Impact of Second Opinions in Breast Cancer Diagnostics and Treatment: A Retrospective Analysis

Heeg, Erik; Civil, Yasmin A.; Hillen, Marij A.; Smorenburg, Carolien H.; Woerdeman, Leonie A. E.; Groen, Emma J.; Winter-Warnars, Hillegonda A. O.; Peeters, Marie‐Jeanne T. F. D. Vrancken

doi:10.1245/s10434-019-07907-6

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…In contrast, recent retrospective studies in other oncology settings (e.g. breast cancer surgery) suggest much higher discrepancy rates between first and second opinion [25,26]. Given our setting in medical oncology, most patients had advanced cancer and were treated with palliative intent.…”

Section: Discussionmentioning

confidence: 77%

Reducing uncertainty: motivations and consequences of seeking a second opinion in oncology

et al. 2020

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Background: Cancer patients increasingly seek second opinion (SO) consultations, but there is scarce empirical evidence to substantiate medical and psychological benefits for patients. This is the first study to examine patient-and oncologist-reported (1) motivations and expectations of patients to seek a SO, (2) the perceived medical outcome, and (3) psychological consequences of SOs over time (i.e. patients' uncertainty and anxiety). Material and methods: This multi-informant longitudinal cohort study (SO-COM) included consecutive cancer patients referred for a SO (N ¼ 70; age 28-85), as well as their referring and consulting oncologists. Outcome measures were completed at three time points: Patients and referring oncologists reported motivations and expectations before the SO (T 0 ), patients and consulting oncologists reported the medical outcome of the SO (i.e. discrepancy between first and second opinion) immediately following the SO (T 1 ), and patients reported their uncertainty and anxiety at T 0 , T 1 , and two months following the SO (T 2 ). Results: Cancer patients most frequently reported wanting expert advice, exhausting all options, and/or needing more information as motivations for SOs. Referring oncologists rather accurately anticipated these motivations, except most did not recognize patients' information needs. The vast majority of patients (90.0%) received a medical advice similar to the first opinion, although 65.7% had expected to receive a different opinion. Patients' uncertainty (F ¼ 6.82, p¼.002; g 2 ¼.22), but not anxiety (F ¼ 3.074, p¼.055, g 2 ¼.11) was significantly reduced after the SO. Conclusions: SOs can yield psychological benefits by reducing patients' uncertainty, but the added medical value remains debatable. Referring oncologists may not be fully aware of their patients' information needs. Patients should be better informed about goals and benefits of SOs to better manage their expectations. More cost-effective ways of optimally providing medically and psychologically valuable SOs need to be explored.

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Section: Discussionmentioning

confidence: 77%

Reducing uncertainty: motivations and consequences of seeking a second opinion in oncology

et al. 2020

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“…16 A Dutch study also attested to these discrepancies and showed that 45% of second opinions resulted in a different diagnosis than the original. 17 To analyze whether switching to a super-specialist workflow at UMC Utrecht may have been responsible for the drastic increase in significant findings since 2016, we reviewed as a pilot experiment 92 (54.7%) of the cases from 2014, a year before super-specializing and yet close to the switch, to exclude that environmental and other factors varied much. From the 92 reviewed cases, nine showed previously undetected significant findings, including six cases of LCIS, three cases with atypical ductal hyperplasia and one DCIS.…”

Section: Discussionmentioning

confidence: 99%

Time Trends in Histopathological Findings in Mammaplasty Specimens in a Dutch Academic Pathology Laboratory

Stutterheim,

ter Hoeve,

Maarse

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Reduction mammaplasties are often performed at a relatively young age. Necessity of routine pathological investigation of the removed breast tissue to exclude breast cancer has been debated. Past studies have shown 0.05%–4.5% significant findings in reduction specimens, leading to an ongoing debate whether this is cost-effective. There is also no current Dutch guideline on pathological investigation of mammaplasty specimens. Because the incidence of breast cancer is rising, especially among young women, we re-evaluated the yield of routine pathological investigation of mammaplasty specimens over three decades in search of time trends. Methods: Reduction specimens from 3430 female patients examined from 1988 to 2021 in the UMC Utrecht were evaluated. Significant findings were defined as those that may lead to more intensive follow-up or surgical intervention. Results: Mean age of patients was 39 years. Of the specimens, 67.4% were normal; 28.9% displayed benign changes; 2.7%, benign tumors; 0.3%, premalignant changes; 0.8%, in situ; and 0.1%, invasive cancers. Most patients with significant findings were in their forties (P < 0.001), the youngest patient being 29 years. Significant findings increased from 2016 onward (P = 0.0001), 86.8% found after 2016. Conclusions: Over three decades, 1.2% of mammaplasty specimens displayed significant findings on routine pathology examination, with an incidence rising to 2.1% from 2016 onward. The main reason for this recent increase is probably attributable to super-specialization by the pathologists. While awaiting formal cost-effectiveness studies, the frequency of significant findings for now seems to justify routine pathological examination of mammaplasty reduction specimens.

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“…Several recent studies have examined the effect of discrepancies in care plans among oncology specialties. Heeg et al found that nearly 60% of discrepancies in diagnostic and treatment proposals were categorized as major: neoadjuvant systemic treatment instead of primary surgery, breast-conserving surgery instead of mastectomy, and proposing postmastectomy immediate breast reconstruction [ 9 ]. Moreover, several studies have demonstrated that second opinions in pathology demonstrated clinically significant discrepancies, which could drastically affect treatment decisions [ 10 - 12 ].…”

Section: Discussionmentioning

confidence: 99%

Second Opinions in Breast Cancer Surgery: What Have We Learned?

Beer¹,

Allison²,

Fisher³

et al. 2022

Cureus

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IntroductionSecond-opinion consultations (SOCs) provide many benefits. However, duplicate office visits and the logistics of transferring medical records may be concerning for delaying treatment. There is currently no clear understanding regarding the characteristics of patients with breast cancer who desire second surgical opinions or if this contributes to delays in care. MethodsA review of our institutional database from July 1, 2019, to December 31, 2019, identified breast cancer patients who were documented to be SOCs or primary consultations (PC). Neoadjuvant chemotherapy patients were excluded. Comparisons of patient characteristics, tumor characteristics, and surgery factors were performed using chi-square analysis. All analyses were two-tailed and statistical significance was assigned at p <0.05. This study was deemed IRB-exempt. ResultsIn our review, 158 breast cancer patients were identified, 21 (13.3%) SOCs and 137 (86.7%) PCs. Of the SOCs, 90% (19/21) underwent surgery at our institution. The study revealed an increased incidence of SOCs in those patients who ultimately underwent mastectomy (p=0.039) as well as those with lower pathologic T stage (p=0.021). There were no other differences in demographics, surgery, or tumor characteristics. No delay was seen in time for treatment. ConclusionsPatients who sought second opinions were more likely to undergo mastectomy and had lower pathologic tumor size. The time from biopsy to surgery appointment was longer in patients who sought second opinions but there were no differences in the time from biopsy or surgery appointment. It is encouraging that those who sought second opinions did not face any delay in care once established.

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Impact of Second Opinions in Breast Cancer Diagnostics and Treatment: A Retrospective Analysis

Cited by 6 publications

References 30 publications

Reducing uncertainty: motivations and consequences of seeking a second opinion in oncology

Reducing uncertainty: motivations and consequences of seeking a second opinion in oncology

Time Trends in Histopathological Findings in Mammaplasty Specimens in a Dutch Academic Pathology Laboratory

Second Opinions in Breast Cancer Surgery: What Have We Learned?

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