Watchful waiting
Watchful waiting is a conservative management strategy for certain cancers that involves delaying treatment for slow-growing or indolent tumors, particularly in older patients or those with significant health issues. Also known as expectant management or active surveillance, this approach is often considered for cancers like prostate cancer and Non-Hodgkin lymphoma. It entails regular monitoring through tests and assessments to detect any signs of cancer progression, allowing for timely intervention if necessary.
The main advantage of watchful waiting is the avoidance of potentially harmful treatment side effects until it is deemed essential to act, which can help preserve the patient’s quality of life. This option can be particularly appealing for individuals with other health conditions that may exacerbate the impact of cancer treatments. However, some may perceive the decision to delay treatment as risky, leading to increased anxiety and the possibility of missed opportunities for early intervention if cancer growth occurs more rapidly than expected.
Ultimately, the choice of watchful waiting is highly personal and hinges on individual comfort with the approach, understanding of the risks involved, and the ability to monitor health closely. It represents a nuanced perspective in cancer management, balancing the benefits of delaying aggressive treatment against the potential anxiety and risks of cancer progression.
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Subject Terms
Watchful waiting
ALSO KNOWN AS: Expectant management, observation, active surveillance, symptom-guided treatment, deferred treatment
DEFINITION: Watchful waiting is a conservative approach to disease management that delays treatment for slow-growing, indolent cancers and incurable cancer, particularly for older patients or patients with other serious health complications. Watchful waiting is also referred to as expectant management, observation, and active surveillance.
Usage: When watchful waiting is used with precancerous lesions, it requires frequent monitoring to ensure early intervention when signs of cancer appear. This management strategy is often an option for a variety of slow-growing cancers, such as prostate cancer. It is often used with Non-Hodgkin lymphoma as well. However, research and development of new targeted therapies for cancer treatment may reduce the need for this wait-and-see option in the future.
Treatment criteria: The watchful waiting approach is for individuals who meet disease-specific criteria for delaying treatment. For example, in prostate cancer, the prostate-specific antigen (PSA) test, the Gleason score, and PSA doubling time are used to determine when watchful waiting is appropriate. This approach is considered for low-grade cancers when the patient is asymptomatic and for older men who will more likely die of another cause due to the cancer's slow growth. Guidelines for this form of treatment involve scheduled monitoring and an established plan that is instituted to document disease growth. Laboratory studies, diagnostic imaging, and other test findings are assessed at predetermined intervals. The most important consideration is that the patient is comfortable with the option to delay treatment and is educated about the signs and symptoms to watch for that may indicate progression.
Advantages: The major advantage is the postponement of the toxic effects of therapy and cumulative doses of drugs until it is determined that the cancer is growing. The time gained can be used to evaluate treatments and make a choice before it is necessary to initiate treatment. Those with existing conditions that could make the side effects of cancer treatment worse may prefer this option to preserve their quality of life. Watchful waiting does not preclude treating other symptoms, such as pain.
Disadvantages: Delaying treatment is perceived as risky and irresponsible by some individuals. The anxiety and stress this choice would create for them make it unworkable. Also, it is possible that cancer growth could accelerate before it is detected at a regularly scheduled check-up, reducing the window of opportunity for early intervention. For others, especially those diagnosed very late in life, watchful waiting may be preferable to aggressive treatments that can compromise quality of life. The patient must be comfortable with the choice to derive the benefit of extending quality of life by avoiding the side effects of treatment. Numerous studies on patients who chose watchful waiting or active surveillance reveal the decision is personal and complex.
Bibliography
“Active Surveillance for Prostate Cancer - Watchful Waiting for Prostate Cancer.” American Cancer Society, 22 Nov. 2023, www.cancer.org/cancer/types/prostate-cancer/treating/watchful-waiting.html. Accessed 14 June 2024.
Algotar, Amit, et al. "Obesity as a Risk Factor for Prostate Cancer Progression in the Watchful Waiting Study." Cancer Research, vol. 67, 2007, p. 865.
Rittenmeyer, Leslie, et al. “The Experience of Adults who Choose Watchful Waiting or Active Surveillance as an Approach to Medical Treatment: A Qualitative Systematic Review.” JBI Database of Systematic Reviews and Implementation Reports, vol. 14.2, 2016, pp. 174-255. doi:10.11124/jbisrir-2016-2270. Accessed 14 June 2024.
“Watchful Waiting for Prostate Cancer.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/watchful-waiting-for-prostate-cancer. Accessed 14 June 2024.
“What Is ‘Watchful Waiting’ and When Is it Right for Prostate Cancer?” Dana-Farber Cancer Institute, 7 Sept. 2016, blog.dana-farber.org/insight/2016/09/what-is-watchful-waiting-and-when-is-it-right-for-prostate-cancer. Accessed 14 June 2024.