Why it helps to get a second opinion on cancer care

November 19, 2018

Providence Health Team

Most cancer patients don’t need to rush into treatment if they want the time for a second opinion.

A second opinion helps patients become comfortable with a treatment plan and with a physician’s care.

Patients should prepare for a second opinion by tracking their previous appointments and tests, and checking their insurance plans.

A cancer diagnosis usually comes out of the blue, with no warning or preparation. It can cause anxiety and disorientation, and a patient, trying to come to grips with it all, may wonder if a second opinion is needed. Kevin Olson, MD, the executive director of the Providence Cancer Institute in Portland, OR, talks about how to make the decision to seek out another perspective.

Don’t feel rushed if more information is needed

Patients may think that they have to take action against their cancer as soon as possible. However, the best treatment decisions usually require some information gathering beforehand, and that can take time.

“We counsel our patients that we don’t have to make a fast decision in most cancer scenarios,” Dr. Olson says. “It’s not the same as being in the emergency room and being told you are having a heart attack. That’s certainly not the time that people need a second opinion. We are lucky that we usually have the luxury of time.”

Ask two important questions

Dr. Olson says he tells family and friends who are grappling with cancer to ask two key questions before deciding to seek out a second opinion. The first question is whether the hospital holds what is called a multidisciplinary tumor conference.

“Once a core amount of information on a case is obtained, our clinicians bring it to our cancer conference. There, radiation oncologists, medical oncologists, surgical oncologists, pathologists and other specialists will be in the room reviewing the situation and discussing what would be the most effective course going forward,” Dr. Olson says. “It’s a way of getting a built-in second opinion without having to make appointments with other physicians. It’s an important tool that is often being implemented behind the scenes that patients may not know about.” He adds that these conferences are standard practice at the best cancer centers; at Providence, these conferences take place every week.

The second question a patient should ask their doctor: Are treatment recommendations consistent with national guidelines, and if the answer is no, then why not?

“When it comes to guidelines, there are times when the national guidelines don’t address the clinical scenario we are faced with. But if the answer is, ‘Well, I just don’t agree with them,’ I think that’s exactly when you want to start looking for a second opinion,” Dr. Olson says.

Before getting a second opinion, be prepared

The Providence Cancer Institute regularly sees patients who want a second opinion and tries to schedule visits promptly so patients don’t have a long wait time. One of the challenges, however, is making sure that the new physician has all the information necessary in order to make knowledgeable recommendations. Dr. Olson suggests that patients who have electronic portals with their medical history start gathering information there.

“The best thing patients can do is keep track of what tests they’ve had and where they were performed so the second opinion team can be aware of them and go find those results,” he says.

It is also smart to investigate insurance coverage for these appointments. “It’s always disconcerting when we work to get someone into our clinic quickly, only to find out that their insurance doesn’t cover a second opinion,” Dr. Olson says. “It’s wise to not necessarily increase your out-of-pocket expense because you are seeking a second opinion from someone who is not in your network.”

Think about treatment preferences

Getting all of the clinical information is the first step a physician can take toward forming a second opinion, but there is another crucial component. Because there is often more than one way to pursue cancer treatment, frequently a decision is made based on a patient’s values and preferences.

“As physicians, many of us spend our time trying to figure out what is important to the patients at this stage of life and what outcomes they are looking for,” Dr. Olson says. .

The second opinion appointment is also a valuable time for patients to get more educated about their treatment options and how they will affect their quality of life. “We are taking patients who are new to the cancer experience and trying to quickly get them up to speed on the nature of their cancer, their prognosis with and without treatment — it’s an educational kind of experience,” Dr. Olson says.

He adds that often things will look a little clearer to patients at this second opinion appointment. “When patients are told for the first time, ‘You have cancer and here’s what we want to do about it,’ a lot of times they don’t hear what the first doctor says because they are overwhelmed. By the time they see the second doctor, things have settled down a bit and patients may be able to better understand the information the second time around.”

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A nurse navigator can guide the way

Nurse navigators can be invaluable in helping patients through a cancer diagnosis. “Their job is to help patients not get lost in this discussion,” Dr. Olson says. “They are often coaching patients in what questions to ask, whether it’s a first opinion or a second opinion. If the patients are unclear about what they heard from the first doctor and want to pursue a second opinion, a nurse navigator is often familiar with the other experts in the area who might be a good option. They act as impartial coaches to make sure patients’ questions are being answered and that they are comfortable with their treatment plan at the end of the day.”

Often, there’s not just one right answer

Cancer patients should also keep in mind that many times there is more than one way to treat the disease. “It’s important for a doctor to explain all the options,” Dr. Olson says. “It is not uncommon for a breast cancer patient to have the option to start with surgery and then move on to a chemotherapy program; conversely, sometimes the option is to start with chemo and move into surgery. These are different specialties, so you’re getting a second opinion if you have to talk with different specialists.”

It’s also worth noting that what may seem like two vastly different treatment options to a patient may actually be very similar from the physicians viewpoint. Patients who get a second opinion that seems different than the first should ask the doctor if there really is a big difference between the two recommendations. If there is a difference, ask the second physician why they endorse that approach. Dr. Olson says frequently the answer is that the second physician has more clinical information; sometimes, it could be a matter of more expertise in the specific clinical case. “It’s a very valid question and most doctors should have no trouble answering it,” he says.

Finally, a second opinion visit also gives patients the opportunity to feel connected to a physician and their clinical environment. “If you’ve seen two different physicians in two different offices, sometimes one office or one doctor seems like a better fit,” Dr. Olson says. “Even if the recommendations are the same, there is value in making sure a doctor fits a patient’s needs and what he’s looking for.”

To learn more about breakthrough cancer treatments at Providence, and much more, visit finishcancer.org.

OR: Providence Cancer Institute