The Weirdness of Watching and Waiting

Not all cancers are treated quickly…

Lord Saatchi, the advertising mogul who lost his wife to cancer, has likened chemotherapy to medieval torture. As we saw in my last post, drugs like bendamustine are becoming more targeted, but still chemo is a blunt instrument. It does a lot of harm to other, perfectly healthy parts of your body, your immune system for example, as well as hitting cancer cells. This is a price worth paying perhaps if it is going to put your cancer into remission.

But not all people diagnosed with cancer are treated with chemo, or treated at all. Some 15,000 people in the UK are on what is known as a watch and wait routine, which is a bizarre state of affairs where your cancer is diagnosed but then left alone. This is counter-intuitive, in that we all know people die because their cancers are not spotted until too late. Early treatment surely makes the difference between a good and bad prognosis. So why delay? It seems strange, even reckless, to defer the inevitable, especially since the disease is still advancing.

…in fact, treatment can be postponed for as long as possible

For certain types of blood cancer, however, doctors say it does make sense to postpone treatment for as long as possible. These diseases have different properties from solid tumours that you might find in bowel, brain or breast, for example. With the latter, doctors will move as quickly as possible to excise the cancer, and treat the patient thereafter with radiotherapy and or chemo to mop up any remaining malignant cells. But blood cancers have often spread far and wide through the body by the time they are discovered, without cohering into one big lump that constitutes a target. Since there is often no prospect of a cure, there is no point in using up the arsenal of possible treatments before absolutely necessary.

Under these circumstances, the doctor’s job is to keep it under control and treat it when necessary, so it doesn’t get out of hand. Studies show that early deployment of chemo or similar conveys no advantage in terms of long-term survival, when compared to being treated later on. And in the meantime, the science of drugs medicine is advancing rapidly, which means that by the time you stop watching and waiting, there may well be new drugs available that will prolong your life.

But this is little consolation when you find yourself in the bizarre position of having advanced incurable cancer, yet being left alone as if the disease had never existed. One doctor told me his patients thought he was mad when he told them they were going on this regime: my sentiments exactly. In the battle with cancer, the enemy is identified, the guns cocked and loaded, but we’ve decided to hang out and be peaceful for a while. Meanwhile, you check your body every morning for lumps and bumps. Not for nothing is watch and wait often called the watch and worry regime.

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