I was just rewatching the old video mentioned earlier when she met with her surgeon and the one directly following it. That is the Tiffany I remember connecting with and wanting to support in her journey, she was so raw and honest.
But her apologising to her supporters for the bad news emphasised again how much videotaping and having subs changes her perspective, thinking that there's an expectation on her to only have good news to share with her audience. Having even more supporters now and trying to polish her videos, I fear she feels even more pressure to have a happy ending? Or perhaps, on the converse side, if she's received good news (see below), she's afraid to have her viewers up and leave her now? That could well be a possibility too seeing as how focused she's become on increasing her subscriber level.
She reminded me in that video how her surgeon spoke in plain language to her, drew his chair close, and drew a diagram. I have no doubt he spoke equally plainly and in "relatable" (her word) language to ensure she understood this last time, too.
I also went back to look at the studies I found on "watch and wait" for colorectal cancer.
I think what Tiffany might have failed to communicate fully to us is that based on the scans, examination and biopsies, she achieved a "complete clinical response" ("cCr") or pCr (pathological complete response [biopsy confirmed]) following neoadjuvant chemoradiotherapy. I am unclear how this occurred when prior scans showed no change in her status only 4 months ago following the chemo and radiotherapy, yet now they might.
I hope this research is okay to share here for educational purposes under Fair Use exception.
Firstly, it's important to appreciate that a cCr or pCr are not black and white, perhaps this is where Tiffany's confusion lies as it's not as clear cut as doing a boomerang dance singing "I'm cancer free, I'm cancer-free" at this point. It IS complicated, and I've only touched the surface, being a nonmedical layperson. I think, like with any cancer, you're always looking at survival rates and relapse rates. It's not "cancer free" or "cured", But a cCr or cPr is pretty darn good news!
A "watch and wait" approach appears to be premised on achieving a cCr or pCr first though. There is still significant debate and controversy in a watch and wait approach, so it is not established science or established protocol.
The following reviews a "watch and wait" approach in comparison to surgical resection for LARC ("locally advanced rectal cancer"), the full articles can be read in the links provided. Perhaps any medically knowledgeable people can weigh in on this too.
From:
According to the main international clinical guidelines, the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. However, doubts have been raised about the appropriate definition of clinical complete ...
www.ncbi.nlm.nih.gov
"According to the available data, from 10%-25% of patients with LARC achieve a pathologic complete response (pCR) - defined as the absence of viable residual tumour cells in the surgical specimen - after neoadjuvant treatment..."
And further down:
"Subsequent studies carried out by other groups support these data, as shown in a recent systematic review[12] that evaluated a total of 23 studies (867 patients), concluding that
there are no significant differences in OS [overall survival]
and local recurrence between surgically-treated patients and those managed with the watch and wait protocol. However, larger prospective studies are needed to confirm long-term outcomes and to resolve controversies surrounding the selection of candidates for watch and wait, the accurate determination of cCR, and the optimal follow-up protocols."
And:
Background The watch-and-wait strategy offers a non-invasive therapeutic alternative for rectal cancer patients who have achieved a clinical complete response (cCR) after chemoradiotherapy. This study aimed to investigate the long-term clinical outcomes of this strategy in comparation to...
ro-journal.biomedcentral.com
"Patients in whom the watch-and-wait strategy was adopted exhibited a higher rate of local recurrences (14.9% vs. 1.1%), but most (85.7%) were salvageable.
Three-year non-regrowth local recurrence-free survival was comparable between the two groups (98% vs. 98%, P = 0.506), but the watch-and-wait group presented an obvious advantage in terms of sphincter preservation, especially in patients with a tumor located within 3 cm of the anal verge (89.7% vs. 41.2%, P < 0.001). Three-year distant metastasis-free survival (88% in the watch-and-wait group vs. 89% in the surgical group, P = 0.874), 3-year disease-specific survival (99% vs. 96%, P = 0.643) and overall survival (99% vs. 96%, P = 0.905) were also comparable between the two groups, although a higher rate (35.7%) of distant metastases was observed in patients who exhibited local regrowth in the watch-and-wait group."
A later prospective cohort study of 84 subjects in China compared a watch and wait group ("WW") to a surgery group and found that:
"
There was no significant difference in the recurrence and metastasis rate between the two groups."
They concluded:
"
The WW strategy is a feasible treatment option in patients with cCR after NCRT [neoadjuvant chemoradiotherapy]. Surgery may not bring benefits to these cCR patients."
We compared the long-term outcome of the watch and wait (WW) strategy and surgery in patients with locally advanced rectal cancer.This prospective coh…
www.sciencedirect.com
And an earlier meta analysis discussed:
"One of the controversial issues of this pathological entity is sphincter preservation, which is still impossible in up to 50% of low rectum tumor cases, causing a negative impact on the physical and emotional sphere as well as on the quality of life of patients and even their families [
1,
3,
6].
The WW strategy is increasingly accepted as it allows organ preservation and avoids surgical morbidity and mortality; however, despite the large number of publications, it is under constant evaluation and continues to be considered a controversial topic [
9,
14,
15,
16,
17]."
...
"
Oncological results in operated patients with pathological complete response were similar to those in patients under a watch and wait strategy mediating a systematic and personalized evaluation. Surgery can safely be deferred in clinical complete responders."
Background Nonoperative management after neoadjuvant treatment in low rectal cancer enables organ preservation and avoids surgical morbidity. Our aim is to compare oncological outcomes in patients with clinical complete response in watch and wait strategy with those who received neoadjuvant...
wjso.biomedcentral.com
There may be more other published studies that I'm not aware of, I'm sure there are, as I haven't done an extensive search.
So, while I may still have some gaps in my understanding, this information may at least explain WHAT they're doing if I still may be uncertain as to the why or how she matched with this approach, given what we know/don't know about her past treatment response. But, it does appear from the research that a fair # of patients with LARC DO achieve cCr or pCr following initial treatment. I'd have to dig further into the weeds to parse out if any patient profiles lend themselves more to this; I did read that younger age is not a beneficial factor to better outcome.
But this may at least explain where we're at today with no treatment or surgery and only more scans and biopsies scheduled.
