improves their quality of life, and allows them to die peacefully and with dignity. According to one hospice expert, “the mental suffering of a person before death is much greater than the physical”. Therefore, the most important thing is to give patients spiritual care when they are dying, so that they can feel the true love of the human world and spend the last journey of their lives calmly and peacefully. Conclusion In the past, the interest of the public and scholars in the field of oncology has mainly focused on radical treatment, while most of them have adopted a neglectful attitude towards terminal tumor patients, and some have even simply given up on this group of patients. It seems that both doctors and patients want to cure all patients with advanced cancer, but this is not the case, and the majority of patients fail. Palliative care, which was initiated in the 1940s, has gradually developed into one of the most important elements of comprehensive oncology treatment by focusing on advanced and terminal cancer patients with complex conditions. Tumor patients should follow this treatment process. In the first step, comprehensive assessment and correct diagnosis are carried out in multidisciplinary comprehensive oncology treatment centers; in the second step, comprehensive treatment is carried out; in the third step, the patient’s disease is stabilized and a good follow-up treatment plan is formulated to carry out regular follow-up checkups, injections of certain chemotherapeutic drugs with not too strong toxicity, or to deal with certain basic symptoms in primary hospitals. For tumor patients, especially terminal cancer patients, more attention should be paid to adding humanistic care in medical treatment. Only by addressing the physical pain and mental suffering of patients can the quality of their survival be improved. In the past, patients and their families often think that the use of painkillers is easy to become addicted, so they are reluctant to use such drugs. However, a large number of evidence-based medical studies have found that the rate of medical addiction accounts for 0.03%, coupled with the fact that chronic cancer pain is mainly treated with controlled and slow-release formulations and clinical monitoring, the incidence rate will be even lower. Physicians should educate patients and families to correct such misconceptions. It is the responsibility of every doctor and the common responsibility of the whole society to alleviate patients’ symptoms, solve their difficulties and soothe their mental pain.