What is a second opinion in cancer care?

According to survey results, cancer patients are the ones who feel the greatest need for a second opinion. The reasons are varied: a wish to be double sure or a lack of trust in their doctor, the challenge of making a choice among several treatment options, or, conversely, situations where it seems that all options have been exhausted.

After all, what is a second opinion in cancer care?

At first glance, the answer may be rather short. It is an assessment of a specific case of malignant disease, provided by a specialist who has not previously been involved in a patient’s diagnosis or treatment.

But behind the words “what is it” there may be a deeper meaning - what is the current place of this type of medical care in the fight against cancer, why and at what stages it may be necessary, who can provide it?

Why is an alternative view so important

Cancer is always an unexpected and shocking diagnosis. Upon learning about a life-threatening disease, the patients and their loved ones find themselves in a situation of extreme emotional stress. The urge to do something immediately in order not to lose precious time becomes the motive that determines all thoughts and actions. It may seem that contemplating and searching for some alternative solutions are simply inappropriate. But in the vast majority of cases this is not the case. Oncology is a field of medicine in which second opinions play a crucial role, helping to improve therapies and achieve the best possible outcomes.   

A second set of eyes can never hurt

Accurate diagnosis is essential for a favorable outcome in the treatment of any disease, especially cancer. Despite advances in science and the introduction of AI, the laboratory and radiological tests which form the basis of modern cancer diagnosis still depend to a certain extent on subjective factors. Simply put, on what a pair of human eyes sees. But, as is known, to err is human (e.g., due to fatigue, loss of attention, insufficient experience, etc.). Therefore, in the case of cancer pathology second opinion and image reinterpretation are an effective way to double-check the reliability of diagnostic conclusions, therefore creating conditions for correct therapy choices and favorable outcomes.

Rare forms and variants of cancer require special expertise

Even among the most common malignancies, such as breast or prostate carcinomas, there are rare types, such as Paget disease or neuroendocrine prostate cancer. And, of course, there are rare cancer diagnoses that even experienced oncologists may encounter only a few times in their entire practice. In such cases, seeking a second opinion from a physician with the appropriate subspecialty, or a comprehensive tertiary center, is more than justified. Such a step will ensure the accuracy of the differential diagnosis and help to obtain the most optimal treatment.

Cancer care is a field where decisions are not taken alone

When it comes to cancer, it is often not easy to answer the question of which method is the best. It is not uncommon for several options to be considered at the same time, all being fundamentally different in nature. A single specialist is not always able to assess the nuances of each of them. Therefore, to develop an objective decision requires the opinion of representatives of different specialties, such as surgeons, oncologists, therapists, radiologists and even a pathologist who examined the tumor tissue.

In healthcare, the procedure is called a multidisciplinary tumor board. In fact, it is one of the ways of getting a second opinion. Notably, the conclusion of such an advisory group can be obtained remotely. 

Peace of mind is just as important as modern techniques

Many cancer treatments are associated with severe side effects and major changes in lifestyle. It is not easy commit to it.

“Is a stressful operation absolutely necessary?” “Can radiotherapy indeed reduce the risk of relapse?” “Is the aggressive chemotherapy worthwhile?” People are plagued by such questions even with the highest level of trust in their physician.

At what stages in your fight against cancer should a second opinion be sought?

Additional advice may be needed at various points:

• the initial diagnosis-making;
• working out the first line treatment plan;
• disease monitoring;
• in the event of a relapse.

In terms of diagnosis, for example, not only the fundamental distinction between benign, malignant (or borderline, carcinoma in situ) process, but also an accurate definition of the complete malignant tumor profile, i.e. its immunohistochemical and molecular biological profile, are important. The second opinion can confirm whether all these characteristics are fully and correctly determined.

In treatment planning, a doctor should take into consideration not only the standard clinical guidelines, but also the individual patient situation. In this regards, the involvement of another specialist can provide a more objective view and improve the choice of therapy.

Disease monitoring is of key importance in cancer care, and here a second opinion is helpful both in determining the appropriate follow-up plan and in the correct interpretation of findings - for instance, distinguishing between cancer metastasis and benign changes.

In the case of an unfavorable development, i.e. relapse, available therapeutic options may be limited, in which case it is all the more important to get different opinions and involve as many experienced specialists as possible in order to find the right solution and achieve a positive outcome.

How do I prepare for getting a cancer second opinion?

To be more specific, the question is how the patient should proceed, given that they may need a second opinion. Here are some useful tips.

1. Make sure you have full access to your electronic medical record, including the ability to download imaging (radiology) data. If you do not use an electronic version of your medical history, carefully collect all written reports and save imaging files on disks.
2. After the biopsy, in addition to the biopsy report, try to get hold of microscope slides and paraffin blocks with tissue samples, or at least ask how they can be obtained if necessary. These may be needed if your pathology findings are to be reviewed.
3. If possible, keep a record of events related to your health, such as new symptoms, improvement or worsening of your condition after therapy, etc. This information can be an important supplement to objective data (doctor's reports and exam results) in an external evaluation of your health situation.

Where and how should you seek a second opinion on your cancer?

No doubt, second opinions should be obtained from the most reputable sources - specialists and health care facilities that:

• have extensive practical experience in a particular cancer type;
• participate in the development and clinical trials of new diagnostic and treatment methods;
• continuously improve their skills and knowledge by participating in national and international professional associations.

The problem is that collecting and analyzing relevant information on your own requires time and, to some extent, specialized knowledge. But even with the most careful approach, mistakes or a failure in getting the expected results cannot be ruled out.

There are at least three strong arguments in favor of this decision:

1. You won’t need to spend efforts on searching and comparing ratings, physician profiles and hospital descriptions. In the vast majority of cases, you will get a ready-made solution (recommendation of the most appropriate specialist) based on objective analysis and years of experience. If the situation is too far from being standard, it will be much easier for professionals to find the right expert with the help of reliable information resources and extensive contacts with leading international medical community representatives.
2. Patient data shared with the cancer expert for a second opinion will be carefully checked for completeness and relevance, and properly processed and compiled so that the physician can get the maximum information in a convenient format. Thus, they will not spend effort searching for necessary details and will be able to fully focus on your health issue. This shortens the response waiting time and ensure the most benefit of your remote consultation.
3. The service is not limited to the fulfillment of the order placed by the user. They can also count on professional assistance if their cancer second opinion in case of the need for actions dictated by the second opinion encouraged a further action. For example, if one was referred to a specific specialist or medical exam. Your personal manager will remain in touch even after the consultation is completed, ready to provide the necessary assistance.

Regardless of the complexity of the health situation, cancer patients should be aware of the possibility of getting a second opinion. It will help to clarify the diagnosis, choose the most effective method of treatment and increase the recovery chances. For best results and effort efficiency, ure the best result and to save effort. 

References

1. Hillen MA, Medendorp NM, Daams JG, Smets EMA. Patient-Driven Second Opinions in Oncology: A Systematic Review. Oncologist. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. Epub 2017 Jun 12. PMID: 28606972; PMCID: PMC5634767.
2. Lipitz-Snyderman A, Chimonas S, Mailankody S, Kim M, Silva N, Kriplani A, Saltz LB, Sihag S, Tan CR, Widmar M, Zauderer M, Weingart S, Perchick W, Roman BR. Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations. Cancer Med. 2023 Apr;12(7):8063-8072. doi: 10.1002/cam4.5598. Epub 2023 Feb 3. PMID: 36737878; PMCID: PMC10134380.