{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:53:06Z","timestamp":1791175986702,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Watchful waiting, sometimes referred to as active surveillance or observation, is used across a range of cancer contexts to avoid or delay unnecessary treatment and its associated harms. Although this approach may reduce overtreatment, it can also place patients in the unusual position of living with a known cancer that is being monitored rather than immediately treated. This may have important psychological and social consequences. The aim of this review was to synthesize qualitative research exploring patients\u2019 experiences of watchful waiting across cancer contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative systematic review and thematic synthesis of published studies examining patients\u2019 experiences of watchful waiting. Systematic searches were undertaken across major electronic databases and supplemented by hand searching. Eligible studies used qualitative methods and focused on the experiences of adults living with cancer under a watchful waiting, active surveillance, or equivalent monitoring pathway. Included studies were appraised for methodological quality, and findings were analysed using thematic synthesis to generate descriptive and higher order analytical themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty five studies were included, representing a range of cancer types and clinical pathways. Five overarching themes were identified. First, patients described complex emotional responses, including shock, fear, anxiety, uncertainty, and, for some, gradual adaptation over time. Second, decision making was shaped by perceptions of risk, beliefs about treatment, and varying degrees of trust in clinicians and healthcare systems. Third, social experiences were often marked by isolation, misunderstanding, stigma, and strain within family and intimate relationships, particularly where others struggled to understand distress in the absence of active treatment. Fourth, patients drew on a range of coping strategies, including reassurance from monitoring, peer support, information seeking, acceptance, and routines. Fifth, communication and supportive care emerged as central, with patients valuing clear explanations, continuity, validation, and opportunities to discuss uncertainty and emotional burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Watchful waiting is not a passive experience. It can be psychologically demanding and socially complex, even when clinically appropriate. Cancer services should recognize the emotional burden associated with living with untreated but monitored disease and should proactively identify patients who may benefit from clearer communication, reassurance, and tailored psychological or peer support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1830770","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:34:48Z","timestamp":1791174888000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Living with Cancer under watch and wait: a qualitative systematic review and thematic synthesis"],"prefix":"10.3389","volume":"17","author":[{"given":"Clement","family":"Boutry","sequence":"first","affiliation":[{"name":"Institute of Mental Health, School of Medicine, University of Nottingham","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Covington","sequence":"additional","affiliation":[{"name":"Nottinghamshire Healthcare NHS Foundation Trust","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anika","family":"Kochar","sequence":"additional","affiliation":[{"name":"Nottinghamshire Healthcare NHS Foundation Trust","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Nottinghamshire Healthcare NHS Foundation Trust","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Thorpe","sequence":"additional","affiliation":[{"name":"Nottinghamshire Healthcare NHS Foundation Trust","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nima","family":"Moghaddam","sequence":"additional","affiliation":[{"name":"Psychological Health and Wellbeing Group, University of Lincoln","place":["Lincoln, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e12245","DOI":"10.7759\/cureus.12245","article-title":"Clinically significant fatigue in adult leukemia patients: prevalence, predictors, and impact on quality of life","volume":"12","author":"AlFayyad","year":"2020","journal-title":"Cureus"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1037\/ccp0000630","article-title":"Randomized trial of acceptance and commitment therapy for anxious cancer survivors in community clinics: outcomes and moderators","volume":"89","author":"Arch","year":"2021","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"193","DOI":"10.7150\/ijms.3635","article-title":"Cancer and radiation therapy: current advances and future directions","volume":"9","author":"Baskar","year":"2012","journal-title":"Int. J. Med. Sci."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e6329","DOI":"10.1002\/pon.6329","article-title":"What is the relationship between body image and the quality of life of women who underwent surgery for breast cancer? A scoping review","volume":"33","author":"Battistello","year":"2024","journal-title":"Psychooncology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"102942","DOI":"10.1016\/j.eclinm.2024.102942","article-title":"Global unmet psychosocial needs in cancer care: health policy","volume":"78","author":"Bergerot","year":"2024","journal-title":"EClinicalMedicine"},{"key":"ref6","year":"2024"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1108\/EOR-02-2023-0003","article-title":"Accepting the unacceptable? Exploring how acceptance relates to quality of life and death anxiety in a cancer population","volume":"1","author":"Brabbins","year":"2020","journal-title":"Emerald Open Res."