January 2015 Ask the Expert: Getting A Second Opinion

January 1, 2015

When you’re discussing a treatment plan with your breast cancer care team, it’s important that you feel comfortable with your doctors and their recommendations. Whether you want to know about other treatment options, feel more comfortable discussing side effects or if you simply feel your team isn’t the right fit for you, getting a second opinion may help.

This January, Living Beyond Breast Cancer expert Paul B. Gilman, MD, answered your questions about when it’s best to ask for a second opinion, how to go about getting one, what to do if your health insurance restricts who you can see for treatment and how to talk to your current team about your desire to seek more information from others.

Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare providerinfo-icon because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counselinginfo-icon or medical advice.

Question: Should I seek a second opinion if my oncologist never went over my scans (showed them to me) or my other tests?

Dr. Gilman: Reviewing test results, including scans and lab tests, is an important part of the patient -physicianinfo-icon dialogue. Occasionally, physicians will take an approach of general reassurance ("everything is OK" or "no news is good news") which may be sufficient for some patients. At times, though, the dialogue may need to be more patient-driven. I would suggest asking your physician to review the test results with you, which can be accomplished during a follow-up visit or with a phone call. I would expect a positive response and satisfactory discussion.

Question: My oncologist refuses to tell me the potential prognosis of my stage 4 HER2-positive breast cancer. Why? Is this enough of a reason to seek another doctor?

Dr. Gilman: While giving a precise prognosisinfo-icon is difficult, a thorough discussion of the outlook with regard to expectations is important, especially for a patient dealing with advanced cancer. The discussion should take into account the variablity in treatment responses and outcomes as well behavior of the cancer that make it difficult to generalize or make predictions that are precise. Nevertheless, the impact on a patient's life and plans make such a discussion imperative. If a physicianinfo-icon is unwilling to have such a discussion despite a request from the patient, it may not be a "good fit."

Question: Can you expand on why so many medical oncologists, at least in my area, do not see patients for a second opinion? I do not want to be cynical but could it be more out of fear of antagonizing their peers rather than doing what may be best for a patient? If a physician is confident about the care that (s)he provides wouldn't they not be afraid of making a recommendation?

Dr. Gilman: Some medical oncologists may not see patients for second opinions because they focus on patients they will be treating or following, as opposed to patients who may return to their treating physicianinfo-icon after obtaining a second opinion. Others may feel that their level of expertise in a specific type of cancer may not be different than that of their peers in practice, which may make the second opinion more of a discussion about the physicians' usual approach and preference. Sources such as the American Cancer Society may be able to provide information about experts who provide second opinion consultations.

Question: If travel is not an issue, where would you send a breast cancer patient for a second opinion, when her oncologist at one of the elite cancer centers in the United States says you should give up?

Dr. Gilman: There are two ways of looking at this. First, one could seek a center where there is a known expertise in breast cancer or a particular individual (or individuals) who is a recognized expert ("thought leader"). Nationally, there are several centers that would meet these qualifications. The other way is to look for promising clinicalinfo-icon trials, some of which may be at a single institution, especially if the patient is being told that there are no remaining treatment options. In this situation, one should be able to receive some guidance and direction from the treating physicianinfo-icon.

Question: If I choose to have a second opinion, do I risk losing my current healthcare team? Do they have to take me back if I decide we’re a better fit than the team I get a second opinion from?

Dr. Gilman: Seeking a second opinion is not uncommon and at the least may provide an additional level of comfort to a patient about to undergo treatment. This is likely to be viewed in this way by the primary careinfo-icon team. One would expect that, should the patient return to them for treatment, care would be provided. The input of the second opinion may also prove to be helpful to those treating the patient though it may not alter the treatment plan initially recommended.

Question: Are second opinions covered by health insurance or do I have to pay on my own?

Dr. Gilman: Insurance coverage is complex and not standard or consistent across different plans. The best approach is to contact the insurer to determine coverage prior to the visit.