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Second Opinion

Second Opinion

Executive Summary

Cancer causes stress among patients and their families, and they need to be motivated to feel confident regarding the care received from medical professionals. The patient needs to seek a second opinion from any oncology professional. The second opinion is not always initiated from the patient's end, and their physician recommends other specialists as part of the second opinion to provide a better treatment approach while also considering cost-efficiency. Choosing second opinions facilitates the treatment options for decision-making among patients who are motivated in conditions when the patients are very uncertain regarding their options or lack confidence in the treatment decision process.

The increasing complexities of treatment decision-making have made the second opinion options very important, allowing the patients to gain confidence in their physician's decision regarding their proposed management plan. There are several advantages and drawbacks of seeking a second opinion in cancer treatment. The second opinion for cancer patients has been effective in improving patients' lives. There is a need to integrate a second opinion to make patients aware of the option of seeking a second opinion in case of any significant discrepancies. When patients delay or avoid deciding on a treatment course, second opinions help reassure and expedite the treatment. Hence, this makes the patients emotionally strong while motivating them to deal with any situation during their cancer journey.

Also Read: Second Opinion In Cancer Treatment

Introduction

The expectation of achieving several opinions regarding any clinical case is considered reasonable. Unavoidable variance in making clinical decisions makes second opinions (SOs) significant in medical science (Briggs et al., 2008; Zan et al., 2010). It provides cost-effective options for ordinary people by providing relief from unnecessary, expensive and invasive diagnostic and surgical procedures (Rosenberg et al., 1995; Ruchlin et al., 1982). People facing critical surgery decisions or other medical conditions are more likely to opt for a second opinion (SO). 

Research on second opinions has revealed that patients are generally satisfied with the process, even if it has not led to a new diagnosis or treatment. Second opinions have become available for other medical indications besides the surgical procedure, and patients can seek different independent opinions independently. The medical symptoms such as cancer or operations, opt for consulting another expert who helps in clarifying the diagnosis and required therapy. Choosing appropriate treatment proves to be difficult for the patients. Hence, it is necessary to support the patients to allow more involvement in making the right decisions (Birkmeyer et al., 2013). The second opinion helps inform the patients regarding their medical indication to determine the need and consequences of therapy for considering treatment as an appropriate approach for them.

Second Opinion in Cancer Care

Cancer is known for deteriorating the patient's quality of life, making them distressed throughout their cancer journey after diagnosis. Hence, there is a need to make them confident regarding the care received from medical professionals. The patients require a second opinion from an oncology professional other than their own. The second opinion initiated by the patients has been demanding. It has become one of the common approaches in the healthcare system, and surprisingly, the field of oncology possesses a higher rate of second opinions. Patients with cancer undergo diagnosis, prognosis, and treatment plans considered a matter of life and death. As the medical information in oncology is quite complex and often characterised by uncertainties, it increases the patient's need for a second opinion. In some conditions, the frequency of requesting an SO in oncology remains unclear (Tattersall, 2011).

Advancements in the evaluation and treatment of cancer have evolved clinical decisions with much more complexities. Options for treatment approaches involving surgery, drug therapy, radiation and reconstruction have increased while possessing preventive options for women at high genetic risk for second cancers. It is valid for the decisions regarding systemic therapies as more of the patients now must consider choices concerning three different medication categories involving endocrine, chemotherapy and biologic in cancer. Some examples include the decision regarding the intake of drug inhibitors for how much duration, undergoing chemotherapy with or without a specific drug before or after surgery and administration of a new biological agent such as pertuzumab.

Also, the diagnostic algorithms responsible for guiding treatment recommendations have become increasingly technical as genomic analysis involving germline genetic testing is integrated into routine care. These decisions of diagnosis and treatment in oncology are considered quite complex and confuse the patients seeking the understanding of a new diagnosis and choosing a comprehensive care plan. Most of the patients have communicated with only recently specialised physicians in charge of their cancer care. The patient should intend between treatment options while appraising the quality of one or more therapeutic relationships. It further increases the burden on the patients with limited educational, social or financial resources. 

