Watchful Waiting Benefits and Risks

Watchful waiting is a term used to describe a period during which a person is closely monitored by his doctor, but no specific medical treatment is given unless symptoms arise or change. It may also be referred to as "active surveillance" or "expectant management." The term watchful waiting is used in medicine for both cancerous, precancerous, and non-cancerous decisions.

Examples

Watchful waiting may be considered, for example, if an individual is found to have a solitary pulmonary nodule on a CT scan of the chest that is unlikely to be cancerous. This may be the best option if the nodule is small (for example, less than 5mm), or if it has characteristics of a benign lung nodule.

While watchful waiting is discussed often with prostate cancer, it is considered less frequently with lung cancer, especially with early-stage lung cancers that have the potential to be cured by surgery and have a low survival rate if left untreated. Watchful waiting may at times be considered if a lung cancer is not likely to be cured by surgery, and immediate treatment is likely to cause more symptoms or discomfort than cancer itself.

Watchful waiting is also a commonly recommended approach for slow growing, or "indolent" lymphomas, such a low-grade follicular lymphoma, and chronic lymphocytic leukemia when no symptoms are present.

Watchful waiting may be considered for some precancerous conditions where the likelihood that they will become cancerous is small (and with careful surveillance, would still be caught very early if it did).

Non-cancerous medical conditions may also be treated with this approach. For example, with an incomplete miscarriage, watchful waiting may be used to see if the miscarriage proceeds naturally rather than using medications or a D and C. It may also be used for ear infections, asymptomatic kidney stones, and other conditions.

Benefits

If a disease is not any more likely to kill you or make you sick without treatment—and this is important to understand well—there are the advantages to choosing no treatment. These can include:

  • No side effects
  • Less chance of developing resistance to medications that might be used later on (this is a very important reason why watchful waiting may be chosen)
  • Fewer clinic/hospital visits
  • Better quality of life
  • Less cost to you

Watchful Waiting Is Not...

There are a few questions friends and family will ask almost immediately upon hearing of your decision for watchful waiting, so it's helpful to talk about what watchful waiting is not.

  • It is not that there are no treatment options
  • It is not that you are too old
  • It is not that you are too sick
  • It's not that your cancer is too advanced to be treated
  • It is not that the treatment is too costly

Watchful waiting does not mean that you will not receive medical care. In most cases, people will have regular clinic visits along with lab and/or imaging tests, to determine if active treatment is needed down the line.

Definition Clarification

Most often, watchful waiting and active surveillance are used interchangeably when talking about treatment. In some cases, however, oncologists may make a distinction, with active surveillance being the term used as described below, and watchful waiting used to describe a setting in which treatment could be started, by is put off due to age or medical conditions that would make treatment poorly tolerated. While the distinction is often made with regard to prostate cancer, a 2018 study found that follow-up was the same whichever term was used.

Risks

The major risk associated with watchful waiting is that a known or precancerous tumor will grow and spread. When watchful waiting is used appropriately, for example, with prostate cancer, it does not increase the chance that a person will suffer or die from the cancer any more than if treatment was started right away.

There can be anxiety associated with watchful waiting, and this can increase when family and friends ask you why you aren't undergoing active treatment. Taking the time to ask questions, and understanding your condition, however, can often alleviate this anxiety. It's important to note that when watchful waiting is used for cancer, it is considered a type of treatment.

Questions to Ask

If you are considering a wait and watch approach, consider asking your doctor these questions.

  • What do you expect will happen if I wait?
  • What will happen if my condition progresses?
  • Could it lower my survival if I choose to wait for treatment?
  • Will waiting make it harder to treat my condition later on?
  • What can I do while I wait? Do a good diet and exercise have any role in my disease?

Support

It can be very hard emotionally to choose a wait and watch approach to diagnosis or treatment. If you are coping with cancer, you realize how the public is programmed that we need to treat cancer aggressively and fast. Take time to weigh the pros and cons of your decision carefully. Ask your friends and loved ones for their input, but the decision must be your own — what you can live with yourself. This can be difficult if others have opinions which differ. Some people find that talking to a social worker or connecting with others via social media who are coping with a similar situation helpful.

You may feel like you are going backward in choosing a watchful waiting approach, but you may think of it differently. With advances in medicine, we are learning that sometimes the best treatment is truly no treatment. Hippocrates was aware of this in writing the Hippocratic oath, but some of that wisdom has been lost in our current age in which it seems more is better and aggressive is good.

A Word From Verywell

Watchful waiting or active surveillance may be the "treatment of choice" in a number of benign, precancerous, and cancerous settings. It does not mean foregoing treatment, but rather, can make it more likely that active treatment will be effective if and when needed.

Also Known As: wait and watch, WAW, expectant management, observation, active surveillance

Sources:

Cooperberg, M. Long-Term Active Surveillance for Prostate Cancer: Answers and QuestionsJournal of Clinical Oncology. 2015. 33(3):238-240.

Herden, J., and L. Weissbach. Utilization of Active Surveillance and Watchful Waiting for Localized Prostate Cancer in the Daily Practice. World Journal of Urology. 2018. 36(3):383-391.

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