Watch and wait

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Observing and waiting ( English watchful waiting or active surveillance ) describes a special treatment strategy in medicine in which an illness is initially not treated ( therapy ), but the course of the disease is checked at regular intervals ( diagnosis ). If certain diagnostic parameters are reached, therapy can be initiated.

Description and examples

Observing and waiting is particularly indicated in the case of illnesses

  • who have a high probability of early self-healing or
  • in diseases for which there is a high uncertainty of diagnosis or
  • in diseases in which the therapy is associated with a high risk, or the risk and the expected side effects of an intervention are greater than the advantages of the intervention.

For example, observation and waiting can be used in prostate cancer . With this concept, it is agreed between the patient and the doctor that initially there will be no therapy, but that the tumor growth will be monitored through regular diagnostics ( palpation , imaging procedures , tumor markers ( PSA ), etc.). Watch-and-wait is primarily used for relatively small, well-differentiated prostate tumors when the patient's remaining life expectancy is less than ten years. The potential side effects ( impotence , incontinence ) of a surgical procedure can have a significant impact on the patient's quality of life . If necessary, therapy can be postponed until it becomes necessary. The background to this approach - called active surveillance by some authors - is that small, well-differentiated prostate tumors do not progress to the point where therapy is even necessary. The probability that the patient will die of another disease is comparatively high. In the event of a relevant tumor progression - with the patient's consent - the therapy is carried out.

With watchful waiting , on the other hand, disease management is largely palliative for patients of advanced age and high comorbidities . There is no curative treatment. Hormone withdrawal is only done when the patient becomes symptomatic.

Other examples of conditions where watch-and-wait may be an option include hemangiomas , mood disorders, and renal cell carcinomas (where the tumor is less than 4 cm in diameter).

Demarcation

In contrast, with the wait-and-see strategy, the primary tumor is removed immediately, but further therapeutic measures ( radiation therapy and chemotherapy ) are initially dispensed with. The further course is also observed here by means of close-knit examinations in order to apply further therapeutic options if necessary. An example of such a tumor is a non-metastatic seminoma. However, the terms are often mixed up in daily practice.

Individual evidence

  1. ↑ Hans U. Schmelz, Christoph Sparwasser, Wolfgang Weidner (eds.): Specialist knowledge of urology: Differentiated diagnostics and therapy. 2nd edition, Springer, 2010, ISBN 3-642-01625-1 , p. 339. Restricted preview in the Google book search
  2. ↑ Rainer Granztow: Differential therapy for hemangiomas. In: Gerd Plewig, Peter Thomas (Ed.): Advances in practical dermatology and venereology 2006. Springer, 2007, ISBN 3-540-30514-9 , p. 458. limited preview in Google book search}
  3. ^ Frank Schneider: Clinic Manual Psychiatry, Psychosomatics & Psychotherapy. Springer, 2008, ISBN 3-540-78466-7 , p. 260. limited preview in Google book search
  4. ^ David Althaus: Praxismanual Depression. Deutscher Ärzteverlag, 2007, ISBN 3-769-10496-X , p. 145. Restricted preview in Google book search
  5. ↑ Christian Doehn: kidney tumors. In: Dieter Jocham, Kurt Miller (ed.): Urology practice. Volume 2, Georg Thieme Verlag, 2007, ISBN 3-131-56733-3 , p. 26. Restricted preview in Google book search
  6. ^ German Cancer Society: Testicular Cancer - Follow-up Care and Rehabilitation. As of April 1, 2011