Therefore, choosing second opinions facilitates the treatment options for decision-making among patients who are motivated by conditions when the patients are very uncertain regarding their options or lack confidence in the treatment decision process. The increasing complexities of treatment decision-making have made the second opinion options very important, allowing the patients to gain confidence in their physician's decision regarding their proposed management plan. Also, there is a possibility that second opinions represent poor communication or care coordination in case there are no socioeconomic gradients, evidence of disagreement regarding communication or decision-making, or differential use of indicated treatments in patients who proceed in comparison with those who do not seek any second opinions.

Patients are referred to some medical oncologist after the diagnosis in such situations. Second opinions are opted by the patients and physicians in community practice to implicate appropriate quality of care to the patients. Characterising the patient and oncologists encountering each other's opinions has encouraged the patient to seek a second opinion. Hence, understanding the perspectives of integrating appropriate decision-making regarding the treatment improves cancer care delivery and related outcomes.

Also Read: How Is a Second Opinion Must in the Fight Against Cancer?

Is seeking a second opinion always necessary?

If you get a common cancer diagnosis that's in its early stages, and you're comfortable with the test results, prognosis and treatment plan your oncologist provides you, a second opinion may not be as important as it would be if you feel unsure about your prognosis or plan, your cancer is complex, or your doctor offers you limited treatment options. Here are five situations under which a second opinion becomes important. 

Benefits of Second Opinion in Cancer Care

The second opinion has various advantages and disadvantages for patients, physicians, and society. Choosing a second opinion helps the patients medically, resulting in improved diagnosis or treatment. It also makes them mentally strong by enabling them to act more independently and exercise some control and freedom of choice (Axon et al., 2008). Reassurance is achieved for both patients and their physicians while opting for second opinions. 

Second opinions in oncology have achieved various benefits resulting in better treatment options. Awareness regarding selecting a second opinion appeals to the patients to double-check their own oncologist's opinion, gather more information and exhaust all other options. Second opinions have helped the patients by providing them with more confidence and choosing the right treatment plan. A second opinion could point to another type or stage of cancer that might alter the treatment plan. If the initial diagnosis is confirmed, a second opinion will provide additional treatment options to consider.

Some hospitals possess technological aspects that are not included in all the facilities. The healthcare system provides second opinion options recommended by the doctors while utilising state-of-the-art techniques and technology, providing more treatment options for cancer involving advanced or personalised treatments for specific requirements of the patients.

The patients are not obligated to undergo treatment under the initial oncologist. A second opinion is influential in confirming the type and stage of cancer if the patient has a rare cancer diagnosis. In some cases, the patient loses hope as cancer becomes untreatable, as per the doctor's opinion. However, an opinion from the second doctor provides potential treatment options to the patients that increase their confidence level for having a second opinion. The second opinion has been effective in saving costs by preventing unnecessary treatment. The patients who opted for second opinions have shown efficacy in reducing the unnecessary, expensive and invasive diagnostic and surgical procedures and saving the rehabilitation costs. The patients have adhered to recommendations of a second opinion for undergoing non-invasive therapy instead of surgical procedures, thus reducing the chances of undergoing surgery and saving the cost.

Our treatment approach at ZenOnco.io

At ZenOnco.io, we evaluate your medical history and perform comprehensive diagnostic testing to recommend treatment for your cancer type and stage, as well as for your individual and lifestyle needs. If you visit us, we do our best to make your stay at our hospital as relaxed and stress-free as possible.

Many factors determine how long it takes to assess a second opinion. While a thorough assessment usually takes a couple of days, in some cases, ZenOnco.io may be able to give a one-day second opinion consultation. When you contact us for a second opinion, we will discuss your particular situation and needs with you. A dedicated team of oncologists, nurses, dietitians and other cancer specialists will collaborate with you to assess your medical history, diagnostic reports and clinical status during the assessment. We will then create your customized treatment plan using all this information.

Drawbacks of Second Opinion in Cancer Care

The possible outcomes of second opinions have revealed that significant decisions of second opinions do not provide medical benefits for patients and, in some cases, might delay their treatment. Second opinions result as physically and psychologically demanding for patients, resulting in disappointment and increased uncertainties and may also affect the relationship with their initial physician (Moumjid et al., 2007). The workload of the physicians is increased and is considered an outcome of the patient's lack of trust. Considering the feedback as per the societal association, a second opinion may be costly while involving additional consultations and diagnostic testing.

