How scary is oncology chemotherapy? As a medical oncologist, I have been asked this question by many patients. Chemotherapy is very scary in the minds of many people, and some even believe that it is worse than the tumor itself. I can’t count the number of patients who have chosen to give up or terminate chemotherapy on their own. It hurts! I have wanted to write such an article for some time. First, let us clarify the purpose of chemotherapy for tumors. Some tumors, including advanced ones, are curable, such as lymphomas, leukemias, reproductive tumors and many tumors that occur in children. Chemotherapy plays a decisive role, without it there is only death and with it there may be a complete cure. This kind of radical chemotherapy is so dose and toxic that patients often can’t stand it, and the treatment risk is so high that it is often a death ordeal, so we call it “dying and living”. In addition, most early and mid-stage solid tumors such as gastrointestinal cancer and breast cancer can be treated with chemotherapy on top of surgery or radiotherapy to improve the cure rate or resection rate and reduce the risk of recurrence. Recently, some advanced solid tumors such as colorectal cancer can even be cured by chemotherapy and radiotherapy combined with surgery. Specific evaluation must be done by a specialized medical oncologist. The intensity of this chemotherapy dose is important and therefore cannot be easily postponed. There are also advanced solid tumors where chemotherapy aims to prolong survival and improve quality of life. These chemotherapies tend to be less toxic and can be treated by a medical oncologist on an individual basis. The average life expectancy of advanced solid tumors without chemotherapy is four or five months, and chemotherapy usually increases life expectancy by six months to two or three years. Some patients can even achieve long-term survival with the tumor. Many patients are able to control their symptoms and improve their quality of life through chemotherapy. Second, whether chemotherapy is intolerable. The doses of chemotherapy are experimented and summarized in clinical studies of hundreds, thousands or even tens of thousands of people. Most people can tolerate chemotherapy according to this standard. Generally speaking, bone marrow toxicity, gastrointestinal reactions, and hair loss are the most common toxicities. The current big advances in antiemetics and whitening injections have made these toxicities minimal. Follow the doctor’s instructions, review the indicators on a regular basis, and treat the side effects promptly if they occur. The main responsibility of medical oncologists is not only to improve the efficacy but also to control the toxicity. Some patients with heterogeneous body, poor physical condition or combined with other diseases may have some major reactions. The medical oncologist will adjust the dose and intensity according to individual conditions. The patient’s physical condition will never be disregarded for the sake of anti-tumor. Again, chemotherapy does not cure everyone. This is a reality that is difficult for many people to accept. But the fact is the fact, and it will not change just because we don’t like it. Even with the most effective regimen, there will always be some people who do not benefit from chemotherapy and progress while on it. The human body is one of the most difficult disciplines, and the scope of what scientific research can currently achieve often leaves us helpless. Doctors must share the best intentions of patients and families, but they cannot help but feel that there is nothing they can do. Some people will ask why the effect of chemotherapy can only last for a while and why the condition of chemotherapy is getting worse and worse. In fact, this is determined by the tumor itself. Even the best drugs cannot be effective in all people, tumor cells are too smart to keep “changing” and keep producing drug-resistant mutations. The progression of the tumor will make the patient’s body function gradually worse and deteriorate, and this process is sometimes difficult to intervene. Treatment by doctors sometimes depends on the attitude of the patient, and in many cases, the family. Families who trust and obey their doctors completely usually have better outcomes for their patients. Finally, this life is once for all, and the choice should always be made by the adult patient himself. However, the national situation often prevents us from informing the patient of the details of his or her condition, and the family often imposes itself on the patient with self-awareness. The medical and insurance situation in our country often makes doctors not only talk about options but also about prices. This is actually a very annoying part of the process that doctors can’t help but talk about. Some patients even have misunderstandings as a result. In addition, patients often misunderstand clinical research, the main purpose of which is to further improve outcomes, generally by seeking to add to the current best treatment or to provide a possibility for patients who have tried all the standard treatments and have run out of options. All new drugs are subject to clinical trials before they become standard of care. All drugs have been tested in animal studies to confirm safety, but of course some unforeseen toxicity may occur in individuals, and it is the patient’s choice whether to participate. Without clinical trials there would be no medical progress.