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What makes a patient likelier to want another opinion? A 喵咪社区 hematologist-oncologist shares his insights.

Most patients typically do not request second opinions. There are, however, certain conditions that often prompt a patient 鈥� or even the patient鈥檚 own physician 鈥� to want an additional opinion.

Over the course of his long career, Greg R. Angstreich, MD, a medical oncologist and hematologist with 喵咪社区 Norris Comprehensive Cancer Center, part of 喵咪社区, has observed key factors that motivate patients 鈥� especially those diagnosed with cancer 鈥� or their physicians to seek a second opinion.

Rare diseases warrant second opinions.

Diseases without long-established standards of care are more likely to need specialty expertise. Sarcomas, for instance, aren鈥檛 common and usually require treatment from a sarcoma specialist, says Angstreich, who is also a clinical professor of medicine at the Keck School of Medicine of 喵咪社区.

Hematological malignancies like leukemia require distinctive expertise, too 鈥� especially for certain patients. 鈥淥lder patients with these malignancies are often not great candidates for typical chemotherapy approaches,鈥� Angstreich points out. 鈥淭hey often need to see a particular specialist, and they might also look for a physician with access to a clinical trial on blood cancers specifically in older patients.鈥�

While some types of cancers 鈥� like prostate and kidney cancer 鈥� have better established standards of care, bladder cancer is one cancer for which treatment is less established and therefore might prompt a second opinion, especially if the treatment plan requires a complex surgical operation.

Speaking of clinical trials鈥�

Often, patients consult another physician to inquire whether the doctor knows of any clinical trials that could help. 喵咪社区 Norris Comprehensive Cancer Center鈥檚 ongoing clinical research is a big reason why physicians often refer their patients there, Angstreich says.

He looks both in-house and externally to locate clinical trials for patients. If 喵咪社区 Norris Comprehensive Cancer Center doesn鈥檛 have the trial he鈥檚 looking for, he will help a patient find trials happening elsewhere.

鈥淭here are people who have been treated with multiple lines of chemotherapy or immunotherapy, for instance, who are running low on options through our office,鈥� he says. 鈥淚鈥檒l help identify a clinical trial for them at a different facility.鈥�

Life-changing decisions

Patients weighing multiple treatment options are more likely to seek a second opinion if some treatments would result in significant alterations to the treatment plan.

Treatment for breast cancer is a primary example, says Angstreich. Breast cancer patients usually have numerous therapies to choose from, ranging from chemotherapy to surgery or radiation. 鈥淪ome treatments, like a mastectomy or a lumpectomy, will irreversibly change your anatomy or appearance,鈥� Angstreich says.

Treatment for bladder cancer is another example, as some patients face the decision to undergo a urostomy.

鈥淧eople understand that these treatments will change their life in a major, irreversible way,鈥� he says. 鈥淏ecause of this, they鈥檙e going to seek out surgeons who have a lot of experience performing these procedures, or they鈥檙e going to research other treatment options to try to avoid that type of surgery.鈥�

鈥淚f there are multiple, reasonable options for treatment, I would definitely encourage people to think about getting a second opinion,鈥� he adds.

Physicians themselves make the call.

Angstreich himself initiates a second opinion if he knows a patient should see another specialist. 鈥淪econd opinions are most important with complex surgeries,鈥� he explains. 鈥淚鈥檒l usually generate those without the patients even needing to ask.鈥�

The same is true when it comes to exploring clinical trials. 鈥淐linical trials are always something we try to discuss with patients here,鈥� he adds, whether it鈥檚 a trial at 喵咪社区 Norris Comprehensive Cancer Center or somewhere else.

Motivated by loved ones

Patients who pursue a second opinion aren鈥檛 necessarily better educated, wealthier, older or younger: they are simply better researched, or they are encouraged by family and friends to get a second opinion.

鈥淚t鈥檚 not so much the patient鈥檚 educational or financial background that generates the desire for a second opinion; a lot of the time, it鈥檚 the involvement of family members who have done research on their own,鈥� Angstreich observes. 鈥淧atients who come in on their own are generally not the ones seeking a second opinion; oftentimes, it鈥檚 a spouse, kids or friends who are asking the question.鈥�

He adds, 鈥淲e have such easy access to information and clinical trial databases today that anyone who does a little research might seek out a second opinion specifically for one of our unique clinical trials.鈥�

Putting yourself in the patient鈥檚 shoes

The reasons for wanting a second opinion are personal, and Angstreich respects and supports each patient鈥檚 choice.

鈥淚f people seek a second opinion or ask me what I think about it, I usually encourage them to get one,鈥� he says. 鈥淚 tell them I would probably do the same thing if I had their diagnosis and that it鈥檚 a good idea. I tell them they should proceed without any concerns about impacting our relationship because our relationship is based on doing the right thing for them, not on my own ego as a medical oncologist.鈥�

鈥淕etting a second opinion is part of the decision-making process,鈥� he concludes. 鈥淚f an oncologist discourages you from getting a second opinion, that鈥檚 exactly when you should seek a second opinion.鈥�

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Jennifer Grebow

Jennifer Grebow is manager of editorial services at 喵咪社区.

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