When to Seek a Second Opinion
There are few conversations more ground shaking than receiving a cancer diagnosis. According to the American Cancer Society, that's a conversation more than one million people have each year with their doctor. And while your current care provider may have a treatment plan and course of action in mind, you may still have lingering questions: Is this my best option? Who else should I reach out to about this? Should I get a second opinion?
It's not uncommon to want additional information or a second opinion regarding your diagnosis and treatment. After all, this journey affects your health and your life, so you deserve to have all the information. Make sure you ask the right questions to the right providers in order to get the care you want and deserve.
When you initially received your diagnosis, you may have zoned out after the word "cancer." Dr. Margarett Ellison, gynecologic oncologist with North Fulton Hospital, says that most patients hear nothing else after a cancer diagnosis is conveyed to them initially. That's completely understandable – it takes some time to process such big news. Because of this, meeting with another doctor may simply be a chance to go over all the information again.
Second opinions are also helpful in the case of particularly difficult diagnoses, such as when cancer is widespread. Dr. Michael Andrews, Chief Cancer Officer of WellStar's Cancer Network, explains, "Sometimes you can look at the X-ray images of the body and tell very clearly what kind of cancer it is. For example, a large lung mass is a lung cancer, and it is clear. But other times when cancer is in different places in the body, where it started may be unclear." In cases like that, oncologists need more than just X-ray information. They'll examine the cancer under a microscope, and a second opinion can help to confirm the diagnosis. Dr. Eric Mininberg, a hematology oncologist from Piedmont Cancer Institute, adds, "A second opinion is often helpful in evaluation of a rare disease by an expert who specializes in that tumor type or when special surgery or interventions
In addition to these medical reasons, a second opinion is also justified whenever you want one for peace of mind about the diagnosis itself or the treatment plan. So whether or not your cancer is rare or medically familiar, your comfort and confidence in the diagnosis and treatment plan are the best reasons to seek a second opinion.
But you know what they say about too much of a good thing – though a second opinion is helpful, enlisting too much information can be overwhelming. By the time you're on a fourth or fifth opinion, the consultations may become confusing or simply repetitious. For that reason, you may be better off seeking just one or two additional opinions and then moving forward with a treatment plan.
What to Expect
A second opinion may do one of two things to the initial diagnosis: confirm it or change it. Though it is possible for different doctors to arrive at different conclusions, you probably shouldn't expect radically different news from your second opinion. Dr. Mininberg says, "In general, the diagnosis is usually the same." Dr. Patricia Thompson, a medical oncologist from Cancer Treatment Centers of America at Southeastern Regional Medical Center, agrees. She notes, "At CTCA, it is rare that we arrive at a different diagnosis."
On occasion, though, the diagnosis does change. A Johns Hopkins study reviewing 800 head and neck cancer surgery cases referred to the hospital between 1990 and 2000 showed second-opinion tissue sample diagnoses changed in seven percent of cases. When that happens, Dr. Mininberg says, "It is imperative for the patient to understand why so they can make an informed decision about what is right for them." Cancer Treatment Centers of America takes the same educational approach if their doctors arrive at a different diagnosis. "All of the information is carefully explained to the patient," Dr. Thompson says. "We make sure they understand the difference of diagnosis as well as their options for treatment."
Dr. Jayanthi Srinivasiah, medical hematologist and oncologist with Georgia Cancer Specialists and DeKalb Medical, explains that even if the diagnosis is the same, the suggested treatment plan could change. "One physician might be comfortable with one option, and a second might be comfortable with another. The patient can choose what [treatment option] they are most comfortable with." Dr. Thompson agrees that a second opinion is valuable for every stage of your journey to recovery. She recommends a second opinion after the initial diagnosis, during treatment to stay educated about your options, and even upon completion of treatment to confirm that you are cancer-free.
Who to Ask
Now that you know what to expect from a second opinion, make sure you set appointments with the appropriate provider or group of providers. Dr. Andrews says cancer care centers, academic settings and large referral centers offer the advantage of having many oncologists, which allows them to specialize in specific cancers. Dr. Srinivasiah agrees that opinions from a variety of specialists can be helpful in determining treatment plans. "There are certain situations, like with breast cancer, where the question is 'Do we first go with surgery or chemo?' A medical oncologist and a surgical oncologist may have varied opinions."
Don't forget that your physician is a beneficial resource too. Dr. Srinivasiah recommends asking, "Are there other types of doctors I should seek for my care?" The American Cancer Society also recommends asking your doctor, "If you had my type of cancer, who would you see for a second opinion?" or simply, "I'm thinking of getting a second opinion. Can you recommend someone?" This way, you can let your doctor's knowledge of the medical field itself and of your particular cancer guide you to the appropriate resources. You may also consider seeking suggestions from support groups, family and friends.
Another consideration is the location of the experts, since some will be closer than others and you may not want or be able to travel far away. Dr. Andrews points out that, thanks to a new partnership with WellStar and Mayo Clinic, "A lot of times the patients don't have to leave our area. We can do a second opinion by loading all the information, X-rays and pathology into a system. Mayo Clinic will review it and give you an opinion within 48 hours."
Accepting a Complement
When seeking additional opinions and resources, don't limit yourself to traditional routes. Dr. Andrews says involving professionals such as dietitians and fitness experts is extremely important. So important, in fact, that WellStar offers a dedicated support practice that includes cancer nutritionists, physical therapists, counselors, social workers and acupuncturists. All of these avenues can help a patient manage symptoms or side effects of treatment and feel as good as possible.
Despite those benefits, it's important not to let complementary methods prevent or conflict with a set treatment plan. Dr. Mininberg says, "In general, I encourage patients to do whatever they can to feel better during therapy as long as it does not interfere or take away from their treatment." Just make sure to keep your medical team informed as you go along. "It is always a good idea to let the treating provider know what additional resources the patient is drawing from," Dr. Ellison says. "Having complete transparency with all providers leads to optimal patient care and outcomes."
Having the Talk
When considering seeking a second opinion, some patients may feel that it's unfair to their first doctor to ask someone else's expertise, or they may just be uncomfortable with the conversation. But your doctor is a professional, and he or she understands that you deserve to advocate for your own care in the way you feel is best. Plus, any concerns about your doctor feeling slighted are probably unnecessary. Dr. Thompson says, "Second opinions are widely accepted and highly recommended by most oncologists." Dr. Mininberg agrees, saying, "If a patient wants a second opinion, we do everything to honor their request." So if you find yourself dealing with a cancer diagnosis, rest assured that your doctor recognizes that your health and peace of mind are the top priorities. A second opinion may be the way to achieve those goals, so don't hesitate to start asking around.
Michael Andrews, MD, WellStar Cancer Network – www.wellstar.com
Margarett Ellison, MD, MHA, FACS, FACOG, North Fulton Hospital – www.nfultonhospital.com
Eric Mininberg, MD, Piedmont Cancer Institute – www.piedmont.org
Thomas Olson, MD, Aflac Cancer Center of Children's Healthcare of Atlanta – www.choa.org
Jayanthi Srinivasiah, MD, Georgia Cancer Specialists and DeKalb Medical Center – www.gacancer.com
Patricia Thompson, MD, Cancer Treatment Centers of America at Southeastern Regional Medical Center – www.cancercenter.com/southeastern