SPECIAL REPORT: HAEMATOLOGICAL MALIGNANCY
Foreword
E
ach year in the UK, several thousand patients are diagnosed with blood cancers but are told that they will not receive any treatment,
possibly for many years or even decades. Some patients will never require treatment; in other cases the disease will eventually show signs of progressing indicating a need to start treatment. Most patients in this situation will have chronic lymphocytic leukaemia or indolent lymphoma – a smaller proportion will have very early stage myeloma. The common feature is that, unlike most solid tumours, these conditions are widely disseminated at the time of diagnosis and there is no point at which early treatment has a high chance of eradicating the disease and achieving cure. Even in the case of lymphoma where there are discrete anatomical lesions, there are malignant cells within the circulation even at the earliest stages. The practice of deferring treatment, known as watch and wait, should be distinguished from palliative care. Patients who are on watch and wait have treatable conditions and the decision not to treat is based on good quality studies indicating no benefit from early treatment. Palliative care is intended purely to suppress symptoms and signs of the condition, although this may prolong survival, it has no direct impact on the disease process. In patients who transition from watch and wait to active treatment, their treatment is in almost all cases, definitive therapy. Patients being managed on a watch and wait may experience stress, as may family members. They will need careful monitoring for signs of progression and may have disease-related problems such as fatigue or relative immunosuppression. Primary care practitioners can offer valuable support, both in psychosocial care and in medical monitoring of these patients.
Martin Richards Editor
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