When Is It Time for a Second Opinion?

From the Editor's Desk
March 3, 2016
Lidia Schapira, MD, FASCO

Anyone whose life is affected by cancer has wondered about when and if getting a second opinion is the right course to take. Second opinions require some coordination and work, but they really are worth the effort. They often help relieve anxiety and clarify how the illness is treated, especially soon after a diagnosis is made. Second opinions can also give you access to more information and resources.

Don’t be afraid to ask for a second opinion. I’ve been on all sides of this issue: as the physician giving the opinion, as a physician whose patient has gone to a colleague across town for another opinion, and as a worried friend and relative seeking confirmation of a diagnosis and treatment plan. So don’t worry about insulting or hurting the feelings of the first oncologist if you tell her or him that you’re going to get another opinion.

Some reasons for seeking a second opinion

  1. You want to confirm a diagnosis.
  2. You want to hear from experts who have access to unique treatments, including clinical trials.
  3. You want different views about how to best manage the cancer.
  4. Sometimes it is not you who wants the second opinion, but a family member instead. 
  5. You want to transfer your medical care to a different doctor. It may be easier to say you are looking for another opinion than to explain that you are actually looking for another doctor.

All of these reasons are perfectly legitimate. A cancer diagnosis is overwhelming and fills your life with uncertainty. Seeking a second opinion can help remove some of that uncertainty for both you and your circle of supporters.

What happens in a second opinion?

Let’s consider an example: a woman has recently been diagnosed with breast cancer after a routine mammogram. She requests a second opinion from an oncologist or a multidisciplinary team of specialists, including a surgeon and radiation oncologist with expertise in treating breast cancer.

During the consultation, the mammography films will be reviewed again. The original biopsy slides will be reviewed too. More experts may be brought in to confirm the diagnosis. Second opinions involve an independent review of all of the data by a multidisciplinary team. It is not uncommon for the review of the biopsy or surgical slides to lead to a change in the diagnosis. This may then lead to a change in the recommended treatment. Because second opinions involve expert review of the evidence, new data may be uncovered that can affect the diagnosis itself or present new options for treatment.

When to decide

Patient advocates say that a second opinion can make you confident that you are doing the best things for your health. However, it is also possible to keep seeking opinions and to not feel satisfied with the results. Remember that the purpose of a second opinion is to confirm a diagnosis, treatment plan, or both. At some point it is essential to decide where your cancer journey is going to go. When a diagnosis has been confirmed by an expert and you feel that you trust your physician, it’s time to move forward.

Here is a personal observation about the entire process. Physicians communicate in different styles. Don’t be confused by different methods of communication. One oncologist may say there is a 20% chance of cancer returning (or a 20% chance of relapse), and this may frighten you. Another oncologist may frame it differently and say you have an 80% chance of being cancer-free and enjoying good health in 10 years.  This is the same information, but it is communicated very differently. The first approach is more likely to persuade you to do something to improve the odds. Meanwhile, the second approach may lead you to ask tougher questions about the tradeoffs involved in going forward with potentially grueling treatment.

Second opinions can save lives by connecting patients with experts in all aspects of diagnosis and treatment. They are not always required, especially for those situations where there is little or no ambiguity about the diagnosis or treatment. But in many cases, a second opinion can empower patients to weigh the pros and cons of treatment and to choose what is best for them. share on twitter