Getting a second opinion is a vital part of becoming more educated about your treatment options and your cancer. The more you are able to learn regarding your cancer diagnosis and options for treatment, the better your chance of getting the treatment which is most appropriate for you. Cancers are more treatable than they were previously, however, there are also a larger variety of treatment options and procedures which are more complicated. Having a second opinion can help you better understand these options and make an informed decision regarding which is option is right for you. Competent doctors will not be offended by second opinions. Second opinions do, however, reassure you and your family and in the end they enable you to get the most right therapy.

What is a Second Opinion?

A second opinion is an evaluation of the cancer diagnosis and recommendations of treatment by the doctor who is currently treating the cancer by an addition, independent physician.

Either the patient or the primary doctor can start the process of obtaining a second opinion. Typically, patients get a second opinion after they are referred to a second doctor or a special multidisciplinary team, comprised of several experts at a cancer treatment center. This physician or team of physicians will look at the following:

• Pathology report (the way the cancer appears under the microscope),

• How extensive the cancer is

• The patient’s physical condition

• The treatment that has been proposed

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The physician(s) then relay their opinion about treatment to both the primary doctor and the patient.A second opinion is more likely to be more comprehensive, or including all possible perspectives, when it is performed with a multidisciplinary team in a cancer center. This team usually includes sub-specialist oncologists, oncologists, radiation therapists. and surgeons.

Why Do I Need a Second Opinion?

A second opinion is a vital part of the process of being educated for cancer patients. In recent times cancer treatment has evolved significantly. Because of this, many cancers are more treatable now then they were previously, especially when the correct initial treatment is selected.

To get the most appropriate treatment, patients need to understand the kind of cancer they have and the available options for treatment. However, today there are many more treatment options, and these treatment options are much more complicated than they have been in the past. For these reasons as well as others, it is to your advantage to get more than one opinion regarding your cancer treatment. In addition, a second opinion will give you the opportunity to get information from a person other than the doctor who will be managing your treatment, which is normally the primary source of information for many patients. Second opinions are common practice in all areas of complex medicine that has many available treatment methods.

Is it “Bad Etiquette” to Get a Second Opinion?

Patients, friends, and relatives should remember that second opinions are a regular part of good cancer management and they should not concern themselves with hurting their primary physician’s feelings. If you opt to get a second, independent opinion, it is very important to communicate with your primary physician to get the information you need for the review, and also to make sure your treating physician informed. The majority of physicians are glad to have another physician review and approve the decisions they have made about the patient’s care, or to suggest other treatment options that could be more effective. In some cases a patient might disagree with their primary physician and may desire to change physicians; however, this is not a second opinion’s main purpose. The majority of the time, you just want to be sure that you are receiving the best advice.

Who Pays for a Second Opinion?

A big problem with getting a second opinion is that insurers might not cover this expense. However, many health care and insurance companies will pay for these opinions and recognise the importance of getting second opinions. In certain circumstances, some insurers may even insist on second opinions. This is usually the case the the patient’s primary physician suggests an expensive form of treatment.

For cancer patients who are members of a Health Maintenance Organization (HMO), their best protection is to seek second opinions even if they have to pay for it. These HMO’s generally try to treat and diagnose patients within their own system because the more money that is spent on treatment and second opinions outside of the HMO, the less money can be used for operation profits and costs. This can create a conflict of interest between the HMO and the patient, particularly if the treatment can only be obtained outside of the HMO system. HMO members might be discouraged from trying more expensive treatments which only offer a small chance for success, even though that chance may be very real. Because of this, getting a second opinion is a good idea for HMO members so they can be sure to be informed of new clinical trials and other new, promising treatments. The majority of reputable HMO’s, however, can offer state of the art cancer treatment for most types of cancer. Anyone considering a specialized treatment, like cancer surgery, within the HMO they are a part of, should ask about the number of like procedures that are performed every year by this HMO and what the results are.

Who Should Get a Second Opinion?

Specific situations where a second opinion is the most useful are not defined. However, there are obvious situations where second opinions can be helpful and beneficial to most patients. These situations include:

• Rare cancers

• An apparent lack of viable treatment options

• A poorly communicated or misunderstood diagnosis

• Treatment plans which involve surgery as the primary treatment

• Treatment plans that involve aggressive treatment

• A diagnosis made by a cancer sub-specialist

• A diagnosis made in a rural or small hospital

• Treatment plans that involve specialized treatment

• Treatments that involve clinical trials

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Diagnosis from a cancer sub-specialist: Many kinds of cancer are treated by several kinds of cancer specialists. An example of this would be prostate cancer, which can be treated by radiation oncologists, urologists who are also surgeons, and/or medical oncologists that use drug treatments. Each of these specialists might think that the treatment they use is the best treatment option for the patient. A good example of this would be in the localized prostate cancer, where:

• Radiation oncologists almost always advise some type of radiation therapy.

• Surgeons almost always advise surgery, such as radical prostatectomy.

Because of this, a patient suffering from a cancer that is treated by sub-specialists might want to consult a general cancer doctor (oncologist) or a multidisciplinary team to get a complete understanding of available treatment options. Looking for a second opinion from another kind of specialist can provide new information, but it can unavoidably bring some confusion as well when considering treatment options. The best method for resolving this confusion is to gather the available information and use it to make an informed decision.

