Tehran University of Medical Sciences Basic & Clinical Cancer Research 2228-6527 17 1 2026 04 27 241 243 Seyedeh Golnaz Ziaei Division of Palliative Medicine, Radio oncology Department, Tehran University of Medical Sciences, Tehran, Iran Mamak Tahmasebi 2025 10 12 2026 01 23 Modern medicine, despite its numerous benefits, often places oncologists in complex clinical scenarios. These situations require intricate choices to ensure patients receive optimal treatment. Advanced cancer patients, especially in borderline situations of expected benefit or increased risk of complications, face unique challenges.1 Overtreatment and undertreatment represent the two extremes of the therapeutic spectrum, both of which signify suboptimal management of cancer patients. These concepts vary significantly across different medical disciplines, healthcare providers, and patients, as there is no universally accepted definition.2 Oncologists undertake complex decision-making processes following detailed discussions with patients and their families, aiming to find the optimal balance in the therapeutic strategy. The question arises: Is it appropriate to recommend a new line of treatment for all cancer patients in the same manner, including elderly advanced cancer patients with comorbidities? As a palliative medicine specialist working in a government hospital in a developing country, when I consult with elderly advanced cancer patients who are resistant to the first-line available treatment, a primary concern for both patients and their relatives is whether to initiate a new, costly treatment with potentially unknown or limited efficacy, as recommended by the oncologist. From an ethical perspective, in some cases, the recommended treatment by oncologists may not be appropriate. This can be evaluated by considering the four fundamental principles of ethics: autonomy, beneficence, non-maleficence, and justice. https://bccr.tums.ac.ir/index.php/bccrj/article/view/583