Cancer Patients Seeking a Second Surgical Opinion: Results of a Study on Motives, Needs, and Expectations

Mellink, W. A. M.; Dulmen, A.M. van; Wiggers, Th.; Spreeuwenberg, Peter; Eggermont, A.M.M.; Bensing, J.M.

doi:10.1200/jco.2003.12.058

Cited by 78 publications

(88 citation statements)

References 26 publications

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“…They are in general more inclined to request a second opinion (Mellink et al, 2003;Tattersall et al, 2009;Gommer, Poos, & Burgers, 2010;Mellink et al, 2006) and consequently, might be more inclined to urge their treating physicians to perform more additional diagnostic procedures and try more experimental and/or aggressive treatments. Still, this does not explain all findings, as the patients of this study received advice in accordance with current international guidelines (IKC, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…The rapid expansion of information supply and seeking, due to the increasing use of Internet-based information sources and the growing autonomy of patients, has contributed to the increase of patient initiated second opinions (Moumjid et al, 2007;Mellink et al, 2003;Maaskant et al, 2009;Tattersall et al, 2009). According to Hewitt et al, in 1982, already 56% of 1500 cancer survivors had sought at least one second opinion (Hewitt, Breen, & Devesa, 1999).…”

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confidence: 99%

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Lung Cancer Patients Benefit from Second Opinions by Improvement of Diagnosis and Therapy

Schook

Avest

Setten³

et al. 2014

CCO

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Purpose: To collect data from the initial evaluation of patients referred for a second opinion to a specialist pulmonary oncology clinic and compare these with the data of the re-evaluation (second opinion) conducted there to identify discrepancies in diagnosis, stage and therapeutic advice. Methods:Demographics and disease characteristics of 188 patients referred between January 2005 to December 2009 were collected from medical records, next to therapeutic advice. The data of both initial and second evaluations were compared with each other.Results: At time of referral, the (clinical/histopathological) diagnosis was known in 174 patients (92.6%) and the stage in 162 patients (86.2%). Forty-eight percent of the patients had received prior therapy and 73% a therapeutic advice. Next to data review, additional diagnostic procedures were performed in 68% of the patients. There were discrepancies between the initial and second opinion in diagnosis (17 patients, 9%), stage (24 patients, 13%) and therapeutic advice (70 patients, 37%). The second opinions led to a total of 91 discrepancies, 53 of these had a potential major impact on patient outcomes in terms of survival, morbidity and quality of life. For patients with advanced lung cancer, the results were similar but the number of changed stages, therapeutic advices and discrepancies with a potential impact on patient outcomes were slightly higher (15%, 40% and 51% respectively). Conclusions:Lung cancer second opinions referrals led to significant discrepancies in diagnosis and therapeutic advice in a substantial number of patients. This might be translated in better (palliative) care.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Lung Cancer Patients Benefit from Second Opinions by Improvement of Diagnosis and Therapy

Schook

Avest

Setten³

et al. 2014

CCO

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“…The demand for such active involvement in medical decisions progressively increased over the years [42,64]. Several studies suggest that about 68% of patients seek a second opinion, so that would get another diagnosis or prognosis, and 65% would assurance regarding the diagnosis or treatment options [44,47,[65][66][67]. Furthermore, the patients might seek another opinion to discuss their diagnosis and/or treatment, especially when they are dissatisfied with the first physician [45,47,63,65,68].…”

Section: Discussionmentioning

confidence: 99%

“…In a recent qualitative study (March 2017), 23 patients with localized or advanced prostate cancer (that sought sec-was related to the amount of information and emotional support provided by the neurologist during the day-care admission [45,47,[70][71][72][73]. Another finding is that the psychological relevance of second opinion led to a short-term increase in patient satisfaction, but, after two years, satisfaction had decreased to the level seen prior to the second opinion; the benefit of second opinion consultations seems to be reasonable in the short term, but limited in the long term [74].…”

Section: Economic Impact Of the "Second Opinion Medical Network"mentioning

confidence: 99%

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The “Second Opinion Medical Network”

