What is 'Watchful Waiting'?
- Prostate cancer: Men with low-risk prostate cancer may choose watchful waiting as a treatment option. This involves closely monitoring the cancer with regular PSA blood tests, digital rectal exams, and imaging tests to monitor the cancer's growth and progression.
- Thyroid cancer: Some cases of low-risk thyroid cancer may also be managed with watchful waiting. This involves monitoring the cancer with regular imaging tests and thyroid function tests to ensure that the cancer is not growing or spreading.
- Indolent lymphomas: Some types of slow-growing lymphomas, such as follicular lymphoma, may be monitored with watchful waiting if the cancer is not causing symptoms or affecting quality of life.
It's important to note that 'Watchful Waiting' may not be suitable for all cases of these types of cancer, and each individual's case should be evaluated by a doctor to determine the best treatment approach. In come cases, there is more frequent testing and monitoring - and that kind of watchful waiting is sometimes called, 'active surveillance'. But 'Watchful Waiting' is the more commonly used term - and not everyone can afford the more frequent monitoring, due to how insurance often limits care.
What happens during Watchful Waiting?
In general, the following steps may be involved in watchful waiting:
- Regular monitoring: The person will undergo regular tests and examinations to monitor the cancer's growth and progression. This may include imaging tests such as CT scans or MRI scans, blood tests, and physical exams.
- Observation of symptoms: The person will be asked to report any new or worsening symptoms related to their cancer, such as pain, changes in bowel or bladder habits, or new lumps or growths.
- Lifestyle changes: The person may be advised to make certain lifestyle changes to help manage their cancer and reduce the risk of it progressing. This may include adopting a healthier diet, increasing physical activity, and quitting smoking.
- Treatment decision: If the cancer begins to grow or spread, or if the person experiences significant symptoms or complications, treatment may be recommended. At this point, the person and their healthcare team will discuss the available treatment options and make a decision about which approach is best for the individual.
Watchful waiting allows individuals with low-risk cancers to avoid the potential side effects of active treatment such as surgery or radiation therapy. It's important for each person to work closely with their healthcare team to develop a personalized monitoring plan and ensure that any changes in their condition are closely monitored and addressed.
What about social support?
Family members can help by attending medical appointments with the person, taking notes during consultations, and asking questions. They can also provide emotional support by listening, offering words of encouragement, and helping the person to maintain a positive outlook.
Social support can also help the person undergoing watchful waiting to cope with the uncertainty and anxiety that may arise during the monitoring period. Friends and family can provide a listening ear and help the person to manage stress through relaxation techniques, such as meditation or deep breathing exercises.
In addition, social support can help to ensure that the person undergoing watchful waiting is following their treatment plan and maintaining a healthy lifestyle. Family members can help to prepare healthy meals, encourage regular exercise, and help the person to avoid tobacco and excessive alcohol consumption.
Overall, social support can play an important role in the success of watchful waiting by helping the person to feel more confident, comfortable, and supported throughout the monitoring process.
What if Watchful Waiting fails - and what about quality of life?
The specific treatment options will depend on the type and stage of cancer, as well as the person's individual circumstances. Treatment may involve surgery to remove the cancerous tissue, radiation therapy to destroy cancer cells, chemotherapy to kill cancer cells throughout the body, or a combination of these approaches.
The decision to begin active treatment will depend on many factors, including the stage and aggressiveness of the cancer, the person's overall health and fitness for treatment, and their personal preferences and goals.
It's important to note that even if watchful waiting fails, there are often still many treatment options available that can be effective in managing the cancer and improving quality of life. It's important for individuals with cancer to work closely with their healthcare team to determine the best treatment approach for their specific circumstances.
What is Active Surveillance, and how is it different than Watchful Waiting?
Active surveillance is a monitoring approach that is used for cancers that are believed to be low-risk and slow-growing. Under active surveillance, the cancer is carefully monitored with frequent tests, such as blood tests and imaging studies, to determine if it is growing or changing. The goal of active surveillance is to detect any changes in the cancer early, so that treatment can be started if and when it becomes necessary.
Active surveillance typically involves a more rigorous monitoring schedule than watchful waiting, with more frequent tests and appointments. The tests used to monitor the cancer may be more sensitive and specific than those used during watchful waiting, and the monitoring plan may be tailored to the individual's specific cancer and risk factors.
In contrast, watchful waiting is a more passive approach to monitoring certain types of cancer. Like active surveillance, watchful waiting involves close monitoring of the cancer, but the monitoring schedule may be less frequent, and the tests used to monitor the cancer may be less sensitive.
Watchful waiting is typically used for older or frail individuals who may not be good candidates for more aggressive treatments. In some cases, watchful waiting may be used when treatment is not expected to improve survival or quality of life, or when the potential risks of treatment outweigh the potential benefits.
Overall, active surveillance and watchful waiting are similar approaches to monitoring low-risk cancers, but active surveillance is generally a more active and rigorous approach to monitoring, while watchful waiting is a more passive approach.
The specific approach used will depend on the individual's cancer, health, goals of care - and also the patients insurance. Insurance (in the USA) is lowering quality of care, by limiting testing and treatments - unless the user has considerable out-of-pocket expenses. Even Medicare is adding more restrictions on testing. In most other countries in the world, cost of care is not an issue.