Active monitoring is sometimes known as ‘watch and wait’. This approach is most often used in patients who are diagnosed with an indolent (slow growing) lymphoma.
Understanding watch and wait (active monitoring)
Active monitoring is sometimes known as ‘watch and wait’. This approach is most often used in patients who are diagnosed with an indolent (slow growing) lymphoma. This approach is used for those who do not have many symptoms or risk factors that require immediate treatment. It is known as ‘watch and wait’ because the doctors will ‘watch’ or monitor the patient and their symptoms and ‘wait’ to treat until the lymphoma is causing problems.
It can be difficult to think of having no treatment for lymphoma. The watch and wait approach does not mean nothing is done, as the doctor is still actively monitoring the patient. Patients are seen regularly by their doctors and are very closely monitored for signs of the lymphoma progressing (getting worse) or causing symptoms that are affecting the body. In addition to the doctor monitoring the symptoms, patients should be monitoring their health as well. The doctor should be notified of any changes or concerns. Many patients will eventually need to have active treatment such as chemotherapy and immunotherapy for their lymphoma. However, some patients with indolent lymphomas never require treatment.
Prof Judith Trotman, Haematologist, Concord Hospital, Sydney
Why is watch and wait used?
In most cases Indolent (slow growing) lymphoma is not curable. Patients may often require periods of treatment and active monitoring over many years. Studies have shown that patients who are commenced on a ‘watch and wait’ approach have similar survival outcomes to patients who are treated early in the course of their lymphoma.
The advantage of waiting to treat the lymphoma is avoiding unwanted treatment side effects and having more treatment options when it comes time to treat the lymphoma.
Who may be treated with the ‘watch and wait’ approach?
Watch and wait or active monitoring, is an approach for patients with indolent lymphomas such as:
- Follicular lymphoma (FL)
Marginal zone lymphomas (MZL)
- Chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL)
- Waldenstroms macroglobulinemia (WM)
- Cutaneous T-cell lymphoma (CTCL)
- Nodular lymphocyte depleted Hodgkin lymphoma (NLPHL)
It is only suitable for patients who are not having any troublesome symptoms. Symptoms that may make the doctor to decide to treat the lymphoma can include:
- Experiencing B symptoms (drenching night sweats, persistent fevers & weight loss)
- Problems with blood counts
- Organ or bone marrow damage because of the lymphoma
What does watch and wait involve?
Patients who are being actively monitored as a ‘watch and wait’ approach will have regular appointments with their doctor. These usually occur every 3-6 months. At these doctors’ appointments the following may be needed:
- A blood test to check general health
- A physical exam to check for any enlarged lymph nodes or signs of progression
- A physical examination & medical history
- Measure blood pressure, temperature, and heart rate
- Check for any B symptoms
- Depending on the patient a CT scan or a PET scan may be ordered
If there are any concerns in between appointments please contact the treating team to discuss this, do not wait until the next appointment.
The ‘watch and wait’ approach may initially cause distress for some patients as it may seem a risky or passive approach to a serious disease. It is important to remember that this approach is a standard way to manage many people diagnosed with indolent lymphoma. Any concerns can be discussed with the treating team.