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Watch and Wait

written by

Leukaemia Care, Charity

  • Couple with doctor Large

Written by Faye Kirkland, GP

This form of management is normally chosen when the type of disease is known to progress very slowly even without treatment, where the disease is stable or known to be non-aggressive or where patients are well and aren’t experiencing physical symptoms resulting from their disease. They are closely monitored so if this changes, medication can be given. An example of where this is commonly used is with chronic lymphocytic leukaemia (CLL) patients. CLL is often found in older patients, incidentally, when routine blood tests are taken.

Research shows taking a watch and wait option is very safe. Patients who are regularly monitored do as well as those who are given immediate chemotherapy. An advantage is that it prevents patients having unnecessary treatments and potential side effects. In addition, early chemotherapy can lead to resistance. This is where the medication may not be as effective if given on another occasion, when it may really be needed.

Some patients cope well with this treatment but each person’s response is different. At such a stressful time, patients often describe feelings of isolation or anxiety if they are put on a watch and wait list. They worry this is a palliative care option, which it isn’t, as active treatment is given if needed. Concerned relatives or friends ask why they’re not having immediate medication, which heightens patient’s anxieties. In many cases, anxiety often rises from the terminology ‘watch and wait’. With this in mind, the phrase active monitoring is more useful.

If you are having this form of treatment, you will have regular hospital visits. How often you are seen depends on how stable your illness is. The doctor will want to know how you’re feeling, look at your blood test results, along with an examination. They will discuss the results with you, so together you can decide on the best course of action. Patients will usually benefit if they keep a record of their results, so they can keep track of how they are feeling which in turn can help them to regain some control. It’s also useful to take someone along with you, as they often remember information you don’t. Decisions on your management plan will also be influenced by your age and overall fitness. In fact, some patients will never progress to needing treatment.

The guidelines around watching and waiting are constantly being reviewed. New methods are being developed that enable specialists to identify which patients have a disease that is likely to progress, and target this group for early treatment.

An important message to get across is that you’re not alone at any stage in your treatment pathway. Your family doctor will be copied into letters from hospital care and so will be aware of your situation. Discussing concerns or questions about your care plan with your GP, a specialist nurse or doctor is vital to alleviate any worries, issues or concerns you might have.

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