Imagine being told you have cancer or a potentially dangerous aneurysm—and then being told the best course of action might be to do nothing. This approach, dubbed “watchful waiting,” is the reality for an increasing number of patients, thanks to powerful new scanning tools. Yet coping with such uncertainty is difficult for most people.
“As the technology gets better and better, we're picking up more of these conditions way earlier than the disease would be symptomatic or dangerous,” says Shelley Hwang, a breast surgeon at Duke University Medical Center, whose practice includes some women who choose surveillance for a precancerous but risky breast condition. Prostate cancer patients represent another large group for whom watchful waiting is often the medically sound choice because the disease may progress very slowly and surgery can lead to incontinence, impotence and other side effects. Smokers and ex-smokers often present with worrisome lung nodules—but only five out of 100 patients will go on to develop cancer.
Despite the favorable odds, many people experience anxiety and distress after such diagnoses. A National Institutes of Health report found in 2011 that just 10 percent of the 100,000-plus men with prostate cancer who are medically eligible for surveillance choose that route every year, and a quarter of those who initially choose to wait and see end up defaulting to treatment within three years. “From a health psychology perspective, there are less invasive ways to treat anxiety than through a surgical intervention,” says David Victorson, a health psychologist at Northwestern University—yet patients often think surgery is their only other option.
Scientists are investigating how best to help struggling patients. One recent study suggests that having faith in your ability to cope is key. Researchers asked 71 watchful waiters with prostate cancer to rate themselves on a series of statements about stress management, such as “Whenever I get negative, I reexamine my thoughts to gain a new perspective” or “I am confident about being able to choose the best coping responses for hard situations.” Men who saw themselves as good at coping suffered less cancer-related distress than those who felt less well equipped, according to the findings published in 2014 in the Journal of Behavioral Medicine. Relaxation skills did not appear to similarly ease negative thoughts. Health care practitioners may therefore want to survey their patients about their coping confidence before sending them off to try and wait patiently. Those who score low may need extra help.
Another promising intervention, once the anxious patients have been identified, may be mindful meditation, which tames worrying by helping people focus on the present. Victorson led a study of prostate cancer patients, currently submitted for publication. He found that the 23 men who completed an eight-week meditation class experienced significantly greater post-traumatic growth—meaning the crisis of their diagnosis became a catalyst for positive psychological change—compared with the 18 men who were given a meditation book only. That psychological payoff persisted at least a full year.
These studies are preliminary—the most effective treatment for medical anxiety is not yet clear. But an important takeaway for patients has emerged: You do not have to face a choice between angst-ridden waiting and risky treatment. Treating the anxiety might be a safer and happier middle ground.