If your CLL is slow growing and not causing you serious symptoms, you likely will not have treatment right away. This approach is called ‘watch and wait’ or ‘watchful waiting’ or ‘active monitoring’.
Watch and wait is the recommended care for those who feel well, have acceptable blood tests, have small lymph nodes that are not causing problems or growing rapidly, and have no significant problems with their liver, kidneys or other organs.
Watch and wait is a strategy where doctors monitor you closely, but do not treat you until symptoms appear or change.
This does not mean your cancer is being ignored by your medical team. During the watch and wait period, you will meet regularly with your cancer specialist to monitor changes in your disease and overall health. At these appointments, your doctor will examine you and do blood tests. They will also ask how you are feeling and about any symptoms you have.
The results of exams and blood tests over time will help your doctor determine if you need treatment and the type of treatment you should have.
Once a patient has been treated, the watch and wait phase starts again, as their medical team will begin to monitor them for a potential return of their cancer.
Understandably, many people worry their CLL will get worse if they don’t have treatment. It is natural to want treatment if you have cancer. Clinical trials comparing watch and wait with early treatment have shown there is no benefit to early treatment for patients with asymptomatic CLL.
The advantages of watch and wait are:
- Therapy can be as effective if it is only started when symptoms begin or there’s evidence of advancing disease;
- You avoid treatment side effects, which can make you feel less well and could limit future treatment options;
- It’s feasible that other treatment options may become available when it is eventually time to treat;
- Your quality of life is likely to be better since you don’t have to go to the hospital for treatment and will not experience any treatment side effects.
The average time people are on watch and wait varies so it is impossible to say how long you will be monitored this way – it may be months or it may be years. Some patients never require treatment as their disease remains stable and they have manageable symptoms or do not experience any symptoms.