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Friday, September 20, 2013

Making a Second Opinion Count

By Richard C. Frank, MD

doctor and patient

Many cancer patients obtain a second opinion at some point in their cancer journey. A second opinion is not always necessary. If the diagnosis and treatment recommendations are straightforward and the oncologists and treatment center in your community are well-established and trusted, then you may not feel you need a second opinion.

The following are the most common reasons for second opinions that I see cancer patients going for:

  1. Peace of Mind: After cancer is diagnosed, the first oncologist will complete the staging work, that is, order any scans or additional testing needed to evaluate the full extent and prognosis of the cancer. Once a patient has a full picture of the cancer and its treatment, it is common to obtain a second opinion from another oncologist at another center. This is mainly done to confirm all of the initial findings and recommendations which will provide peace of mind.  For example, a woman with breast cancer who has had surgery followed by consultation with a medical oncologist at their local cancer center may have the pathology and treatment recommendations reviewed with a second opinion medical oncologist at another cancer center.
  2.  

  3. More Options: Once a patient learns that the treatment involves either surgery, radiation, chemotherapy, or some combination of these, he or she may seek another option for treatment. For example, in dealing with prostate cancer, if the first stop is to a urologist who recommends surgery, a second opinion with a radiation oncologist may provide the option of radiation therapy to treat the cancer.
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  5. More Specialized Care: If a person is diagnosed with a rare cancer, it is common to seek a second opinion at a center that specializes in that type of cancer. For example, a patient with a sarcoma (cancer derived from the supporting structures of the body, affecting 1% of all cancer patients) may receive the diagnosis in their community but seek a second opinion at the Sarcoma and Bone Cancer Treatment Center at the Dana Farber Cancer Institute. The doctors there have expertise in treating a large number of sarcoma patients and have access to the latest clinical research studies. It is common for the initial oncologist to make this kind of referral for the patient.
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  7. Treatment Site Preference: Many cancer patients prefer to receive cancer treatments close to home if those treatments will be the same as those delivered elsewhere (for example, the same chemotherapy regimen). Community cancer care is excellent and patients can be reassured that all oncologists adhere to similar treatment standards and guidelines. On the other hand, some patients need the psychological comfort of a large cancer hospital and are willing to travel out of their communities in order to be treated there.
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  9. Research Studies:  For cancers that are not easily cured with standard therapies, patients may seek a research study (clinical trial) in order to participate in an experimental therapy or approach that may (or may not) be superior to the present standard (trials can be found at clinicaltrials.gov).  For cancers that have progressed after all standard approaches, it is common for the treating oncologist to help their patient find a suitable trial. For example, the cancer center in which I work is participating in a clinical trial of the drug Ibrutinib, for refractory leukemia/lymphoma. Because the results thus far with this drug have been so promising, doctors in my region have been referring their patients to our center because they believe that Ibrutinib is the best treatment option for their patients.
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When planning for a second opinion, you cannot merely ask the first oncology office to “send all the records” and expect things to be in order.

Once you are committed to a second opinion, you must make three calls:

  1. To the office of the oncologist you have already seen, asking for your records to be faxed to the doctor providing the second opinion (you will need to sign a record release).
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  3. To the pathology department or laboratory that processed your biopsies or tumor specimen, asking them to send the pathology slides and a tissue block (if requested) to the referral doctor or his/her pathology department. Or you may pick these up and carry them to the second opinion.
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  5. To the radiology department or office where you had your imaging tests performed, requesting that they make CD-ROM copies of your X-Rays CT, MRI, or PET scans. Carry these CDs to your appointment for the referral doctor to review.

 

You can find more information on second opinions in the 2013 edition of my book, Fighting Cancer with Knowledge and Hope.

 

Posted by: Richard C. Frank, MD at 2:05 pm

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