Watchful Waiting

Reviewed by: HU Medical Review Board | Last reviewed: May 2023

Watchful waiting is an approach that involves closely monitoring a person's condition without giving treatment until symptoms appear or change. This may also be referred to as active surveillance.

Watchful waiting is a potential option for some slow-growing (indolent) blood cancers, including certain cases of:1-4

Some people with certain blood cancers may manage their condition for years with a watchful waiting approach. When watchful waiting is recommended for a person with blood cancer, doctors will monitor the person's health with regular doctor visits, including physical exams and lab tests. If symptoms appear or worsen, additional treatment options may be recommended.5

Doctors will monitor for signs and symptoms, such as:

  • Swollen lymph nodes or certain lymph nodes increasing in size
  • Changes in blood cell counts
  • Enlarged spleen
  • Fevers and drenching night sweats

When watchful waiting is appropriate

Watchful waiting is not the right option for all blood cancers. However, it may be appropriate in cases where the blood cancer is slow-growing or where there are no noticeable symptoms from the cancer. Researchers have realized that in cases like these, earlier treatment may not change a person's chance of survival. Delaying treatment can provide a better quality of life for the present. This is because people may be able to avoid receiving certain drugs and experiencing potential side effects until later.5-7

For people who are good candidates for watching and waiting, the risks of certain treatments may not outweigh the benefits. Each person should talk with their doctor about the risks and benefits of treatment and how they relate to their unique situation.5-7

Dealing with watchful waiting

When the recommended treatment is no treatment, but rather watching and waiting, it can be stressful. This can be especially true if you may have just learned you have blood cancer. It can be reassuring to know that when watchful waiting is recommended, doctors know the disease can remain stable for years and you are not in any immediate danger. Also, watchful waiting means you are being closely monitored, and any changes that might mean treatment is needed will be found.6

It is normal for people under watchful waiting to feel anxiety and a sense of helplessness. If you are dealing with the anxiety of watchful waiting, consider the following approaches:6

  • Focus on the areas of your health you can control, including diet, exercise, and stress management. This can improve your overall health and give you a sense of empowerment.
  • Learn about your condition. Do some research and talk to your doctor. This can help you gain an understanding of the risks and benefits of treatment approaches, including watching and waiting.
  • Get a second opinion. Seeking another opinion from a different doctor may confirm the approach to watch and wait, or it may give you another option.
  • Consider clinical trials. There may be clinical trials that are recruiting people with your condition who have not yet had any treatment. Clinical trials offer an opportunity to receive the latest drugs and approaches.
  • Find ways to express your emotions. Rather than bottling up your emotions like frustration, worry, fear, and anger, find healthy ways to work through them. Try journaling, talking with a friend or counselor, or joining a support group.

Talk to your doctor if you have any questions about your treatment or the watchful waiting approach. While you do not receive active treatment during watchful waiting, you should still tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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