Ready to Fight, but My Doctor Says to Wait: Watchful Waiting after a Lymphoma Diagnosis

By Maureen Salamon and Meredith Begley,

Friday, April 8, 2016

Woman diagnosed with lymphoma

The watch and wait approach to treatment, also called active surveillance, is common treatment for lymphomas that pose no immediate threat to a patient’s health. This hands-off method has been proven to work just as well as active treatment in select patients, and negates the risk of side effects.

  • Watch and wait patients are carefully monitored and more active treatments are introduced if the disease progresses.
  • This approach can be challenging for patients, so MSK offers patient support groups, an online community, and individual and family counseling.

When 47-year-old Nancy Hughes was diagnosed with follicular non-Hodgkin’s lymphoma in 2007, she went into fight mode — but her doctor had another idea.

Memorial Sloan Kettering hematologic oncologist John Gerecitano instead recommended the “watch and wait” approach, in which Nancy, from Hampton Bays, New York, would be monitored regularly and put on chemotherapy only if her disease progressed.

This recommendation, especially in lymphoma, doesn't mean we're telling patients there's no treatment for them.
John F. Gerecitano
John F. Gerecitano oncologist

“I remember thinking, this is insane. I have cancer, you have to get rid of it,” the mother of two recalls. “And I think that’s everybody’s initial response.”

That’s a response Dr. Gerecitano often finds himself receiving whenever he advocates a watch and wait approach for lymphoma patients. 

“This recommendation, especially in lymphoma, doesn’t mean we’re telling patients there’s no treatment for them,” he says. “We know from the data that harm will not come from waiting.”

Also called active surveillance, watch and wait is a common treatment strategy at MSK and other top cancer institutions for lymphomas that pose no immediate threat to a patient’s health.

“Some lymphomas can be treated like chronic conditions such as diabetes or high blood pressure, where we manage them over time,” says Dr. Gerecitano, who recently led a trial for Venetoclax, a new FDA-approved lymphoma drug.

Even though that’s good news, the plan can still lead to tremendous anxiety. Many patients are skeptical about holding off on active treatment.

“It causes understandable anxiety when you tell patients they have cancer and that they should sit on the sidelines,” he says. “We live in a culture in which cancer is seen as an enemy that has to be actively fought.”

But the surveillance is called “active” for a reason. Usually, patients are first assessed every three to six months. Once doctors understand the disease’s growth pattern, they can sometimes space patients’ visits further apart — but they’re always carefully monitored.

Monitoring Can Safely Last for Years

At MSK, lymphoma experts typically recommend active surveillance for around 30% of lymphoma patients. Others are advised to start immediate treatment with chemotherapy, radiation, or surgery. But the hands-off approach has been proven to work just as well in select patients, and also negates the risk of side effects from treatment, Dr. Gerecitano says.

“These are lymphomas that are unlikely to cause an immediate threat to a patient’s overall health,” he says, adding that some lymphomas often take two to five years to cause problems severe enough to tackle with active treatments.

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Helping Patients Cope with Anxiety

Despite the evidence, convincing some patients that watch and wait is the best approach is still extremely challenging.

While Nancy initially wanted to eliminate the cancer as quickly as possible, she says she “knew during the first meeting” that she could trust Dr. Gerecitano.

Medical oncologist John Gerecitano meets with a lymphoma cancer patient
Lymphoma is a blood cancer that starts in the body’s immune system cells. It is one of the most common forms of cancer in adults. Learn more about treatment options for all types of the disease.
Learn more

“I just had the utmost faith in his decision-making,” she recalls.

Dr. Gerecitano also tells patients that prudently waiting to launch active treatments allows for “the accrual of better weapons. Almost every year there are breakthroughs in the treatment of lymphomas.”

To respond to patients’ fears, MSK doctors typically schedule longer office visits so they have time to fully explain their recommendations. “When we sit and tell patients all of the information, most feel comfortable with active monitoring,” he says. “We find that investing this time is worth it if we can spare patients the unnecessary side effects of chemo or prevent them from developing treatment resistance.”

To help patients cope with the potential emotional strain of waiting, MSK also offers patient support groups, an online community, and individual and family counseling.

Dr. Gerecitano recommends that his patients stay physically active, not only to decrease the risk of lymphoma-related blood clots but also to keep their energy levels up. “It’s important to get in the best place mentally and physically during that time,” he says. “This will help them when it is time to fight.”

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Time Heals

Nine years after her diagnosis — with the disease still posing little threat — Nancy has made peace with her treatment plan.