In some of the cases, second opinions evolved from the anxiety of the patients, which is found common in the conditions of cancer diagnosis and treatment. It results in consultation with many physicians for the same illness episode leading to patient confusion and resource waste when there is no informed reconciliation of conflicting opinions and developing a higher risk of in-hospital complications (Chang et al., 2013). Although second opinions are in practice, many of the organised programs have not considered it part, and hence, there is no organised mechanism for the same. Hence, second opinions can be a financial burden for both patients and systems without a regulated agent. 

Evidence for Second Opinion being beneficial for patients 

Research studies have been conducted to evaluate the impact of opting for second opinion options on patients' quality of life. The studies have found that 1 out of 6 patients consulted with a doctor have undertaken a second opinion in the past years. Most of the patients choosing a second opinion are cancer survivors (Hewitt et al., 1999). The weightage of second opinions in radiology and pathology in cancer care is well studied. The experience and expertise of the pathologists involved and the type of specimen and cancer reviewed have affected the discrepancy rate, with higher error rates, mainly evaluated in lymphomas, sarcomas, and cancers of the brain, skin, and female reproductive tract (Renshaw & Gould, 2007). 

Follow-up care has been undertaken while choosing a second opinion, and the restaurant's outcome on patients' health has been evaluated. The results have revealed that follow-up biopsies opted for a second opinion diagnosis in cases of discrepancies. The patients have undergone new diagnoses resulting in more consistent with the original diagnosis (Swapp et al., 2013). Also, second reviews of mammography studies have suggested that the first review misses 10% to 20% of malignant tumours. Hence, second opinions positively impact diagnosing cancer cases and thus improve the patient's quality of life by providing them with a practical treatment approach at the appropriate time. The second opinion is given to the patient while analysing the extent of its practice that improves the quality of patient care and analyses its variations for different medical conditions.

Most patients have been satisfied with the outcome after choosing a second opinion to improve their quality of life. The increasing errors in the diagnostic approach and the option of a second opinion have been appealing and considered a practical strategy among the patients who use them after being recommended by physicians and doctors. The second opinion significantly changed the diagnosis, prognosis, or treatment and analysed the patients' satisfaction with the second opinion process. 

Impact of a Second Opinion on patient’s diagnosis

Second opinions have attracted several patients to improve their quality of life in situations when they have lost hope. It shows efficacy in reducing diagnostic errors in medicine in most cases. The second opinion has been considered equal or better quality than the first. The physicians have shown a positive attitude towards patients who are options for a second opinion. Patients have been provided with a better opportunity to communicate with the specialist to enhance the quality of care and reduce inappropriate diagnosis or treatment. Second opinions provide better access to newer techniques or facilities and consulting physicians with more experience with complex or rare cases. The second opinion services determine cancer treatment in high-volume centres that provide more effective treatment than the previous ones.

The second opinion for cancer patients has also been effective in improving the lives of patients living in rural areas and overseas. Several insurers offer the cost and expenditure by seeking second opinions for their treatment. Some medical specialities experienced significantly more changes in diagnosis or treatment, and changes in diagnosis and treatment had a more significant impact on patients with cancer than on patients with general medical concerns. There is a need to integrate a second opinion to make patients aware of the option of seeking a second opinion in case of any significant discrepancies. When patients delay or avoid deciding on a treatment course, second opinions help reassure and expedite the treatment. Hence, this makes the patients emotionally strong while motivating them to deal with any situation during their cancer journey.

10 Reasons to get a second opinion

Mindfulness

Cancer is a complex disease to fight, and having the right team on your side can make all the difference. Also, in such circumstances, getting a second opinion only to ensure your original team's diagnosis and treatment plans are correct might go a long way toward restoring your faith in them.

Different viewpoints

Successful therapy is usually the result of the combined knowledge and efforts of a group of oncologists, surgeons, nurses, and others. Also, each team member contributes their expertise and experience, resulting in more diverse approaches.

Treatment choices are hazardous

Surgical procedures and other treatments might have life-altering outcomes. Moreover, it's a bad idea to agree to any process without learning everything there is to know about it.

You have a cancer that is rare or unusual

Rarer cancers receive less attention from researchers. In such circumstances, obtaining a second opinion from a physician who has not previously handled your problem is quite beneficial.

Clinical trial participation

Clinical trials assist doctors in developing new cancer treatments. Also, getting a second opinion on cancer at a different facility can often lead to you learning about clinical trials that could benefit you with your treatment. Your current hospital may be unaware of this information.

