SECOND OPINIONS

Second Opinions?

SECOND OPINIONS

Getting a second opinion on a cancer diagnosis seems like the logical thing to do, but is it? Taking that step to see another specialist for your disease might actually bring new information that you will have to deal with that is different from what you were first told. That second opinion might involve using a different medication, new surgery or an alternate radiation schedule. After you have all that new information you then have the enormous task of deciding which you should follow. Then comes all the extra worry, anxiety and aggravation you are already having to deal with. Remember that there is no “right” plan.

Other challenges of a second opinion is the doctor may say something about your prognosis that weighs heavily on you, such as how long you may survive. This is sometimes a subject that patients tend to hold on to over time. If you are told your situation is hopeless, then you are left to deal with it. Being told you should do well and then you have nausea and horrible fatigue, you then feel you have failed to handle it well enough. Usually you are told to follow up with your own doctor because there is nothing more the specialist can do for you. That seems like a sure fired death sentence.

The practical side of a second opinion is time and money spent that can become a major issue over time for most people and further stress the patient.

Ideally, if you want a second opinion, get it from a doctor who is an expert in the type of cancer you have, and they are usually in academic medical centers affiliated with universities, designated NCI (National Cancer Institute) or NCCN (National Comprehensive Cancer Network). If this medical center is far from where you live, the money problem will be the cost of airfare and hotels plus your actual medical bills. Family able to go with you who are able to shoulder their costs might also be a factor, but you need all the support from family and friends that you can get.

Taking all these challenges into consideration, is it worth it to get a second opinion? If you have a good working relationship with your oncology team, maybe you don’t need to travel for that second opinion. Medical doctors and researchers have come up with specific treatment plans for many types of cancers, and evidence based practice guidelines (EBPG) tell the doctor the best way to treat certain cancers. You may not need to travel for a second opinion if there is an EBPG for your type of cancer.

If you do have a rare cancer or your doctor does not see many patients with your kind, a second opinion will likely be worth the added stress, time and money. Going to multiple doctors (doctor shopping) for second opinions can actually worsen the anxiety. All you need for a goal is to develop an evidence-based treatment plan with a doctor that you trust to manage your cancer as well as possible. Any second opinions from an expert should be shared with your oncologist so that he/she may use this as part of your treatment plan.

Some tips for a second opinion are: Create & update a medical notebook, bring all scans to your appointments, write out your questions prior to appointment, take medications to your appointment, log what your doctor says, visit a designated academic medical center, visit clinicaltrials.gov, take someone with you and do something FUN in the city you are visiting. Be sure to ask how many patients they treat with your type of cancer, are they willing to work with your oncologist, how often do you return for updates, what would they do if they were you and what other resources do they have to help people with cancer.

Take control and accumulate as much information on your cancer as possible and use that support from your family and friends to make things easier for you. Never give up hope based on one doctor’s opinion if you aren’t comfortable with the information. Search for other alternatives for treatment.

Dr Fredda Branyon

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