Also referred to as 'watch-and-wait', 'active surveillance' and sardonically as 'watch-and-worry', watchful waiting refers to the practice of withholding treatment for cancer until the patient becomes symptomatic or tests indicate that the cancer is spreading.
For example, during a routine exam a doctor may find something that makes him suspicious for a certain cancer, and later tests verify a positive diagnosis but the cancer is indolent, or very slow-growing, or the condition may be pre-cancerous, raising a dilemma that is currently unresolved: treat the patient with chemotherapy or other hardcore modern anti-cancer therapies and assume the associated risks, or do nothing and wait. Thus the term.
In general, watchful waiting includes regularly scheduled check-ups, scans, blood work and biopsies in an effort to keep as close an eye as possible on the progression of the disease.
What 'watchful waiting' is effective for and why
Watchful waiting is only practical in situations where this is a diagnosis of an indolent cancer, or in situations where lab work has uncovered a pre-cancerous condition. In the first instance, patients diagnosed with follicular lymphoma are often subject to watchful waiting because this non-Hodgkin lymphoma subtype tends to be so indolent, and free of any symptoms, until the disease reaches stage IV, when the patient may finally become symptomatic. In the second, perhaps the most predominant example of the last few decades is in cases of prostate cancer; a positive PSA (prostate-specific antigen) test can be indicative of prostate cancer, but it can also indicate a pre-cancerous condition that will never develop into prostate cancer.
Given the severity of treatments currently available to treat these cancers, caution—in the form of watchful waiting—often is the most sensible course of treatment, but this hardly means that it is an easy or palatable course for the patient.
Side effects
The most significant 'side effects' of watchful waiting are probably psychological: many patients who are put on this kind of active surveillance endure varying levels of stress and anxiety that have a negative impact on their quality of life. it becomes difficult to live a normal life with the knowledge of cancer looming over one's shoulder. Furthermore, there is concern that watchful waiting may result in medical intervention that proves too late to be effective.
Sources
Studies relevant to watchful waiting
