Second Opinions

Carolyn Vachani, RN, MSN, AOCN
Abramson Cancer Center of the University of Pennsylvania
Last Modified: July 22, 2013

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Many people hear a diagnosis of cancer and think they must make a decision and jump into treatment the next day. While this can be true in certain types of lymphoma and leukemia, for the average patient, a few weeks to get another opinion and weigh your options is realistic. Believe it or not, there is no cookbook to follow when treating a cancer and you can encounter different treatment options for the same patient, even within the same institution. Every patient is different and each case should be decided individually. A second opinion can present different treatment options that were not known about or offered by the first physician or it can act as a quality check to confirm the first suggested treatment. There are many reasons to get a second opinion, including: a rare type of cancer or unknown primary site, you live in a rural area that does not treat many cancers, you have been told "there is nothing we can do", or you just don't feel comfortable with the first doctor you saw.

Second opinions are also a way to educate you about the options. If one doctor says treatment A is the best, but doctor number 2 does not agree, ask them to explain why. Many patients fear offending their doctor by getting a second opinion. A good doctor understands the need to research all of your options, particularly when dealing with something as scary as cancer. If your doctor discourages a second opinion or infers that you can't get better care somewhere else, all the more reason to get another opinion. You do not need the permission of your doctor to get a second opinion, except in the case of needing a referral from your primary doctor for an HMO insurance carrier.

The "big cancer center" is not near my home. Getting a second opinion at a major medical center does not mean you have to get your treatment there. In many cases they can provide recommendations for treatment that can be taken to your local doctor. It can be well worth a long drive or overnight visit to get a second opinion on your options.

Educate yourself on the "standard" therapies for your tumor type. The National Comprehensive Cancer Network establishes guidelines for treatment options that are available on their website: www.nccn.org. If you see an oncologist who encourages you to participate in a clinical trial of a new medication compared to a placebo or a drug not typically used in your tumor type, but you know that drug X is effective in your tumor type, you can ask appropriate questions. Clinical trials are extremely important to improving cancer care, but you must weigh the risks and benefits of each option for your situation. In most cases, if you are offered a clinical trial, it should not be your only option and you should also have the option of a "standard therapy".

Many patients think of a second opinion when it comes to treatment with chemotherapy or radiation therapy, but not always when surgery is the treatment of choice. Surgical oncology is a specialty in itself and if you require a big surgery for your cancer, a second opinion from a board-certified surgical oncologist may be in order. In some cases, one surgeon may say a tumor is inoperable, but a more experienced surgeon may say differently. Pathologists also offer second opinions on the actual diagnosis of the tissue taken for biopsy. Many patients do not think to question the actual diagnosis, but if you have a diagnosis of a rare tumor type or an unknown primary site, pathology review may be warranted.

So, how do you find a doctor for a second opinion? The National Cancer Institute designates institutions as "comprehensive cancer centers". To receive this designation, the institution must meet specific criteria regarding laboratory and clinical research into prevention and treatment of cancer. Visit the NCI website to learn more about the program or view the list of centers. This may be a good place to find a multidisciplinary center or an expert in unusual tumor types.

Contact your local American Cancer Society chapter. They maintain a list of the cancer centers and facilities in the area and the types of diagnosis they treat. Many advocacy organizations maintain websites that can recommend specialists in the tumor type they are interested in. The NCI's neuro-oncology branch in Maryland offers second opinions on various types of brain tumors.

As for finding a pathologist to review slides, there are a few resources available:

If you can identify a center that specializes in your tumor type, call the pathology department of that institution and ask how to go about having your slides reviewed. This can usually be done by mail, so geography need not limit where you can send the materials. If you don’t know of an expert center, try one of the major cancer centers in the US. There is a fee for having slides or tissue reviewed by an expert, but many insurance companies will reimburse part, if not all, of these fees. Fees typically range between 150-250 U.S. dollars.

The Joint Pathology Center provides pathology consultation for military personnel, veterans and other federal agency employees. Learn more on their website.



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