Palmieri¹

2017

Int J Pathol Clin Res

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The "Second Opinion Medical Network" is a consultation referral web and medical office system recruiting a wide panel of real-time available specialists, to whom any patient affected by any disease or syndrome and not satisfied with the diagnosis or therapy can apply for an individual clinical audit. Due to the physician-patient communication gap, most of the patients usually wander around the medical websites looking for proper answers to their health problems. However, this search often becomes compulsive and obsessive and frequently ambiguous and frustrating. Palmieri, et al. defines this borderline or even pathological behavior as the "Web Babel Syndrome"-psychological imbalance affecting young and elderly patients, often with multiple synchronous diseases receiving by their care givers heterogeneous and misleading informations or advices, as well as, confused, contradictory statements and prescriptions. To deal with this problem, the "Second Opinion Medical Network" aims to be a useful "problem-solving" support revisiting each conflictual diagnostic and therapeutic step and properly re-addressing tailored treatments and prognoses, preventing unnecessary investigations and unhelpful and expensive medical and surgical interventions.The aim of this editorial is to describe the role and benefits of such a medical network in our web connected health care system. KeywordsSecond opinion, Network, Surgery, Cancer, EconomyIn 2002, a survey of 4,530 people in Europe and USA showed that 32% of Europeans and 43% of Americans preferred to use health web sites, sponsored by BBC and Yahoo, for health information [3]. However, the internet sites are often lacking of adequate information concerning disease complications and aftercare [4]. This web-searching behaviour is often continuous, compulsory, somehow obsessive, leading to the "Web Babel Syndrome", defined as a physician-patient communication gap frequently occurring when the patient affected by multiple synchronous pathologies, feeds back heterogeneous and misleading informations and prescriptions with the risk to drop in a confusionary state [5][6][7][8].In 1999, the Institute of Medicine report cited fatal medical errors in some 40,000-98,000 Americans PER year [8] supporting once more the concept that a further consultation or specialistic second opinion may be useful antidote to lethal misdiagnosis [9].The term "second opinion" has been widely reported also in histology [10,11] and pathology (e.g. thyroid pathology) [12][13][14][15][16][17][18][19][20] where the diagnosis is often difficult, misunderstood and strongly based on the healthcare professionals' experience. It has been defined as a qualified, interdisciplinary medical opinion, based on medical evidence, of an experienced medical specialist or a team [21]. An effective and helpful second opinion strategy in various pathologies (e.g. oral pathology) is the use of smartphones and software applications, such as WhatsApp Messenger, a crossplatform mobile messaging application that allows the exchang...

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Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations

et al. 2023

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Background Data on the clinical value of second opinions in oncology are limited. We examined diagnostic and treatment changes resulting from second opinions and the expected impact on morbidity and prognosis. Methods This retrospective cohort study included patients presenting in 2018 to a high‐volume cancer center for second opinions about newly diagnosed colorectal, head and neck, lung, and myeloma cancers or abnormal results. Two sub‐specialty physicians from each cancer type reviewed 30 medical records (120 total) using a process and detailed data collection guide meant to mitigate institutional bias. The primary outcome measure was the rate of treatment changes that were “clinically meaningful”, i.e., expected to impact morbidity and/or prognosis. Among those with treatment changes, another outcome measure was the rate of clinically meaningful diagnostic changes that led to treatment change. Results Of 120 cases, forty‐two had clinically meaningful changes in treatment with positive expected outcomes (7 colorectal, 17 head and neck, 11 lung, 7 myeloma; 23–57%). Two patients had negative expected outcomes from having sought a second opinion, with worse short‐term morbidity and unchanged long‐term morbidity and prognosis. All those with positive expected outcomes had improved expected morbidity (short‐ and/or long‐term); 11 (0–23%) also had improved expected prognosis. Nine involved a shift from treatment to observation; 21 involved eliminating or reducing the extent of surgery, compared to 6 adding surgery or increasing its extent. Of the 42 with treatment changes, 13 were due to clinically meaningful diagnostic changes (1 colorectal, 5 head and neck, 3 lung, 4 myeloma; 3%–17%) . Conclusions Second‐opinion consultations sometimes add clinical value by improving expected prognoses; more often, they offer treatment de‐escalations, with corresponding reductions in expected short‐ and/or long‐term morbidity. Future research could identify subgroups of patients most likely to benefit from second opinions.

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Cancer Patients Seeking a Second Surgical Opinion: Results of a Study on Motives, Needs, and Expectations

Cited by 78 publications

References 26 publications

Lung Cancer Patients Benefit from Second Opinions by Improvement of Diagnosis and Therapy

Lung Cancer Patients Benefit from Second Opinions by Improvement of Diagnosis and Therapy

The “Second Opinion Medical Network”

Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations

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