Cancer: Should You Get a Second Opinion?

Cancer can be incredibly complicated. Getting a second opinion is a common thing to do no matter what your diagnosis is. There are certain situations, however, when a second opinion regarding your cancer treatment and diagnosis is especially important. This video is not intended as medical advice. Talk with your doctor before beginning any new health practice.

Transcript:

Hi and welcome to Cancer Straight Talk.  I am Dr. Lisa Schwartz and today I am going to talk about whether or not you should get a second opinion regarding your cancer diagnosis and treatment.

First of all let’s talk about what a second opinion is.  A second opinion usually involves a consultation with another doctor who has expertise in cancer treatment. This usually means a practicing oncologist. While your family physician, relatives, and neighbors may all have varying levels of experience with cancer, consulting with them does not constitute a second opinion. You may, of course, value their opinions and suggestions, but to be clear, they are not second opinions.

If your treatment involves more than one type of therapy, for example chemotherapy and surgery, you may want to see both a surgeon and a medical oncologist for a second opinion. The doctor you choose for a second opinion may be well known in his field or not. You should probably look for a doctor who is not in the same group practice as your original oncologist. Keep in mind that a second opinion does not mean that you have to switch doctors. In fact, after a second opinion, many patients get treatment from their original doctor, especially if the second opinion is in agreement with the first.

Cancer is complicated. Usually there are so many treatment options that it is almost always reasonable to get a second opinion. That doesn’t mean that you have to, but it is a reasonable thing to do if you want one. There are certain situations in which a second opinion may be particularly valuable.

If you have a rare or even just an uncommon cancer, get a second opinion if you can. In fact, you should ask your doctor to refer you to someone who has some experience with your rare cancer. This may mean travel for you. It may mean a visit to an academic teaching hospital. If you are not able to see the second opinion doctor in person, your doctor may be able to discuss your case with the expert by phone.

Some academic centers will even open up their tumor boards to doctors in the community who have difficult cases. A tumor board is a meeting attended by cancer doctors of different specialties such as medical oncologists, surgeons, radiation oncologists, pathologists, and radiologists who all get together and talk about difficult or interesting cases. Usually a recommendation about treatment results from this meeting.

Next, if you are dealing with a childhood (pediatric) cancer, you absolutely should get a second opinion at an academic medical center. Pediatric cancers are not common and are almost always treated at academic medical centers where there are physicians with expertise and experience in treating pediatric malignancies. In addition, many pediatric cancer patients are treated on a clinical trial which tend to only be available for children at academic medical centers. This participation in clinical trials has led to dramatic improvements in survival from childhood cancers over the years.

For adults, a clinical trial may also be available for your particular cancer. These can be done in community oncology practices or academic centers. Clinical trials help us determine the most effective treatments for a particular cancer. Often a new drug or procedure is being tested against the existing standard of care. Many community oncologists have access to clinical trials, and if you are interested in participating in a research study, you should ask your doctor if there are any trials for which you qualify.

There may be a clinical trial open at a different treatment facility to which your doctor does not have access. In this situation, you could ask your doctor for a referral to that other facility. Then you will be evaluated to make sure you are eligible for the trial, and it’s up to you to decide whether or not you want to enroll.

Another reason to seek a second opinion is if there is a new treatment for your cancer which is not available from your doctor. Usually this involves new technology or training. For example, robotic surgery is becoming more popular as a treatment for prostate cancer. Your doctor’s hospital may not own the equipment (the “robot”) to do this surgery and you may therefore choose to seek out a facility where this is offered.  I am a radiation oncologist and there may be very specialized types of radiation that your facility does not offer.

Another technology is breast brachytherapy which is a type of radiation therapy and is not available at every hospital. So if you want to investigate a new technology that is not available from your doctor, you may want to get a second opinion from a doctor who does have the technology in which you are interested.

And lastly, if you ask your oncologist whether or not you need a second opinion and he or she gets defensive, then you should probably get a second opinion (unless you have a very routine cancer). An oncologist who is comfortable that he is recommending the standard of care should have no reason to discourage you from seeking a second opinion. Certainly if you have a very common cancer with which your oncologist has ample experience, then a second opinion is not necessary. But you can still get a second opinion if you want one.

Patients are often concerned about hurting their doctor’s feelings if they want a second opinion or if they choose to switch doctors. This is when your care and best interest should truly be the top priority. The most important aspect of your treatment is that you have confidence in your treatment team. It is vital that your doctors communicate with one another and with you.

I certainly hope this has been helpful for you.  It would make me really happy if you would leave a comment below with any questions you may have and click the like button if you enjoyed this.  If you are watching this anywhere other than my blog, please go to CancerStraightTalk.com and sign up for further posts and updates.  Take care.