Seeking a Second Opinion
Another perspective on your disease may help you find the best cancer care.
By Stephen Ornes
In November 2012, when she was 52 years old, Shannon Semple was diagnosed with a disease she didn’t have. She credits getting a second opinion with saving her life.
Semple, a physician assistant at a regional hospital in New Bern, North Carolina, had developed a persistent fever and high blood pressure. She spent a few days as a patient in the same hospital where she works, but her condition puzzled her doctors. They ultimately diagnosed her with a tick-borne illness. Antibiotics helped at first, but her symptoms returned.
“I had an overwhelming sense of unwellness,” she recalls. Later, she would learn that blood tests failed to show any signs of tick-borne diseases. In January 2013, weighed down by uncertainty, Semple returned to work at the hospital. There, she examined the CT scan of her abdomen that her doctors had ordered and spotted a large lesion on one of her vertebrae. Her radiologist had dismissed it as benign. Additional tests performed later revealed a large mass in her chest, and that led her to go to the hospital at the University of North Carolina (UNC) in Chapel Hill, about three hours away from New Bern.
The news wasn’t good, but it was accurate. Semple had metastatic cancer of the thymus, a small organ behind the sternum and between the lungs that produces a hormone to help stimulate the production of T cells—white blood cells in the body’s immune system. The thymus is only active until a person starts puberty. Then it goes quiet—most of the time. Thymic cancer is exceedingly rare; only about 400 people are diagnosed each year in the U.S. By the time Semple was diagnosed, the cancer had invaded surrounding tissue, including lymph nodes and bone. Her diagnosis in April 2013 was followed by years of difficult treatments, but if she hadn’t checked in with other doctors, she says, she wonders if she’d still be alive today.
Though seeking a second opinion is common, it may not be the norm among people diagnosed with cancer. Recent surveys have found that many, and probably most, cancer patients do not seek out another opinion. They may be missing out. Though few studies have rigorously examined the impact of second opinions, those that have been done suggest getting another perspective can help improve cancer care, change a treatment plan, bolster a patient’s confidence and, in some circumstances, even alter a diagnosis.
More Information, More Assurance
A cancer diagnosis brings a barrage of information about both the disease and its treatment, and it’s normal for patients to want to learn more or to wonder if another doctor would make the same recommendation. That’s where a second opinion comes in: It can help patients feel more secure in their decisions or get more information about their options.
“Patients need to have enough information and comfort with the people that are stakeholders in their clinical care,” says urologic oncologist Michael Poch at the Moffitt Cancer Center in Tampa, Florida. “Sometimes it takes additional input from another physician or another institution to be comfortable.”
Poch and his colleagues see many patients seeking second opinions and help them confirm their plan of care. “It provides some reassurance,” he says.
But not everyone seeks a second opinion. In a study published in Cancer Investigation in January 2017, for example, a team of researchers from the J.W. Goethe University in Frankfurt, Germany, surveyed 106 cancer patients and found that only about one-third had received second opinions. Of those patients who sought a second opinion, 80 percent wanted to confirm their diagnoses and roughly half said they wanted to better understand the diagnosis. The vast majority said they were reassured by the experience.
A second look may also change the direction of care. In 2005, researchers in the Netherlands analyzed data from more than 300 patients who had sought care at a second-opinion clinic in the Erasmus University Medical Center Rotterdam. Most of the patients were women with breast cancer, and all the patients had already seen an oncologist in a general or university hospital. When the physicians at the second-opinion clinic reviewed pathological and radiological charts, they recommended treatment plans different from the first opinion in more than 100 cases—or about one in three. Half of those were significant enough to trigger changes in the patient’s recommended treatment, such as advising radiation instead of surgery.