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"5262","DOI":"10.1002\/pon.5262","article-title":"A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer","volume":"28","author":"Charlick","year":"2019","journal-title":"Psychooncology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1007\/s10549-010-1077-7","article-title":"Effects of breast cancer surgery and surgical side effects on body image over time","volume":"126","author":"Collins","year":"2011","journal-title":"Breast Cancer Res. Treat."},{"key":"ref10","year":"2018"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1001\/jamaoto.2018.4131","article-title":"Patient experience of thyroid cancer active surveillance in Japan","volume":"145","author":"Davies","year":"2019","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"7159","DOI":"10.1007\/s00520-022-07044-z","article-title":"Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis","volume":"30","author":"Donkor","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1016\/j.esmoop.2023.101155","article-title":"Anxiety and depression in adult cancer patients: ESMO clinical practice guideline\u2020","volume":"8","author":"Grassi","year":"2023","journal-title":"ESMO Open."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.hoc.2014.09.004","article-title":"Nonoperative management of rectal cancer: identifying the ideal patients","volume":"29","author":"Habr-Gama","year":"2015","journal-title":"Hematology"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1001\/jamapsychiatry.2018.3181","article-title":"Risk of suicide after cancer diagnosis in England","volume":"76","author":"Henson","year":"2019","journal-title":"JAMA Psychiatry"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/j.ejon.2013.03.003","article-title":"Informing future research priorities into the psychological and social problems faced by cancer survivors: a rapid review and synthesis of the literature","volume":"17","author":"Jarrett","year":"2013","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1002\/pbc.24375","article-title":"Factors associated with poor quality of life in survivors of childhood acute lymphoblastic leukemia and lymphoma","volume":"60","author":"Kanellopoulos","year":"2013","journal-title":"Pediatr. Blood Cancer"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e0192097","DOI":"10.1371\/journal.pone.0192097","article-title":"Patient and provider experiences with active surveillance: a scoping review","volume":"13","author":"Kim","year":"2018","journal-title":"PLoS One"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.jad.2012.03.025","article-title":"Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age","volume":"141","author":"Linden","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"153402","DOI":"10.1016\/j.phymed.2020.153402","article-title":"Protection against chemotherapy- and radiotherapy-induced side effects: a review based on the mechanisms and therapeutic opportunities of phytochemicals","volume":"80","author":"Liu","year":"2021","journal-title":"Phytomedicine"},{"key":"ref21","year":"2025"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s12955-025-02357-z","article-title":"Psychosocial factors associated with quality of life in cancer patients undergoing treatment: an umbrella review","volume":"23","author":"Marzorati","year":"2025","journal-title":"Health Qual. Life Outcomes"},{"key":"ref23","year":"2018"},{"key":"ref24","year":"2016"},{"key":"ref25","volume-title":"Bringing Together Physical and Mental Health","author":"Naylor","year":"2016"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.jclinepi.2017.06.020","article-title":"Cochrane qualitative and implementation methods group guidance series\u2014paper 3: methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings","volume":"97","author":"Noyes","year":"2018","journal-title":"J. Clin. Epidemiol."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2870","DOI":"10.1111\/codi.15838","article-title":"Burden of disease experienced by patients following a watch-and-wait policy for locally advanced rectal cancer: a qualitative study","volume":"23","author":"Pennings","year":"2021","journal-title":"Color. Dis."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e13678","DOI":"10.1111\/ecc.13678","article-title":"Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: a systematic review and meta-analysis","volume":"31","author":"Russell","year":"2022","journal-title":"Eur. J. Cancer Care"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/1471-2288-8-45","article-title":"Methods for the thematic synthesis of qualitative research in systematic reviews","volume":"8","author":"Thomas","year":"2008","journal-title":"BMC Med. Res. Methodol."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1002\/pon.3157","article-title":"Employment status and quality of life in recently diagnosed breast Cancer survivors","volume":"22","author":"Timperi","year":"2013","journal-title":"Psychooncology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/s11357-025-01676-9","article-title":"Depression increases cancer mortality by 23-83%: a meta-analysis of 65 studies across five major cancer types","volume":"48","author":"Ungvari","year":"2026","journal-title":"Geroscience."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1990","DOI":"10.1017\/S0033291717000447","article-title":"Efficacy of meaning-centered group psychotherapy for cancer survivors: a randomized controlled trial","volume":"47","author":"Van der Spek","year":"2017","journal-title":"Psychol. Med."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"152544","DOI":"10.1016\/j.comppsych.2024.152544","article-title":"Acceptability, tolerability and safety of the BRIGhTMIND trial: connectivity-guided intermittent theta-burst stimulation versus F3- repetitive transcranial magnetic stimulation for treatment-resistant depression","volume":"136","author":"Webster","year":"2025","journal-title":"Compr. Psychiatry"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"110304","DOI":"10.1016\/j.jpsychores.2020.110304","article-title":"The effects of acceptance and commitment therapy on the psychological and physical outcomes among cancer patients: a meta-analysis with trial sequential analysis","volume":"140","author":"Zhao","year":"2021","journal-title":"J. Psychosom. 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