Doing Nothing: An Unexpected and Possible Lifesaving Cancer ‘Treatment’

Cancer treatments can undermine health. That’s well understood, but now researchers better know when that cost just isn’t worth it.

By:  Sheramy Tsai

A cancer diagnosis can trigger terror or an instinctive battle response. The urge to do something—anything—can be overpowering.

The urge to fight cancer aggressively fuels a multi-billion dollar industry in the United States. Millions undergo treatments with limited effectiveness, preferring action over the potentially more healthful option of “watchful waiting.”

This often overlooked approach involves careful monitoring of the patient’s condition without active treatment until it becomes necessary. It’s a strategic pause, grounded in evidence that some cancers, when caught early or found to be slow-growing, do not require immediate intervention.

The watch-and-wait approach is advised for certain early-stage or slow-growing cancers where immediate treatment does not improve survival rates. This strategy is most common with prostate cancer but is also considered for breast, thyroid, and some blood cancers.

Watchful waiting reduces the toll of unnecessary cancer treatments, both financially and in terms of patient suffering. While few currently choose this less invasive path, growing awareness of its benefits is gradually making its way into clinical practice and cancer strategies focused more on the patient than the disease.

David Gay is one of the beneficiaries of this approach.

In 2014, Mr. Gay faced his third biopsy results in the stark silence of a urologist’s office. He was poised for a fight, resolute in his preemptive decision: “If it’s cancer, it’s coming out,” he told The Epoch Times.

Yet, when confronted with the reality of his diagnosis, his perspective changed. Heeding his doctor’s counsel and with his family’s support, he chose not to rush into surgery or radiation, but to opt for watchful waiting.

Mr. Gay’s decision reflects an emerging trend built on clearer insights about cancer prognosis and research that challenges the rush to conventional treatment.

 

The Watchful Waiting Approach

Active surveillance and watchful waiting offer personalized, conservative treatment paths.

While the terms are often used interchangeably, the American Cancer Society differentiates between “active surveillance” and “watchful waiting.” Active surveillance involves regular doctor visits, blood tests, and biopsies, while watchful waiting implies a more relaxed follow-up based on symptoms.

“One of the reasons to think about active surveillance and delaying treatment is to prevent side effects, which almost always accompany treatment for cancer, including problems related to surgery,” writes Stanford oncologist, Dr. Lidia Schapira for the American Society of Clinical Oncology.

Reflecting a growing acceptance of less aggressive treatment options, active surveillance has more than doubled in U.S. urology practices for prostate cancer, rising from 26.5 percent in 2014 to 59.6 percent in 2021.

A 2012 study published by The New England Journal of Medicine, reported no significant survival difference after 12 years between men with early-stage prostate cancer who underwent surgery and those who opted for watchful waiting.

“Absolute differences in mortality between the study groups were less than 3 percentage points,” wrote the authors, adding that a subgroup of men with higher prostate-specific antigen (PSA) values or higher-risk tumors may have benefitted from surgery.

More recent findings suggest even if a cancer progresses during active surveillance, that does not decrease the high survival rate. The study found that 97 percent of men with localized prostate cancer survive for at least 15 years, irrespective of treatment. However, researchers pointed out that side effects impacting urinary and sexual function in those opting for treatment could persist for over a decade.

As diagnostics and treatments improve, Dr. Schapira envisions cancer becoming manageable. “With better and more precise treatments, we will face a growing number of individuals whose cancer becomes a ‘chronic disease,’” she told The Epoch Times. In other words, it’s something people live with rather than wage war against.

Innovations like circulating tumor DNA (ctDNA) detection are paving the way for active surveillance to become a more prevalent option in managing solid tumors, explained Dr. Nathan Goodyear, an integrative health physician specializing in oncology, in an interview with The Epoch Times. CtDNA is DNA from cancerous cells that have died and broken off from the tumor, circulating in the blood. Testing for ctDNA can let doctors detect and diagnose cancer and provide insight into treatments, and whether a given tumor is growing or shrinking. These advanced detection methods could lead patients to choose to take a more passive stance toward their cancer, he predicts.

But even with effective detection methods, some people may prefer to get their cancer treated. According to Dr. Goodyear, the watchful waiting approach to cancer treatment is a nuanced choice that may not suit every patient.

“Watchful waiting is not for all cancer patients, just as ‘shock and awe’ treatment campaigns are not for all cancer patients,” he said.

He emphasizes that the appropriateness of this method should be carefully considered through thorough evaluation and candid conversations based on realistic expectations, potential risks, and the benefits it offers.

 

Proactive Strategies in Watchful Waiting

Contrary to perceptions of passivity, Dr. Goodyear defines watchful waiting as a proactive, health-centric approach distinct from conventional treatments.

“Watchful waiting by no means implies non-treatment. The concept only applies to the conventional strategy of surgery, chemotherapy, radiation, and conventional immunotherapy,” he explained.

Nutrition is a cornerstone of this strategy, as Dr. Goodyear notes its importance in strengthening the immune system and engaging the body’s defenses against cancer. Equally vital are lifestyle modifications such as regular exercise, stress management, restorative sleep, and nurturing relationships, which collectively form a comprehensive support system for cancer patients, regardless of treatment protocol.

It is worth noting that the body is actively removing problem cells and cancer cells, but this mechanism can break down, letting cancer cells grow. This problem can be exacerbated by lifestyle choices like smoking or eating a diet high in added sugars.

The 2021 ERASE Trial, (exercise during active surveillance for prostate cancer) focusing on men with non-metastatic prostate cancer under active surveillance, reinforced the value of lifestyle changes in cancer care. The study found that high-intensity exercise significantly reduced PSA levels, a primary indicator of prostate cancer. The slower increase in PSA levels among participants suggests that regular exercise might slow the progression of the disease.

In addition to these physical benefits, the approach of “letting go,” a pivotal aspect of watchful waiting, plays a crucial role in the healing process. In relinquishing the urge for immediate aggressive medical intervention, patients allow themselves time for reflection and consideration of all treatment options. Health care worker and patient experience shows this mental shift can be therapeutic, reducing anxiety and empowering patients to take control of their health journey.

 

Financial Toxicity of Cancer Treatment

Cancer care costs are projected to rise in the United States from $183 billion in 2015 to more than $246 billion by 2030. Key drivers include an aging population, increasing cancer cases, costlier treatments, and health care inflation.

These financial side effects also severely strain patients’ and families’ finances. Annual out-of-pocket costs, including copayments, deductibles, and uninsured treatments, total around $21 billion.

Cancer care costs per patient in the United States can be hefty, especially for uninsured individuals, ranging from $100,000 to $300,000 for treatments like chemotherapy and surgery. The average expense is around $160,000.

A survey by the American Cancer Society Cancer Action Network of more than 1200 patients highlights cancer’s severe financial toll: most were unprepared for the costs, leading to lifestyle changes and debt. More than half the patients faced credit score impacts and debt collections, with many delaying care or choosing cheaper treatments.

Adding to these financial challenges, a report by U.S. Democratic Representative Katie Porter reveals a significant rise in cancer drug costs. The average price of new cancer drugs in the United States in 2021 was $283,000—up 53 percent from 2017. This escalation continues year after year.

Watchful waiting and active surveillance might ease cancer care’s financial strain. Though under-researched, early findings show promise in cost-effectiveness, particularly for prostate and thyroid cancers in older patients, by reducing the need for expensive treatments.

Debate continues over the pharmaceutical and health care industries’ promotion of aggressive treatments. The ongoing question is whether financial incentives influence treatment approaches.

(TheEpochTimes.com)