Who needs a second opinion after a cancer diagnosis
Should everyone who's diagnosed with cancer get a second opinion?
Getting a second opinion after a cancer diagnosis is almost always a good idea -- and not just from another oncologist. Consider enlisting the expertise of a pathologist to doublecheck the lab findings on which the recommended treatment is based. And when it comes time for surgery, ask the right questions to be sure you've got the right person for the job.
If the cancer is a very common type or is in an early stage, it may be safe to follow the oncologist's recommendation without getting another opinion. But in the vast majority of cases, it's quite valuable to get another perspective. And if the cancer is a rare type or is unusual in any way, it's extremely important to consult at least one additional expert.
Why should I get a second opinion about a cancer diagnosis?
First of all, two minds are better than one. The two doctors may agree with one another, in which case you'll have the peace of mind that comes with confirming that the treatment plan is a reasonable one. However, if the oncologist has made a mistake -- and mistakes do happen -- a second opinion could make all the difference in the patient's outcome.
Sometimes, for example, one oncologist will say that a cancer is too advanced to operate, while another oncologist -- who might be more familiar with that particular type of cancer or with the surgical procedure that would be required to remove it -- will consider it operable. In other cases, bringing in a specialist leads to the discovery that it's a different kind of cancer altogether. The new oncologist may have more experience with rare types of cancer, or he may interpret the test results differently or decide to run new tests, which could provide new insight.
If you're trying to decide whether getting a second opinion is worth it, ask yourself whether you'd go the extra mile if a second examination discovered that the cancer is a more treatable type than the first doctor believes.
Dealing with doctors regarding a second opinion about cancer
How can I avoid offending the cancer doctor?
You may be concerned that the doctor will take your request for a second opinion as an expression of doubt or lack of confidence in her skills. Keep in mind that oncologists receive this request very frequently. While some oncologists do resist when patients ask for a second opinion, most are supportive of the idea.
No matter which way the oncologist reacts, all patients have the right to get a second opinion, and you may need to assume the role of advocate for the person in your care to make sure this happens. (For more information on this issue, see " What's the best way to ask for a second opinion on how to treat my mother's breast cancer? ")
"Some doctors appreciate it when you want to bring in another expert because then the decision about treatment doesn't rest solely on their shoulders," says Bonnie Bajorek Daneker, author of The Compassionate Caregiver's Guide to Caring for Someone With Cancer. In cases where there's more than one treatment option to choose from, Daneker says, a doctor may welcome having another expert weigh in.
How do I find the right oncologist for a second opinion?
If a patient has been diagnosed with a rare cancer, what you really want is to find an expert in that particular type of cancer. If such an expert is available locally, you should probably switch to that doctor.
If you can only find an expert who is far away, which is likely, the local oncologist may be able to work with him via telephone or e-mail consultations. While this sounds awkward, it can deliver a big payoff.
A specialist may know of a promising treatment that a local oncologist, who hasn't seen many such cases, doesn't know about. And if it's a treatment that's only available in a particular location, it may well be worth traveling for. Bringing in a specialist might also help a patient gain access to a clinical trial if that's a viable option.
Pathology and second opinions on cancer
Is it a good idea to get a second opinion on the pathology results?
Yes, a second opinion from a pathologist can be extremely valuable. The pathologist is the doctor who specializes in reading and interpreting lab results, while an oncologist is the doctor who treats the diagnosed cancer. So it's important to feel confident that the original diagnosis was made correctly, particularly if there's any question about the interp
retation of the biopsy or lab results, or if there's more than one possible plan of action.
Pathologists aren't infallible in interpreting lab results, and a second opinion is the most effective way for patients to uncover and correct errors that might result in an incorrect diagnosis. Because the treatment plan depends on the kind of cancer and how far it has spread, the interpretation of the pathology dramatically affects treatment and prognosis.
How do I get a second opinion from a pathologist?
Start by obtaining a copy of the pathology report and cell slides from the doctor, and then seek out pathologists who specialize in the type of cancer the doctor thinks the patient has.
There are a number of renowned cancer institutes that offer pathology services nationwide. One of the most respected is the Armed Forces Institute of Pathology , in Washington, D.C., which offers the most advanced diagnostic and imaging techniques. Other pathology services are available at major cancer centers such as Dana Farber , in Boston, and the M.D. Anderson Cancer Center , run by the University of Texas in Houston.
You might even want to send the slides to more than one pathologist. Usually, the more information you have, the better off you are. If a pathologist doesn't agree with the original interpretation, she can perform additional studies to confirm or correct the original diagnosis.
One caveat, however: If the oncologist tells you that the cancer is aggressive and there's no time to waste, it may be a mistake to delay while waiting to obtain a second opinion. There's nothing more disheartening than consulting a specialist who finds new cell growth that has occurred since the original tests were performed.
Second opinions from cancer surgeons
Should I get a second opinion from another surgeon?
If an oncologist has referred you to a particular surgeon, you'll want to check out that surgeon's credentials and, if possible, interview her.
Whether you accept that surgeon depends on the type of cancer and how common the indicated surgical procedure is. If the cancer is in the early stage and the advised procedure is common, it may not be necessary to get a second opinion or to look for a specialist.
However, if the cancer is a rare type or has invaded the surrounding tissues in a way that makes the surgery tricky, it's a good idea to look for a surgeon who has extensive experience performing that specific type of surgery.
How will I know whether I have the right surgeon?
If you have a choice of surgeons, start by looking for someone who has treated the particular form of cancer. The questions you might ask when choosing a surgeon include:
- How often do you perform this type of surgery?
- How many of these procedures have you performed?
- What's the overall success rate for this type of surgery?
- What's the success rate for those surgeries that you' ve performed?
What else should I find out from the surgeon?
You'll want to talk to the surgeon about other issues, such as what to expect when the patient undergoes the procedure. This kind of information can affect important treatment decisions.
If the patient is extremely frail, for example, and you discover that the surgery is very demanding, the recovery time long, and the percentage of patients with positive outcomes low, you might rethink your treatment options. To zero in on this information, ask the surgeon to list all of the risks and complications, even rare ones, and also ask for a realistic estimate on recovery time.