Watch and Wait

Imagine being diagnosed with a life-threatening disease. Now imagine being told by consulting physicians that you should not begin any treatment yet. Instead they advise you to "watch and wait." They explain that only if your disease progresses or causes other problems should you consider starting treatment.

To people unfamiliar with indolent lymphomas and certain other cancers, this may sound crazy. Meat for malpractice, even. But it's not. There are times in medicine when you are wise to heed the adage to "hurry up and do nothing."

Given the mass marketing of the notion that "early detection saves lives," how could this be?

Watch and wait is a reasonable approach if these conditions are met:

• The disease is not causing you any problems now (i.e., the disease is not causing symptoms or damaging vital structures).
• More advanced disease responds as well to treatment as early disease (i.e., your prognosis is no better if you begin treatment right away; your prognosis is no worse if you delay treatment).
• Treatment carries risk.

Based on these three criteria, delaying treatment is a logical plan. But some patients can't bear the thought of letting a life-threatening disease (such as cancer, even an "indolent" cancer) go untreated. Tomorrow I'll discuss some tips for Healthy Survivors living in "watch and wait" mode.

Comments

[Polly Leshan]

Thanks, Wendy. We KNOW that about CLL, but it is good to be reminded from time to time that watch and wait IS the best approach. I send you JOY, Polly

[Finn]

It's also the best approach for recurrent ovarian cancer spotted through rising CA125 levels before symptoms appear. Earlier treatment offers no survival advantage, just a longer period of having to deal with chemo side effects. Even knowing this, I'm sure if my level rises my initial impulse will be to start treatment immediately. But it would be like yanking your hand back after putting it through glass: giving in to the natural impulse to act quickly just causes more damaage.

[Wendy S. Harpham, M.D.]

Great graphic image to make my point. Thanks, Finn. With hope, Wendy