Watchful waiting is an approach that involves closely monitoring a patient’s condition without giving treatment until symptoms appear or change, or until test results show changes. Also called active surveillance, watchful waiting may be a potential approach in certain cases of bladder cancer.1
Non-muscle invasive bladder cancer (NMIBC) – a type of cancer that has not invaded the bladder wall – should be evaluated to see if it is slow-growing. This is also called “low grade.”1 The grade is defined by how closely the cancer cells resemble healthy cells, with low-grade looking the most like normal cells and high-grade cancers looking the least like normal cells. Low-grade tumors tend to grow and spread slowly.2 The grade and stage (extent or spread) of the cancer is determined by looking at the cells under the microscope from a cystoscopy specimen, as well as other screening tests to determine if the cancer has spread. There is much diversity within bladder cancers that are NMIBC, and treatment is based is unique to the individual and their specific type of cancer. For people with certain NMIBC tumors that are determined to be low-risk and slow-growing, watchful waiting may be an appropriate option.1
If it’s cancer, why wait to treat?
When someone receives a diagnosis of bladder cancer, it’s natural to want to take action to treat it. However, the treatments for bladder cancer – including surgery, radiation therapy, and chemotherapy – have significant side effects and can greatly impact a person’s quality of life. Research has shown that for low-grade NMIBC tumors, watchful waiting is safe and reasonable. Not using active treatment, delaying or avoiding such treatment, improves the individual’s quality of life, and the frequent monitoring and testing enables doctors to notice if there are any changes in the bladder cancer. Some patients can delay treatment for years, and some may never need treatment.1
Understanding the risks and benefits
Every person with bladder cancer is unique, and it’s important for each individual to discuss with their doctor the risks and benefits of all recommended treatment approaches, including watchful waiting. Watchful waiting can be beneficial in delaying possible side effects, like the risk of bleeding or perforation of the bladder with surgery.1 When recommending treatment options, doctors also consider the general health of the patient and what other conditions they may have (called comorbidities). Treatments such as chemotherapy may be difficult for some people to tolerate, as they can cause significant side effects. Delaying these types of treatments may be in the best interest for the individual’s overall health, especially in cases where the type of bladder cancer is known to be low-risk and slow-growing.
The risk of watchful waiting is that the cancer may grow and spread. In general, cancers are easier to treat when they are caught in their early stages. Watchful waiting or active surveillance is not an appropriate option for people with aggressive or fast-growing bladder cancers. Another downside to watchful waiting is that it can be stressful or anxiety-provoking for the patient. Some people may find this approach difficult or impossible to manage, and they may decide to have treatment instead.3
Dealing with watchful waiting
When the recommended treatment is no treatment, but rather watching and waiting, it can be stressful for the individual who may have just learned they have bladder cancer. It can be reassuring to know that when watchful waiting is recommended, doctors know the disease can remain stable for years and the patient is not in any immediate danger. Also, watchful waiting means the patient is being closely monitored, and any changes that might indicate that treatment is needed will be found.4
It is normal for watchful waiting patients to feel anxiety or a sense of helplessness. For those who are dealing with the anxiety of watchful waiting, consider the following approaches:
Learn about your condition. Do some research and talk to your doctor to 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 may give you another option.
Consider clinical trials. There may be clinical trials that are recruiting patients with your condition who have not yet had any treatment. Clinical trials offer an opportunity to receive the latest medications and approaches.4
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, such as journaling, talking with a friend or counselor, or joining a support group.
Miyake M, Fujimoto K, Hirao Y. Active surveillance for nonmuscle invasive bladder cancer. Investigative and Clinical Urology. 2016;57(Suppl 1):S4-S13. doi:10.4111/icu.2016.57.S1.S4.
Tumor grade. National Cancer Institute. Available at https://www.cancer.gov/about-cancer/diagnosis-staging/prognosis/tumor-grade-fact-sheet. Accessed 8/2/18.
Sutton A. Watchful waiting: when treatment can wait. Center for Advancing Health. Available at http://www.cfah.org/prepared-patient/prepared-patient-articles/watchful-waiting-when-treatment-can-wait. Accessed 8/2/18.
Tompa R. When the recommended treatment is nothing. Fred Hutch Cancer Center. Available at https://www.fredhutch.org/en/news/center-news/2016/10/cancer-waiting-game-when-the-recommended-treatment-is-watch-and-wait.html. Accessed 8/2/18.