Cancer and Watchful Waiting

Guest Post by Kevin McLaughlin
Executive Editor, Cancer Today

When my father was diagnosed with prostate cancer, alarm bells sounded because my mother had died of metastatic colorectal cancer just a few years before. Surely, I thought, doctors would act quickly to remove my father’s prostate and save his life. Imagine my surprise when the oncologist recommended no treatment at all. My father had an indolent tumor, the doctor said, the slow-growing kind that doesn’t need immediate medical attention. Let’s just watch and wait, he advised.

Photo by Vera LaMarche

Photo by Vera LaMarche

Watchful waiting, or a more rigorous approach sometimes called active surveillance, has become a common choice for men with low-risk prostate cancer. Research published in the July 7, 2015, Journal of the American Medical Association found that about 40 percent of men with low-risk prostate cancer chose active surveillance from 2010 to 2013, up from about 10 percent from 2005 to 2009.

But as Cancer Today contributing writer Heather Stringer found, most of these men have the waiting part down pat, but haven’t quite mastered being watchful. Stringer reported that a study published in the Dec. 1, 2015, Cancer found that “less than 5 percent of men undergoing active surveillance met the study’s definition of adequate follow-up: a doctor’s appointment and a PSA [prostate-specific antigen] test every six months and a second biopsy within two years of their initial diagnosis.”

Active surveillance isn’t confined to patients with low-risk prostate cancer. Contributing editor Sue Rochman reported that a similar approach is being taken with patients who have certain types of slow-growing blood cancers. Research has found that early treatment of these patients before symptoms develop doesn’t improve survival and can expose them to treatment-related side effects. These patients experience no gain and a lot of pain. But again, blood cancer patients who are waiting need to be watchful by adhering to the follow-up protocol recommended by their health care team.

Watchful waiting is sometimes referred to as watchful worrying. For my father and the family, there was some worry about our choice, but it turned out to be the right one. He died in 2006 of causes unrelated to his prostate cancer. Of course, for some patients, quick action is required and active surveillance isn’t an option. Other patients may want to be treated for their cancer right now, even if active surveillance is possible.

In the end, it should be the patient’s decision to make after consulting with his or her health care team, family members, and friends. But if active surveillance is the choice, it’s vital for patients to follow a regular schedule of doctor visits and testing.

Kevin McLaughlin is the executive editor of Cancer Today, the quarterly magazine for cancer patients, survivors, and caregivers published by the American Association for Cancer Research (AACR). You can read his complete column in the summer 2016 issue of Cancer Today.

A recent study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the AACR, explored some of the factors that influence patients’ choice of active treatment or active surveillance for low-risk prostate cancer. The full study is available online.