You are sitting in front of the doctor and she has a serious expression on her face as she tells you solemnly, “I’m sorry sir, but your test results have positively concluded that you have cancer.”
Everything else she says fades out to a dull drone in the background as you contemplate everything in your life that may now have changed with this diagnosis.
The consultation session ends with the doctor having detailed out the steps you have to take on your treatment journey, of which you probably heard and processed nothing, and you go home in a state of shock.
The next day, you get up in a haze and you think that everything that happened the day before is a dream. Then it strikes you. Is it real? Do I have cancer? And the next question that automatically arises is, “Should I get a second opinion?”
Second opinion consultations are common in medical practice, especially so in cancer. The consultant giving the second opinion will evaluate the patient’s case and give their best advice, based on current best-practices and their own experience.
It is important to note that the consultant does so in an atmosphere of respect for both the patient, in terms of trying to fulfil their need to seek more information about their disease; as well as the primary consultant in terms of respecting their findings and opinions about the patient’s case.
Some people are of the opinion that their primary consultants are unhappy when they seek a second opinion. It is quite common for patients to think that, “… my doctor will get angry if I get a second opinion, he thinks I will run away to another doctor.”
Please allow me to clarify that no doctor has this in mind. Most doctors, are absolutely fine with you getting a second opinion.
If they do come across as seeming unhappy about you getting a second opinion, it is because they are only concerned that the patient will delay treatment and continue ‘shopping’ for doctors to give them an answer or a favourable diagnosis or reassurance that they may never get- and in cancer, this delay may cause harm to a patient.
Why do cancer patients seek a second opinion?
Studies done in a cancer-specific population revealed some of the reasons behind why patients seek second opinions during cancer. 1,2
One of the main reasons for second opinions are as depicted in the common scenario above, where during the initial consultations patients are usually in shock due to the life-threatening character of cancer as well as the accompanying treatment regimens which are also perceived to be toxic and difficult to undergo.
However in other scenarios, it could also be due to the fact that they were dissatisfied with the first consultant they saw or even, with the diagnosis itself especially if it was a positive cancer diagnosis. By going to a second doctor, they hoped that the diagnosis would change. 1,2
Should cancer patients seek a second opinion?
In a US National Cancer Institute (NCI) centre, it was found that 43% of patients with breast cancer had a change in diagnosis when they had a second opinion and the study thus supported that patients should get second opinions 3
In a different study of rarer bone and soft tissue tumours in children, it was found that about 30% of first and second opinions of diagnoses differed in patients; although only 8% of this caused a change in clinical diagnosis and how the patient was managed. 4
In yet another study, discrepancy rates (difference between first and second opinions) were even lower at around 2.2% for major discrepancies. 5
Even though almost all the studies were not Malaysian, the medical benefits of getting a second opinion overall doesn’t really seem to be warranted.
However, getting a second opinion is not just about the medical benefits.
Get a second opinion if any, some or all of the following reasons apply in your case: 6
| You are found to have a rare or unusual cancer |
| Your doctor is not a specialist in treating the type of cancer that you have |
| Your doctor is uncertain about the type and stage of cancer you have |
| You think your doctor is underestimating the severity of your condition or comes off as taking it lightly |
| You cannot understand clearly or have trouble communicating with you doctor over the diagnosis and treatment plan |
| Your doctor gives you a few treatment options and you have difficulty in deciding despite the doctor’s recommendations |
| You want to have the peace of mind of having all options explored and that you are making the correct treatment choice. |
| You think there are other treatments available other than what the doctor is telling you |
What do you need to seek a second opinion?
The evidence around whether patients should get a second opinion is really mixed.
It is important that you get all copies of the investigations that has been carried out by the first consultant.
These include surgical operative reports, biopsy reports, a copy of the discharge summaries, if these were given to you. In terms of CT scans and/or MRIs or other investigative procedures where the results are in the format of CDs, please get copies.
Second, get your first consultant to write down what is their planned treatment plan for you. You can get it written down by the doctor or alternatively via voice recording if allowed to do so.
Who to go to for a second opinion?
Most doctors who are your first doctor will be happy to recommend someone to seek a second opinion to. However, some patients are suspicious and worried on whether the doctors are working together (which is ethically an offense so THEY DO NOT do this)
You can look up a doctor yourself for a second opinion via the National Specialist Registry and subsequently look for the respective specialist in that field which is near or convenient for you. Always look for a doctor in the particular specialty that you have been diagnosed with.
However, be careful that you check and visit credentialed, properly practising physicians and not Doctor X or Y recommended by a friend or someone you heard of (as there as still cases of quacks pretending to be proper doctors in Malaysia who recommend unrecognised and ineffective alternative treatments).
Possible Challenges in Seeking a Second Opinion in Malaysia
In Malaysia, there is a bit of difference in terms of second opinions. Patients in the private sector getting diagnosed with cancer, find it much easier to get a second opinion. Their primary consulting physician usually gives them a copy of all the results of the investigations that they have undertaken.
On the other hand, many patients in the public sector often face problems. Sometimes, they have to wait for weeks to get an official report from the medical records office after paying a fee. In some government hospitals, patients are not allowed to even get copies of their investigation results.
Waiting for medical reports to be written for you to seek a second opinion may take a long time and cause a lot of delay in starting treatment, especially when it comes to a cancer diagnosis.
Always speak to the doctor and see whether they can assist you in writing a memo on their proposed treatment plan, and if medical reports may take too long to get as in some weeks, ask them if you can snap a picture of your own investigations’ results via your phone if needed, so that you can then take it to the doctor.
If you want to seek a second opinion, it is your right to do so. It’s important to remember that.
References
1. Mellink WA, Van Dulmen AM, Wiggers T, Spreeuwenberg PM, Eggermont AM, Bensing J. Cancer patients seeking a second surgical opinion: results of a study on motives, needs, and expectations. Journal of clinical oncology. 2003;21(8):1492-7.
2. Tattersall MH, Dear RF, Jansen J, Shepherd HL, J Devine R, G Horvath L, Boyer MJ. Second opinions in oncology: the experiences of patients attending the Sydney Cancer Centre. Medical Journal of Australia. 2009 Aug;191(4):209-12.
3. Garcia D, Spruill LS, Irshad A, Wood J, Kepecs D, Klauber-DeMore N. The value of a second opinion for breast Cancer patients referred to a National Cancer Institute (NCI)-designated Cancer center with a multidisciplinary breast tumor board. Annals of surgical oncology. 2018 Oct 1;25(10):2953-7.
4. Al-Ibraheemi A, Folpe AL. Voluntary second opinions in pediatric bone and soft tissue pathology: a retrospective review of 1601 cases from a single mesenchymal tumor consultation service. International journal of surgical pathology. 2016 Dec;24(8):685-91.
5. Strosberg C, Gibbs J, Braswell D, Leslie RR, Messina J, Centeno BA, Coppola D. Second Opinion Reviews for Cancer Diagnoses in Anatomic Pathology: A Comprehensive Cancer Center’s Experience. Anticancer research. 2018 May 1;38(5):2989-94.
6. American Cancer Society (ACS). Seeking a Second Opinion [Internet]. 2018 [Cited: 1st August 2019). Available from: https://www.cancer.org/treatment/finding-and-paying-for-
Cancer Matters is a column on various issues related to cancer in Malaysia.
Dr Murallitharan M. is the Medical Director of the National Cancer Society of Malaysia (NCSM). He can be reached via email at [email protected]
