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MEDICAL Q & A: Sometimes Nothing Is Best About Cancer – Entertainment & Life – Sarasota Herald Tribune



Q: What is "watchful waiting" after a cancer diagnosis?

A: Watchful waiting, which includes regular blood tests, scans, and doctor visits, is sometimes referred to as "active monitoring." A recent JAMA study found that 72 percent of men under the age of 65 who had prostate cancer had opted for surgery or radiation. A decade earlier, the numbers were reversed: only 27 percent chose monitoring.

As the study numbers suggest, many physicians advise men with low-risk prostate cancer to choose active monitoring through surgery and radiation; Not only is this less invasive approach, it can help men avoid incontinence and impotence, often associated with more aggressive treatment, without compromising survival.

"I think it's very important," said Otis Brawley, chief physician of the American Cancer Society opposite the Washington Post, citing the trend toward surveillance. By 201

0, he said a man diagnosed with prostate cancer "was instructed to get the prostate by next week at the latest."

Harry Herr, a urological cancer surgeon at the Memorial Sloan Kettering Cancer Center in New York, said the key to determining low-risk prostate cancer is a bunch of metrics and tests – including a prostate biopsy – that differentiate indolent (or slow) Can be aggressive cancer growth, which can be deadly.

For a patient with an indolent tumor who probably will not kill him, Mr. says, "It's better to do nothing, even if the patient has cancer."

The reason is that the treatment can cause havoc in many ways, sometimes without improving life expectancy. Especially prostate cancer surgery can have serious consequences, including incontinence and impotence.

For those who have been diagnosed with certain low-risk cancers, such as prostate, thyroid and an early form of breast cancer, a ductal carcinoma is known in situ or DCIS. Aggressive treatment can affect the quality of life and bring no longevity benefit. Mr., who has been treating cancer patients for more than 40 years, said less is often more.

But how do you convince the patients to accept that? In a recent study involving five physicians and more than 1,000 patients, Behfar Ehdaie, a surgical oncologist at Memorial Sloan Kettering, has partnered with the Harvard Business School faculty to use behavioral psychology techniques to help physicians actively monitor patients with prostate cancer better explain.

Ehdaie said he teaches surgeons to emphasize in their discussions with patients that "all major cancer guidelines recommend active monitoring for patients with low-risk prostate cancer."

Another approach is to create credibility in patients by helping them perceive bias. For example, when a surgeon tells a patient that "in your case, I recommend active monitoring rather than surgery," the patient tends to do so to give more credibility to the opinion, as it comes counter-intuitively from a surgeon.

Does this approach also apply to other cancers? Yes, Ehdaie said, "We have begun to adapt these strategies in advising women with breast cancer regarding contralateral prophylactic mastectomy."

It refers to women who choose to receive a double mastectomy if only one breast has a tumor, believing that it actively reduces their risk of future recurrence. Regardless, the first prospective randomized US clinical trial, COMET, to determine if active surveillance is safe and effective for women with DCIS (Stage 0 breast cancer) is underway.

All cancers are not equal and active monitoring is not the best way down the line. However, more information and more context can often help in decision-making, and action is not always the best option despite our natural inclination.

– Steven Petrow, The Washington Post


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