Watchful waiting is a strategy that healthcare professionals use to closely monitor a condition’s progression rather than treating it immediately. Doctors often recommend it when the risks of immediate treatment outweigh the benefits.

This approach can help reduce unnecessary medical interventions but requires consistent, close communication with a healthcare team. Watchful waiting may provide a balance between active treatment and observation.

Doctors use watchful waiting for various conditions.

This article discusses watchful waiting and when healthcare professionals may recommend it. It examines how long healthcare professionals advise using watchful waiting, what to expect with this strategy, and its benefits and risks.

Watchful waiting refers to carefully observing a medical condition without providing active treatment unless symptoms worsen.Share on Pinterest
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Watchful waiting refers to carefully observing a medical condition without providing active treatment unless symptoms worsen.

The goal is to wait and see whether the condition progresses or remains stable. It can be a helpful strategy for conditions that are not severe, likely to resolve without intervention, or where the risk of disease progression is low.

Unlike more proactive treatments, such as medications or surgery, watchful waiting emphasizes monitoring symptoms and tracking their changes. Depending on the condition, individuals may need the following:

  • frequent checkups
  • diagnostic tests
  • self-monitoring to check it is not worsening

Healthcare professionals may recommend watchful waiting for the following conditions:

  • Kidney stones: Urologists may advise watchful waiting for kidney stones less than five millimeters in diameter that do not cause symptoms. Around 80% to 90% of kidney stones pass without treatment.
  • Enlarged prostate: A healthcare professional may recommend watchful waiting for a slightly enlarged prostate with mild symptoms. They may arrange annual checkups and give lifestyle advice, such as maintaining a moderate weight, limiting alcohol and caffeine intake, and performing regular physical activity.
  • Ear infection in children: Doctors often suggest watchful waiting for 2 to 3 days before prescribing antibiotics to a child with an ear infection. This approach usually gives the immune system time to fight off the infection and means a person can avoid taking antibiotics.
  • Gallstones: Many people do not experience symptoms with gallstones. A healthcare professional may recommend watchful waiting instead of surgery unless complications arise.
  • Inguinal hernias: Research indicates that it is safe for men with inguinal hernias who have few to no symptoms to delay surgery and watch and wait. However, around 70% of individuals with inguinal hernias develop symptoms and require surgery within 5 years.

Cancer

In cases where a person has certain or chronic cancer, such as prostate cancer and chronic lymphocytic leukemia, doctors may recommend watchful waiting.

Watchful waiting in cancer could be appropriate for:

  • cancers that grow very slowly and may never need treating
  • certain early stage cancers where there is no benefit in starting early treatment
  • circumstances where there is a need to reduce a person’s overall exposure to the side effects of cancer treatments — such as radiation therapy, chemotherapy, and surgery — until it is necessary
  • older adults who are not suitable candidates for extensive surgical procedures
  • individuals with health problems that make treating cancer more challenging
  • vulnerable populations where the risks of repeated tests or treatments are higher than the potential benefits
  • people who do not want cancer treatment

The team in charge of a person’s cancer care considers several factors when determining whether watchful waiting is the most suitable treatment plan. If symptoms worsen, they may offer alternative treatment options.

The duration healthcare professionals use watchful waiting depends on several factors, such as the:

  • condition
  • severity of symptoms
  • likelihood of progression
  • risks and benefits of watchful waiting
  • person’s age, health, and medical history
  • individual’s preferences

Depending on the condition, watchful waiting time could vary between days and years.

For example, guidelines for otitis media with effusion — also known as glue ear — recommend 3 months of watchful waiting before considering surgical intervention. This is because the condition may resolve without treatment.

On the other hand, the watchful waiting period may continue indefinitely for some cancers if they remain slow-growing and symptomless. Some people with localized prostate cancer may never have treatment. However, this can quickly change to active therapy if there are signs of progression.

Watchful waiting involves monitoring a person’s symptoms to see whether they improve or worsen.

For infections, this could mean self-monitoring or parental monitoring of a child’s symptoms. In some cases of ear infection, a doctor may suggest managing pain and fever with over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil).

For people with localized prostate cancer, watchful waiting focuses on symptom tracking and treating symptoms as they arise to help maintain a person’s quality of life. It does not involve regular checkups, known as active surveillance, and aggressive cancer treatments.

Watchful waiting has several benefits and risks, which may differ depending on the condition. Before deciding whether watchful waiting is the most appropriate treatment strategy for them, a person should discuss these in detail with a healthcare professional.

Benefits

Benefits of watchful waiting may include:

  • avoiding the treatment side effects
  • avoiding overtreatment or unnecessary treatments
  • not requiring regular imaging tests, blood tests, or biopsies
  • maintaining quality of life without treatment-related complications
  • reducing medical expenses
  • offering individuals the flexibility to make treatment decisions when they feel comfortable rather than rushing into interventions that may not be necessary

Risks

Risks of watchful waiting may include:

  • the condition gets worse without noticeable symptoms, resulting in a missed opportunity for early intervention
  • experiencing anxiety from not treating the condition right away
  • the delay in treatment making future interventions more challenging or less effective
  • partners and family worrying and not understanding why their loved one is not receiving treatment

Experts sometimes use the terms “watchful waiting” and “active surveillance” interchangeably. Although they both involve delaying treatment, they differ in their intent and intensity of monitoring.

Healthcare professionals often use active surveillance for conditions that have a higher risk of progression, such as early stage cancers. It is a more structured form of monitoring than watchful waiting, and it involves regular blood tests, imaging, or biopsies to detect cancer changes that may require immediate treatment.

Watchful waiting, on the other hand, centers on symptom management with fewer tests. It aims only to begin treatment if the symptoms or condition worsen.

Active surveillance in prostate cancer

A 2023 study including data from almost 350 urology practices across the U.S. found that nearly 60% of individuals with low risk prostate cancer use active surveillance for their condition.

According to the American Cancer Society, active surveillance in prostate cancer typically involves the following:

Healthcare professionals may recommend watchful waiting to track symptoms of a condition and only provide treatment if symptoms worsen or the condition progresses.

Watchful waiting may also be a strategy in various health conditions, including localized prostate cancer that is not causing symptoms. This approach may benefit older adults and individuals with other severe health problems by delaying regular testing and treatment until necessary. Regular testing and checkups for prostate cancer are known as active surveillance.

Watchful waiting has several benefits and risks. People can weigh these and discuss them with a healthcare professional before deciding whether it is appropriate for them.