onkommon.com
Decision
Conservative management & active surveillance
Sometimes the right decision is to watch carefully and treat nothing yet.
What it is
Not every cancer needs treating immediately, and not every finding needs treating at all. Active surveillance means a defined schedule of tests with pre-agreed triggers for intervening, it is a plan, not an absence of one.
This is the hardest option to be offered in India, because it can feel like being sent away. It is also the option least likely to be offered by an institution that earns from the alternative.
When it is used
- Low-risk prostate disease, where the evidence for immediate treatment is weak
- Small, indolent findings, some thyroid, kidney and haematological conditions
- Where the risks of treatment plausibly outweigh its benefit given age, fitness or other illness
- Where a patient, properly informed, chooses not to have treatment
How the decision is made
- What exactly will be monitored, with what test, at what interval.
- What result or symptom would trigger a change of plan, written down in advance, so it is not renegotiated under pressure.
- What the honest trade-off is, including the risk of waiting.
- Best supportive care, where active treatment is not the goal, is a plan with its own targets, symptom control, function and time at home.
Consultation and surveillance planning here. Monitoring tests at partner diagnostic centres, on a schedule we run and recall you against.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- The surveillance schedule and its written triggers
- Structured recall, we contact you, so watching does not quietly become forgetting
- Symptom control through pain and palliative medicine, at any stage
- Advance care planning, where you want your preferences on record
- Re-review whenever anything changes
Performed and billed elsewhere
- Surveillance imaging and blood tests
- Any biopsy, if a trigger is reached
- Active surveillance only works if the surveillance actually happens. If you have not heard from us on schedule, phone. The plan is the appointments.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- What would we gain by treating now, and what would we risk?
- What are we watching, how often, and what changes the plan?
- What happens if I miss appointments?
- If I choose not to have treatment, what will you still do for me?
Support that goes with it
Where this is used
Cancers this commonly forms part of
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.