“I think just as with anything else, time makes it better,” she says. “When you go in for your appointments, those can be a little anxiety producing. But as time as progresses it just gets easier to process.”


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I too was diagnosed with nhl 5 years ago by a local hematologist. I went straight to Sloan Kettering immediately after. Dr. Paul Hamlin recommended the "watch and wait" approach. Last year one of the lympnodes on my neck was swollen due to a infection (was not life threatening) my dr recommended a radiation treatment called the "boom boom" treatment. I did not have to do it but I didn't want to walk around with this lump on my neck any longer. I had Two quick very low dose radiation treatments with absolutely zero side effects and the lump was gone within a week and nodes back to normal. I see my Dr every 6 months only need one CAT Scan a year!

This process of the wait and see has worked very well for me. I don't dwell on it at all. I know that it's being looked at carefully and I know if I start to have any symptoms of my disease I will be taken care of immediately by the amazing Dr's and nurses at Sloan. I am in the best hands in the world.

I highly recommend it and obviously Memorial Sloan Kettering care.


Laura Pergola

Dear Laura, thank you so much for sharing your experience. We are happy to know you are doing well and have felt well-cared for by your MSK team!

I was just diagnosed with multiple myeloma. What insurance does memorial Sloan Kettering accept. I would like a second opinion

Dear Lourdes, we are sorry to hear about your diagnosis. For more information about the health insurers that provide coverage for care at MSK, please visit If you would like to make an appointment, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

My husband was diagnosed with Non Hodgkins Lymphoma in Jan 1997. He had half a lung removed and a mild chemo treatment in NJ. Almost 2 years later it came back and we decided to go to MSKCC. After a round chop in 1999 it returned. Dr Zelenetz started him on Rituxan in August thru Sept 2001. He was in remission for 14 years and last June we found out it is active again. Now they are watching and waiting..... We were very anxious when he had the biopsy and Thanx to Dr Zelenetz he has made us realize this is the best "non-treatment" at this time.

Dear Betty, thank you for sharing your husband's experience. We're glad to know that he has felt well-cared for by Dr. Zelenetz, and we wish him well as he continues with his care plan.

I have been recently diagnosed with cancer and have spent weeks being tested for the place of origin ,still with no concrete evidence of anything! I have been told it is stage four and still have not had any treatment! I would like to come there for a second opinion,or at least a concrete diagnosis,some empathy and compassion!I am frightened and alone.

Dear Taryn, we are sorry to hear about your cancer diagnosis. If you would like to make an appointment with one of our specialists for a second opinion and a discussion of your treatment options, please call our Physician Referral Service at 800-525-2225. We also offer a number of support resources to help our patients who are living with advanced disease. Thank you for reaching out to us.

Dr. G is a God send. I am blessed he is my Dr.

I agree Mike. Dr G is the best. We are so very fortunate!!

My wife is diagnosed with folliculotropic mycosis fungoides (FMF). We are based out of India.She has two conflicting reports about bone marrow involvement.Our oncologist has started her on Methotrexate .Her PET CT is normal and no lymph node is involved .We are very anxious about the line of treatment because of conflict in reports. Is it possible to take second opinion remotely from MSKCC for international patients ?

Dear Tarun, we are sorry to hear about your wife's diagnosis. Please contact our International Center to arrange for a review of her medical records by one of our specialists. Our International Center can be reached via email at To learn more about our services for international patients, please visit Thank you for reaching out to us.

I've been treated for marginal b zone splenic NHL since 2002 by Dr.Noy at Sloane. Dr.Noy is a very good doc.

Dear Melinda, we are glad to know that you have felt well-cared for by Dr. Noy. Thank you for kind words!

I have MALT marginal zone. I am on watch and wait with Matthew Matasar, the greatest and most wonderful doctor in the world. I love Dr. Matasar.

Dear Eve, we appreciate your kind comments and are glad to know that you felt well-cared for by Dr. Matasar!

I was diagnosed with MALT Lymphoma, under the care of the wonderful Dr. Paul Hamlin, and just finished radiation therapy at MSKCC! Dr. Shepherd is my awesome radiology oncologist!! I won't know if I'm in remission until the end of October, but I feel I'm getting the best possible care at Sloan!! I feel so lucky to be able to be treated here!! The doctors and nurses are exceptional here!! ❤️

Dear Kim, we are sorry to hear about your diagnosis, but are glad to hear that you have felt well-cared for by your MSK team. Thank you for your kind words!

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