Initial diagnosis by non-cancer specialists: A patient who has been diagnosed by a non-cancer specialist can benefit from getting a second opinion. Within the United States, doctors that are not oncologists frequently diagnose and treat their patients who have cancer. Internists, family doctors, gynecologists, ear-nose-and-throat doctors, pediatricians, urologists, and other non-cancer specialists can diagnose and treat cancer. However, a patient treated a cancer treatment specialist should consider getting a second opinion. In some circumstances, a physician will not refer a patient for second opinions because they might lose control and/or treatment revenue, they might feel threatened by their patient believing that another doctor could be more knowledgeable, or they are too busy to consult with other physicians. A patient with a physician who fits these descriptions most likely needs a second opinion the most.

A diagnosis that is poorly understood: Patients that feel that they might not fully understand their diagnosis and options for treatment should consider getting a second opinion. A second doctor may explain it in a way that the patient can understand better, or just hearing the diagnosis again may assist the patient in overcoming any denial that they might be experiencing.

An apparent lack of viable treatment options: Second opinions can be helpful for some patients who have been informed that there is no viable treatment for their type of cancer, and that no survival or relief from the cancer symptoms are possible. These patients have little or nothing to lose from seeking a second opinion. In these circumstances, patients should search out institutions and doctors which specialize in the treatment of their kind of cancer and have clinical trials. This is often accomplished by finding out which cancer care centers are undergoing clinical trials of novel treatments that are relevant to the type of cancer that is affecting the patient. There is information available on the internet that can help patients locate these institutions and physicians.

Treatment plans that involve clinical trials: When the treating physician recommends participation in a clinical trial, getting a second opinion is advised to be certain that this treatment is appropriate. There are multiple kinds of clinical trials which may or may not benefit patients with a specific cancer. Physicians participate in cancer research when they enroll their patients in a clinical trial. However, doctors often have difficulty finding patients to participate. As a result, some doctors may unconsciously suggest a trial which might not represent the best possible treatment for that particular patient.

Although a clinical trial might be the best treatment option for you, you should carefully consider all the possible clinical trials before you select the one recommended by your treating physician. Two ongoing sources of information concerning clinical trials includes easy-to-use, comprehensive listing services which are made available by CancerConnect.com and the National Cancer Institute (cancer.gov).

Surgery as a primary treatment: If any doubt exists about the inoperability or operability of a cancer, it is wise to get a second opinion. In these circumstances, patients are advised to get a second opinion in institutions that treat large numbers of patients. For example, esophageal cancer might be considered inoperable in hospitals that perform one of those procedures a month, while an institution that performs many of these procedures every day might consider it operable. Also important to note is that these institutions may note that cancer may be inoperable and the surgery could be harmful, even if a less experienced hospital was willing to do the procedure.

Rural practices and small hospitals: Patients that live in rural areas and get treatment in a small hospital would do well to get a second opinion from a larger medical institution before they start treatment. Although a smaller hospital usually delivers excellent treatment, it is wise to be sure that the treatment that is recommended is appropriate and can be administered safely. Rural and small hospitals might not see many cancer patients, and although they are generally fully capable of administering treatment, it is a good idea to get a second opinion to help decide what the best treatment is. Occasionally, the treatment that is recommended can determine whether the patient can be treated at the local hospital or whether they should travel to a bigger medical institution. An example of this would be that most smaller hospitals can deliver chemotherapy very effectively, but they may not offer more complicated procedures, such as a stem cell transplant.

Aggressive treatment: Most cancers that can be cured by the use of chemotherapy (testicular cancers, some lymphomas, acute leukemias) will require intensive treatment like radiation therapy or high doses of chemotherapy. A second opinion is helpful in making sure that the right intensity is used to attain the cure, rather than just temporary remission. Sometimes oncologists will treat patients that have curable cancer with lower doses of chemotherapy in an attempt to limit the side effects. This can seriously compromise the patient’s chances of being cured. Also, an intensive treatment requires a rigid adherence to the drug dosages prescribed to be sure that optimal results occur, complications are monitored, and aggressive supportive care is properly managed. Often intensive treatment can be delivered locally, but patients are generally best treated in a center that utilizes state of the art protocols and treats many patients. If you are contemplating an aggressive treatment, it is wise to determine how many patients your local treatment center treats per year, and what their results are. Ask your treating doctor about their own results, and not results that are from patients who have been treated in other institutions.

Rare Cancers: When dealing with rare cancers, seeking a second opinion is usually the best course of action unless the diagnosis was made at a center which specializes in that particular cancer’s treatment. If there is a local expert available, it is advisable to switch treatment to that physician. If the expert is located too far away, which is usually the case, your home doctor can most likely coordinate treatment by e-mail or phone. Even if the type of cancer you have is not rare, you can benefit from finding someone who has a special interest in that kind of cancer. For example, kidney cancer is not exactly rare, but it isn’t really common either. Generally patients suffering from kidney cancer will be treated on clinical trials which are carried out in one of several big institutions. This is done because clinical trials often require specialized treatment, and if there are not enough patients who have kidney cancer being treated at one cancer care center to make the research meaningful, that center may not offer the treatment.

Specialized Treatment: Not every medical centers offers the specialized treatments that can offer patients the best results. In those circumstances, getting a second opinion is wise. For example, blood or bone marrow stem cell transplants could offer the best chance for a cure or to control the cancer for patients with lymphoid and blood cancers such as lymphoma, leukemia, and multiple myeloma and other cancers like ovarian, breast, and testicular.

Specialized treatment might also be required for patients suffering from liver cancer. Recent clinical trials suggest that sophisticated techniques like radioactive isotopes, intra-arterial chemotherapy, conformal radiation therapy. radiofrequency ablation, and chemo-embolization can be a major benefit in treating liver cancers. However, some centers do not have the capability to deliver these kinds of treatment. Patients who have liver cancer and other cancers which may be treated by a specialized method should get a second opinion at a specialized institution.