When a patient is discovered to have cancer, one of the primary goals is to have the tumour removed by surgery. Although this provides excellent oncological control, it is associated with morbidity and functional problems in cancer survivors. Recent studies have shown that the immediacy to perform a resection does not always lead to improved clinical outcome. Furthermore, cancer surgery can often lead to complications where the quality of life for the patient is compromised by toxic side effects and /or damage to nerves, organs or healthy tissues. A number of recent clinical trials in the field of cancer surgery have advocated the concept of watch and wait, watchful waiting, active monitoring or surveillance, which are terms used to describe a monitoring strategy for cancer. The concept may be antithetical but the functional advantage of these alternatives is clear even though there is some concern about the risk. Though the evidence is still weak, current studies suggest that with adequate selection and follow-up, this oncological risk is small. A major consideration for clinicians is now to maintain quality of life for all patients. Our objective in this proposal is to implement novel approaches so that cancer surgery can be avoided, where we aim to (a) develop new monitoring technologies from industry so that the surveillance window can be increased to allow for better treatment options over time and to avoid surgery, (b) develop new ‘watch and wait’ strategies in order to study the behaviour of the cancer so that any risks to the patient can be minimised leading to a better clinical outcome and (c) train a new generation of preclinical and clinical scientists to be able to implement this new concept as standard of care and to maximise the benefits of an active monitoring policy.

Coordinator: ACADEMISCH ZIEKENHUIS LEIDEN The Netherlands

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