Watch and wait for Non-Hodgkin Lymphoma (NHL)
Watch and wait means delaying treatment until it is needed. For some people with non-Hodgkin lymphoma, this is an option.
Your doctor may suggest that you do not need to start treatment straight away. Instead you have regular tests and appointments to monitor the lymphoma and check for signs that you need to start treatment. This is called watch and wait. It is a way of delaying treatment until it is needed.
Watch and wait is an option for some people with low-grade lymphoma. It is not suitable for high-grade lymphoma.
Watch and wait is most likely to be offered to people who have low-grade lymphoma but who do not have symptoms.
A watch and wait treatment plan lasts an average of about 3 years. For some people, it is shorter than this, and for others it can be much longer.
Sometimes people worry about not having treatment immediately. But there can be advantages to delaying treatment.
- Studies have shown that people who decide to put off having treatment until it is needed live as long as people who start their treatment immediately. They also respond just as well to treatment.
- You will not experience side effects from treatment until it is absolutely necessary.
- Effective treatments can be kept in reserve for you until they are needed.
- Low-grade lymphoma can go through periods when it is more active and others when it is stable or even shrinks. In some people, the lymphoma may shrink without any treatment. This is called spontaneous regression.
Even when you are not having any treatment for lymphoma, you will still see your cancer specialist regularly. At each appointment, they will check you for signs that you may need to start treatment. These signs might include:
- unexplained weight loss, severe night sweats or unexplained fever (B-symptoms)
- a lower than normal number of red blood cells (anaemia), white blood cells or platelets in your blood
- the lymphoma starting to grow quickly
- the lymphoma starting to affect an important organ, such as a kidney
- the lymph nodes getting bigger and bulky
- a build-up of fluid in the tummy area (ascites) or in the lining of lungs (pleural effusion).
If you are worried about delaying treatment, here are some helpful tips from people who have experienced watch and wait:
- Make sure you understand why watch and wait is recommended and what other treatment options there may be. If you have any concerns, talk to your doctor.
- Think of your time without treatment as an opportunity to make the most of your quality of life. Use it to do things you enjoy, and to get as fit and healthy as you can. We have more information about maintaining a healthy lifestyle.
- Try to focus on the present rather than what might happen in the future.
- Express your feelings – you can do this by talking to family and friends, joining a support group or online forum, or by keeping a journal.
Although watch and wait can be difficult to adjust to at first, many people find it gets easier as time goes on.
Below is a sample of the sources used in our non-Hodgkin lymphoma (NHL) information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
National Institute for Health and Care Excellence (NICE). Guideline NG46. Haematological cancers: improving outcomes. 2016.
National Institute for Health and Care Excellence (NICE). Guideline NG52. Non-Hodgkin’s lymphoma: diagnosis and management. 2016.
Treleaven, et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. British Journal of Haematology. 2011.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Anne Parker, Consultant Haematologist; and Professor Rajnish Gupta, Macmillan Consultant Medical Oncologist.
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