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Published: March, 2019; Vol 15, Num 10

 

What Is Watchful Waiting and Is It Right for You?

Thanks to advances in medical technology, many health conditions are now being detected earlier when they are most treatable. But rather than rushing to prescribe medications or surgery, health care providers may choose to monitor the condition to see whether symptoms progress, stay the same or improve on their own. This type of treatment is called “watchful waiting” or “active surveillance” and while some people may think it means “do nothing,” watchful waiting allows health care professionals and patients to learn more about the condition and plan how to manage it.

Why It Could Be Better to Watch

Watchful waiting is sometimes used when serious conditions are known to be slow-growing, like certain types of prostate cancer. It’s also used when the risks of aggressive treatment are greater than the benefits. For example, many cancer treatments can cause permanent side effects including heart failure, hormone problems and infertility. If a cancer isn’t likely to progress or it isn’t believed that a patient needs to undergo surgery until later, a health care provider may recommend starting with a regimen that could include checkups, blood tests, biopsies and imaging exams.

Watchful waiting is also sometimes used when treating certain heart conditions. For example, less than half of people with abdominal aortic aneurysms require surgery within the first three years of diagnosis. During this time, a health care provider may require scans every six to 12 months and might prescribe medications to lower blood pressure and cholesterol levels, which can help slow the growth of the aneurysm.

What to Do if You’re Asked to Practice Watchful Waiting

Questions to ask if your health care provider suggests watchful waiting include:

  • What is the expected course of this condition or disease?
  • If I wait, will my condition be harder to treat later?
  • What types of monitoring will I receive?
  • Are there therapies or activities I can do to slow or halt the course of my condition or disease?
  • At what point would you recommend I move to more aggressive treatment?

During watchful waiting, the patient may also be asked to keep a diary related to their symptoms and record any problems they experience. They may also be encouraged to adopt lifestyle changes that include eating a better diet, achieving a healthier weight, exercising on a regular basis and managing stress. Through watchful waiting, some people are able to delay aggressive treatment for months or even years. Others may never need anything more than close monitoring.

“Watchful waiting may allow people to have a good quality of life and have the tumor completely arrested,” said Dr. James Studts, a psychologist who treats oncology patients. “Take diabetes. You don’t cure diabetes, you manage it. With cancer, maybe we don’t have to get it all, maybe we can arrest it or stop it so it doesn’t spread or doesn’t affect major organ systems.”

Watchful waiting is also sometimes used as a precursor to treating conditions with antibiotics and opioid pain relievers, which can contribute to antibiotic resistance and addiction. Conditions like kidney stones, which will often pass on their own (you may be asked to increase your water intake) and lower back pain, which often resolves with time, are also candidates for watchful waiting. Watchful waiting may be used when treating minor illnesses in children like ear infections that may go away on their own. The health care provider may prescribe an antibiotic and ask the parent to wait a few days to see if the child’s immune system can resolve the condition.

As with all types of medical treatment, watchful waiting is not without risk. Cancers may progress faster than anticipated. People suffering from back pain may need surgery. If your health care professional recommends watchful waiting and it doesn’t feel right to you, get a second opinion. You have the final say in your (and your children’s) medical treatment. If you’re not comfortable, get more information before making your decision.

[Janet Lubman Rathner]