Cancer Second Opinion 101: Top 10 patient and provider Q&A

Lily Tang Contributor

Dr. Tang is currently a medical physicist and faculty at Yale New Haven Hospital/Smilow Cancer Hospital. She was trained at the Harvard Medical School/Massachusetts General Hospital and at the University of California/San Diego. She held faculty appointments at the University of North Carolina/Chapel Hill, and at the Memorial Sloan Kettering Cancer Center. She has rich experience about cancer second opinion.
What is a second opinion?
Because the diagnoses and treatment plans associated with cancer care are so complicated, it’s normal to experience confusion and doubt.

You might worry that your doctor has not found all the potential cancer, or that another doctor or hospital might propose a different treatment, or that a different doctor might know of some unconsidered treatment option. Therefore, you request a second opinion. Basically you simply ask a new doctor to either confirm the initial diagnosis and treatment plan, or provide an alternative.
Will my original doctor feel offended if I want to get a second opinion?
N o. As mentioned above, second opinions are routine in cancer care. Most doctors won’t feel offended. Everyone wants to make sure your diagnosis and treatment plan is the best for you. In the rare case where your initial doctor might feel it’s not necessary to get a second opinion, you can be firm and polite, and insist that your decision be respected. You don’t need your doctor’s permission. Above all, it’s important to have this conversation early.
When I should seek a second opinion?
Here are some scenarios:

1. When you want to explore all potential options.

2. When you want assurance that all your tumors were located.

3. Whenever you feel uncomfortable with your doctor, or your diagnosis, or with your treatment plan.

4. When your local cancer center is small. You want to know how a big center would treat your case.

5. When your health insurance requires it.

6. Whenever your cancer is rare, and your initial doctor is not experienced with that type of cancer.

7. When you simply want peace of mind.
What questions should I ask the second opinion doctor?
H ere are some questions:

1. Confirmation of diagnosis.

2. What treatment option would you recommend for MY situation?

3. Are there any new treatment options for MY case?

4. Am I eligible for a clinical trial?

5. What are the side effects of the treatment options?

Are there any publications to support the importance of cancer second opinion?
Yes. In the review mentioned earlier. Ruetters et al [1] summarized 13 medical papers on cancer second opinion. They found “Depending on the study, between 6.5% and 36% of patients search for a second opinion, due to a variety of reasons. Changes in diagnosis, treatment recommendations or prognosis as a result of the second opinion occurred in 12-69% of cases. In 43-82% of cases, the original diagnosis or treatment was verified. As a result, patient satisfaction was high, and the second opinion was deemed as helpful and reassuring in most cases.
What is a good second opinion?
Personalizing care and treatment options in a kind, ethical and scientific approach is the key to a first and second opinion.

An opinion without execution path would be useless. Therefore, a good second opinion should be a care package including below components:

1. Explain and review the first opinion with the patient.

2. Have a discussion about the patient wishes, intentions, and priorities in order to come up with a treatment plan that would offer the best outcome.

In some cases, the best plan and options will be provided to the patient based upon the latest clinical trials supporting the treatment decision.

3. Have followups with the patient treatments.
Where can I find a second opinion?
You can ask your initial doctor to recommend one. Some cancer centers may require you to do another set of exams in order to provide second opinion. Some don’t, and offer remote cancer second opinion. Such as, Memorial Sloan Kettering, Stanford, Mayo Clinic. However, the wait time is typically long and often it only provides a written report without patient interaction.

Liyfe Clinic also offers remote cancer second opinion care telemedicine package, which includes the components mentioned above. The turnaround time can be as fast as the 2 days.
Can I google or go to social network to find similar diagnosis and compare the treatment option?
T hat could be very dangerous. Although it’s convenient to search for information online, there is misinformation everywhere. The information you find may be inaccurate or not applicable to your situation.

[1] Ruetters D, Keinki C, Schroth S, Liebl P, Huebner,Is there evidence for a better health care for cancer patients after a second opinion? A systematic review . J Cancer Res Clin Oncol., 2016, Jul; 142(7):1521-8.

2 replies on “Cancer Second Opinion 101: Top 10 patient and provider Q&A”

I was told not to take any suppliments during the chemo therapy. Just wonder in the case of constipation, can i take probiotics supplement and high fibre supplements during the chemo?

Many Thanks in advance!