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Inside Health Care: Watchful Waiting


On Patient POV blog, journalist Laura Newman, writes about Paul's experience with choosing active surveillance when diagnosed with prostate cancer. Newman explains, 'Active surveillance is a strategy for forgoing immediate treatment in favor of regular scheduled testing and clinical exams to closely monitor the disease.' When Paul began active surveillance, 'he was racked with insomnia.' He felt that he had to 'overcome this sense that he is doing nothing.'

Paula Span on The New York Times' New Old Age blog wonders, 'When to Treat Prostate Cancer?' She mentions a recent post she came across on GeriPal, a geriatrics and palliative care blog, written by specialists at the University of California, San Francisco. They analyzed a recent study in the New England Journal of Medicine on treating prostate cancer with surgery versus watchful waiting. Ken Covinsky, M.D., M.P.H., on GeriPal writes:
'While decisions will still depend greatly on the preferences and values of each patient with prostate cancer, we now have good reason to believe that that younger men derive some benefit from definitive surgical treatment and that older men are probably better served by watchful waiting. The men who agreed to be randomized to help us learn how to best manage prostate cancer are owed our gratitude and thanks.'

June brings us Father's Day and Men's Health Month, so Gary Schwitzer takes some time to focus on well-intentioned efforts to raise awareness about prostate cancer. Gary offers cautions about how cancer statistics are often framed.
'This is what such campaigns tend to do - use the scariest numbers to "heighten awareness." Such promotions might help more men if they spent more time discussing the poor quality of shared decision-making that takes place around prostate cancer issues. The DECISIONS survey found that "most prostate cancer screening decisions did not meet criteria for shared decision making because subjects did not receive balanced discussions of decision consequences, had limited knowledge, and were not routinely asked for their preferences."

For more on Watchful Waiting see: Jessie Gruman's recent post, Appointment in Samarra*: Our Lives of Watchful Waiting and check out our related Prepared Patient feature article and the 1st Person experiences of Syd Ball and Nikkie Hartmann.

Medical journalist, Laura Newman, blogs at Patient POV. You can follower her on Twitter @lauranewmanny. Journalist Paula Span writes for The New York Times: The New Old Age blog. She can be followed on Twitter @paula_span. Ken Covinsky, M.D., M.P.H., is one of the contributors to GeriPal, a Geriatrics and Palliative care forum. You can follow Ken Covinsky on Twitter @geri_doc. Gary Schwitzer is publisher of and blogs on Gary Schwitzer's HealthNewsReview Blog. You can follow him on Twitter @garyschwitzer.

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