Active Surveillance
A friend of mine has cancer. It is contained and not growing (or at least growing very slowly), so his oncologist has recommended active surveillance as the treatment plan for now. Active surveillance is a strategy in which patients are monitored closely with treatment delayed until something changes that indicates the cancer is progressing. There are several reasons for this option, but the most critical are delaying the side effects of treatment and improving the quality of life during the surveillance period.
Basically, while the cancer is a threat, aggressively treating it when the threat is low is more harmful to the patient than waiting it out for a while. The age of the patient plays a significant role, too. If you are old enough when certain types of cancer are detected, you may not live long enough for the cancer to become a primary problem. In this case, the side effects and risk of treatment are completely unnecessary and only serve to make what life you have left less enjoyable.
No one likes talking about cancer. When you are diagnosed, your first thought is, “How are we going to fight this, kill it, eradicate it?” Living with cancer and not doing anything about it seems wrong. One of the most common problems associated with active surveillance is anxiety. It’s just hard to know that you have cancer in your body and not be actively fighting it.
Leaders are often faced with a similar issue. You find a problem that, if it grows and goes unchecked, could be very detrimental to the community. However, it is barely noticeable at the moment, and to eradicate it would mean significant trauma to the organization and the people near the situation.
Some leaders rush to surgery every single time. This is the “nip it in the bud” tactic. There are many situations where this is a great approach. Specifically, when the cost and disruption to solve the problem is low and the options to deal with it decrease exponentially as the problem grows, the best choice is to deal with it quickly. Things like sexual harassment, physical abuse, lying, stealing, and drug and alcohol use and/or abuse are all things that should be “nipped in the bud.”
However, there are situations where drastic measures cause more harm than the potential they have for good. While cancer rarely “resolves” on its own, many of the initial problems we spot may actually resolve over time with the proper “active surveillance.” The key is that we aren’t doing nothing; we just aren’t doing everything.
Active surveillance includes—at a minimum—regular checkups, specific testing, monitoring for change, and timely decision-making.
For active surveillance to work, we must have regular checks of the situation. We are not ignoring the problem—quite the opposite. We are looking at it very closely, very often. This scrutiny may be the proximate cause of change—hopefully positive—in the person and their condition. Turing Award winner, Richard Hamming, said, “You get what you measure,” which is another way to say that observation impacts the observed.
Observation isn’t just a casual look. Observation entails specific “tests” to get hard data that can be analyzed. Some thought needs to be given to what would be the indicators of the situation changing—positively or negatively. Don’t take this part lightly. Having credible indicators of change is critical to active surveillance being proactive rather than merely procrastinating.
Noticing changes in the situation as early as possible means being objective about the data. If a cancer patient says they feel great, but their PSA number is climbing rapidly, the oncologist is going to recommend more aggressive treatment. Leaders must be careful not to let optimism (or pessimism) skew their judgement. Doctors often consult with another doctor; leaders should do the same thing (but probably with other leaders).
Finally, we have to make decisions. There is inertia in everything we do. Inertia is the tendency to keep things the same, keep moving in the same direction at the same speed, and resist change. Leaders must be willing to make difficult choices where people are concerned. As much as we would like, our communities can’t be everything for everybody. Often, the choices we make are less helpful for one person in order to be very helpful to most people.
Doctors know when to actively surveil and when to operate— not because they possess some superpower, but from exposure and experience. The more we do, the more we know. If you are a younger or less experienced leader, find someone with more time behind the wheel and learn from them. Great leaders treat each “case” as the unique situation it is and find the best course of “treatment” for the individual and the group. Having a variety of proactive options in our toolkit serves our team well, The Bison Way.