You don't like the options that are now available to you.

If you're not sure about the first diagnosis or treatment option, get a second opinion on cancer. Never agree to a procedure that you don't agree with. Learn more and get a second opinion.

Issues with communication

If you have trouble understanding your doctor or the recommended treatment, you should seek a second opinion.

Your physician isn't a specialist.

If your doctor isn't a specialist on the type of cancer you've been diagnosed with, you should seek a second opinion.

The therapy appears to be ineffective.

If you are experiencing significant side effects or are not responding well to the prescribed medication, it may be time to seek a second opinion.

The most recent treatment choices

Similar to clinical trials, your doctor or hospital may be ignorant of a new style of treatment that is available. Getting a second opinion can help you learn more about a recently developed treatment or technology.

Key Points:

  1. Why Seek a Second Opinion: Understand the reasons why seeking a second opinion is crucial in cancer treatment. Discover how it can provide a fresh perspective, confirm the initial diagnosis, offer alternative treatment options, and instil confidence in your chosen path.
  2. Expanding Treatment Options: Learn how a second opinion can broaden your treatment options. Different healthcare providers may have diverse expertise, experience, and access to cutting-edge therapies. Exploring these alternatives can help you explore the best possible treatment plan tailored to your specific needs.
  3. Validation and Peace of Mind: Discover how a second opinion can validate the initial diagnosis, ensuring accuracy and increasing your confidence in the recommended treatment. This process can alleviate doubts, provide peace of mind, and help you feel more actively involved in your healthcare decisions.
  4. Building a Supportive Network: Seeking a second opinion allows you to build a supportive network of healthcare professionals who collaborate and contribute to your cancer care. This collaborative approach fosters a comprehensive understanding of your condition and enhances the quality of your treatment plan.
  5. The Process of Seeking a Second Opinion: Gain insights into the practical aspects of seeking a second opinion. Learn how to approach healthcare providers, gather medical records, and prepare for consultations. Emphasize the importance of clear communication between healthcare teams to ensure a seamless transfer of information.

Relief & Comfort from pain and other side effects in Your Cancer Journey

For personalized guidance on cancer treatments and complementary therapies, consult our experts at ZenOnco.io or call +91 9930709000

References

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  2. Ruchlin HS, Finkel ML, McCarthy EG. The efficacy of second-opinion consultation programs: a cost-benefit perspective. Med Care. 1982;20:3–20. https://doi.org/10.1097/00005650-198201000-00002
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  7.  Wijers D, Wieske L, Vergouwen MD, Richard E, Stam J, Smets EM. Patient satisfaction in neurological second opinions and tertiary referrals. J Neurol 2010; 257:1869–74. https://doi.org/10.1007/s00415-010-5625-1
  8. Birkmeyer JD, Reames BN, McCulloch P, Carr AJ, Campbell WB, Wennberg JE. Understanding of regional variation in the use of surgery. Lancet. 2013;382(9898):1121–1129. https://doi.org/10.1016/s0140-6736(13)61215-5
  9. Tattersall MH. Can a second medical opinion on a patient with cancer be truly independent? Asia Pac J Clin Oncol 2011;7:1–3.  https://doi.org/10.1111/j.1743-7563.2010.01368.x
  10. Axon A, Hassan M, Niv Y et al. Ethical and legal implications in seeking and providing a second medical opinion. Dig Dis 2008;26:11–17.  https://doi.org/10.1159/000109379
  11. Mustafa M, Bijl M, Gans R. What is the value of patient‐sought second opinions? Eur J Intern Med 2002;13:445–447. https://doi.org/10.1016/s0953-6205(02)00138-3
  12. Chang H-R, Yang M-C, Chung K-P. Can cancer patients seeking a second opinion get better care? Am J Manag Care. 2013;19:380–387. PMID 23781892
  13. Hewitt M, Breen N, Devesa S. Cancer prevalence and survivorship issues: analyses of the 1992 National Health Interview Survey. J Natl Cancer Inst. 1999;91(17):1480-1486. https://doi.org/10.1093/jnci/91.17.1480
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Swapp RE, Aubry MC, Salomão DR, Cheville JC. Outside case review of surgical pathology for referred patients: the impact on patient care. Arch Pathol Lab Med. 2013;137(2):233-240. 10.5858/arpa.2012-0088-OA

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