Senior man waits at station for train to arrive

Watchful Waiting Treatment for Non-Hodgkin Lymphoma Patients

Watchful waiting is a form of active surveillance that can be used for the non-Hodgkin lymphoma (NHL) patient when there is no immediate threat to the patient’s health. 20% of non-Hodgkin lymphoma patients may have no symptoms and have a longer median survival. Watchful waiting is recommended for those NHL patients with low tumor burden. Research studies have demonstrated that treatment delays as long as three years were associated with similar overall survival rates as compared with immediate initiation of chemotherapy.1

Watchful waiting can be challenging

Results of the National Lympho Care Study suggest that watchful waiting is an acceptable treatment option for select patients and it may maintain quality of life and reduce medical costs.

The study included 1754 patients, 22% were assigned watchful waiting, 17% received the medication rituximab alone, and 61% received chemoimmunotherapy. The long-term follow-up survival data from this study, using a multivariate analysis revealed no significant difference in overall survival.

Therefore, those patients with less aggressive features, with low tumor burden may have no survival benefit with immediate treatment.

However, the patient must accept living with untreated cancer as a trade-off to avoid the immediate risk from treatment. I was shocked and disturbed with the notion of having cancer when diagnosed and told that treatment would be delayed. I had trouble wrapping my head around this concept. It was not until I reviewed the published literature that I began to understand.

This approach can be challenging. Reassurance can be provided by patient support groups, online communities like Blood-Cancer.com, and individual and family counseling. As a Leukemia and Lymphoma, First Connection volunteer, I have listened to and supported patients who verbalized concern.

Harm will not come from waiting to start treatment

We know from research that harm will not come from waiting. Some physicians have compared NHL to a chronic disease such as diabetes or hypertension.

With watchful waiting, you do not have to deal with treatment side effects such as hair loss, infections, and nausea.

Even though the patient is not receiving actual treatment, the patient will visit the physician every three to six months for physical assessments and laboratory work. The oncologist will ask the patient to report any symptoms such as, fatigue, changes in or swelling of lymph nodes, loss of appetite, weight loss without trying, feeling itching, or night sweats.

This “hands-off approach” has been proven to work just as well in select patients without the risk of side effects. My watchful waiting lasted one year when my lymph nodes became larger as my disease progressed. I then began chemotherapy and immunotherapy.

Research continues in the treatment of NHL. It is our hope that while waiting for treatment, other breakthrough treatments are in the pipeline.

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