“Watch and Wait” - Examining the potential impact of uncertainty in illness on the mental health of individuals with Chronic Lymphocytic Leukemia and Low Grade Lymphomas

Chronic lymphocytic leukemia (CLL) and non-localised low grade or indolent lymphomas (LGL) are two of the common cancers that individuals are diagnosed with in the UK. Both of these chronic illnesses are considered slow growing and these individuals are often diagnosed when one is not exhibiting any symptoms from the cancer. For a high proportion of individuals who are diagnosed with these forms of cancer, they are subject to a form of care known as “watch and wait”. As conventional chemotherapy treatments do not cure the disease nor prolong survival, a policy of watch and wait is utilized until the patients become symptomatic from the disease. For those patients who have been given a diagnosis of CLL, the watch and wait approach will include periodic medical examinations and laboratory analysis to determine whether the disease is stable or beginning to progress. The goal is of course to maintain QOL by not administering unnecessary treatment rather than ‘least invasive treatment’. Such an approach is due to the fact that the research has not evidenced a medical benefit for early intervention. Since being given a diagnosis of cancer and being told that there would be no immediate intervention may be contrasting to how an individual would conceptualize cancer, the researchers questioned the impact that such a diagnosis and form of care can have on the individual’s well-being. Participants with a diagnosis of CLL or LGL were recruited to complete psychological questionnaires (uncertainty in illness, anxiety, depression posttraumatic stress). These questionnaires were administered 4 times over a 12-month period to determine the impact of the diagnosis and what being placed on watch and wait has on their psychological well-being. Results indicated that a high proportion of participants were above clinical cut-off at time-1, but that there was also not much group or individual change over the 6-month time period. Results also highlighted that posttraumatic stress at time-1 was the strongest predictor of psychological distress at 6-months, and a number of strong relationships between the psychological variables were also found at time-1, following the participants’ initial diagnosis. Although preliminary, the findings were not in keeping with initial hypotheses that psychological distress would decrease over time-1, as participants developed greater understanding and had less uncertainty about their illness as well as watch and wait as a form of care. The findings suggest that the there is an impact that such a diagnosis and form of care can have on an individual psychologically, and more research needs to be undertaken to understand this effect and how to better support these individuals with their diagnosis of cancer.