Research has shown that for patients with chronic lymphocytic leukemia (CLL), whose disease is not acting aggressively, immediate treatment is not always the best approach. This may seem confusing or concerning for patients and their families who want to begin treatment as quickly as possible. Sarah Cannon blood cancer experts answer common questions regarding this treatment approach.
"Watchful waiting is a way to decrease the overall exposure a patient has to treatments," says Michael Tees, MD, a transplant hematologist at the Colorado Blood Cancer Institute. "Over the past 10 years, we have identified that this strategy likely provides a benefit to patients by decreasing the amount of therapy without affecting the overall survival."
Ian Flinn, MD, PhD, Director of the Blood Cancer Research Program at Sarah Cannon Research Institute explains that after the first consultation, he sees patients with CLL every three months for the first year and every six months after that. If symptoms begin appearing or anything changes, he recommends that the patient comes in more frequently, and discusses treatment options. The average patient may use the watchful waiting approach anywhere from one to five years.
"Studies show that early treatment for CLL is effective, but not any more so if you begin treatment before symptoms start appearing," said Dr. Flinn. "If we wait until a patient has disease symptoms and then treat the patient at that time, the overall success is just as high and a patient may have gone for years without the side effects of treatment."
Temporarily waiting for treatment may still make patients anxious.
"In many regards, watchful waiting is an excellent strategy, but of course there are concerns by patients about sitting on a disease," said Dr. Tees. "In order to combat their anxiety, we tailor our approach to each patient so he or she understands the rationale."
"It's a difficult conversation to have, because anyone who researches cancer, learns that early treatments usually lead to better outcomes," says Dr. Flinn. "But this is not the case for all cancers, especially certain types of blood cancer. We walk through the options with our patients and provide them with the latest data related to their disease. Upon review of options, it's rare for a patient to disagree with the watchful waiting treatment approach."
Blood cancer specialists assess each patient to develop a treatment plan and timeline specific to their cancer and health.
"Through proper management and observation, CLL can be managed,"says Dr. Tees. "It's possible for a patient to have a more aggressive disease, but in that case, we identify those patients and provide treatment options early, usually bypassing watchful waiting altogether. The best thing you can do if you have CLL is to see a blood cancer specialist and design an individualized treatment plan together."
It is important to keep in mind that watchful waiting can be part of the middle of the treatment process, the beginning or the end, depending on the specific patient.
Talk with your blood cancer specialist to determine what treatment plan is best for you.