November 01, 2007
WebMD

Cancer: When Do You Need a Second Opinion, and Why?

After you've been diagnosed with cancer and your doctor has outlined your treatment, you may still have a nagging doubt: what if my doctor is wrong? No matter how much you like or trust your oncologist, it's natural to wonder if something was missed or if a new treatment is available. If you have any doubts, get a second opinion.

Getting a second opinion is increasingly common, experts say. "In the past, people with cancer were often anxious about asking for a second opinion," says Terri Ades, MS, APRN-BC, AOCN, director of cancer information at the American Cancer Society in Atlanta. "But today, they're much more comfortable." And you should be comfortable. This is your medical care and your life. Getting a second opinion is your right as a patient.

Besides, with something as serious as cancer, having the input of another expert makes sense. When you're shopping for a new car, you don't buy from the first salesman you meet. You shop around. And if you're willing to make that effort with a car, shouldn't you be at least as careful in deciding on your cancer treatment?

Experts say that doctors should never try to prevent you from getting a second opinion -- instead, they should encourage it.

"Doctors want patients and their families to feel comfortable with their treatment," says Harold J. Burstein, MD, a staff oncologist at the Dana-Farber Cancer Institute in Boston and an assistant professor of medicine at Harvard Medical School. "Second opinions are often really helpful because they offer reassurance."

So what do you need to know about getting a second opinion? WebMD asked the experts.

Why Get a Second Opinion?

What are the benefits of getting a second opinion? Jan C. Buckner, MD, chair of medical oncology at the Mayo Clinic in Rochester, Minn., gives part of the answer: "Not everybody is right every time," he tells WebMD. He has seen cases in which a second opinion changed the treatment, prognosis, and even diagnosis.

But while there's always a chance that a second opinion will completely alter your treatment, experts say that such cases are in the minority.

"Second opinions can be useful for many reasons, even if the doctors are following standard guidelines," says Burstein. "They can confirm the direction you are already heading, but they might also suggest new directions or considerations, or perhaps clinical trials, that are being pursued at comprehensive cancer centers. Experience matters in caring for cancer patients, and second opinions allow patients to tap into a wealth of oncology experience."

Even if most second opinions just confirm what you already know, they still play an important role. A second opinion offers peace of mind.

"Without getting a second opinion, people are sometimes obsessed with 'what ifs,'" says Buckner. "What if I'd had a different treatment? What if I'd seen a different doctor?" Getting confirmation from a second opinion can really help. You know that multiple experts agree on the treatment you need. You can feel more confident that you've made the best possible choice.

Who Needs a Second Opinion?

Getting a second opinion is never a bad idea. But there are instances in which you absolutely need one. They are:

If you have any doubts about your doctor or don't get along with him or her. Having a good working relationship with your doctor is crucial. If you don't have it, find someone else with whom you're more comfortable.
If your doctor doesn't have much experience treating your cancer. Ask your oncologist up front about whether he or she has a lot of experience treating your type of cancer. If not, you need a second opinion. Having experience is crucial in treating any cancer, says Burstein.
If you have a rare type of cancer. If you have a common cancer of the breast or prostate, there are plenty of good doctors that can help. But the average oncologist may not have seen many -- or any -- cases of a rare cancer. The problem is not just a lack of experience. "The rarer the cancer is, the more likely it is to cause a difference of opinion in how to treat it," says Buckner.
If your doctor says no lifesaving therapy is available.
Getting a second opinion is usually pretty straightforward. First, check with your insurance company to see if they'll cover it. Many insurers actually require a second opinion before cancer treatment. Next, ask your oncologist or your family doctor to refer you to another specialist for a second opinion.

You could also ask friends and family for a name of someone they liked. Or you could seek out an expert at a specialized cancer treatment center closest to your home. Online, you can use the WebMD Physician Directory to find a cancer specialist near you.

Do You Ever Need More Than 2 Opinions?

If two opinions are better than one, doesn't it logically follow that three -- or four, or five -- would be even better? Experts say that in most cases, the answer is no. If two doctors reach a consensus, then there's little point in hunting down more people who will almost certainly say the same thing.

However, there are rare occasions when a third opinion can be helpful, says Ades. Occasionally, specialists might disagree on the best course of treatment. For instance, a person with prostate cancer might get one piece of advice from his urologist and another from his oncologist. In these cases, Ades says, getting a third opinion could help. "It gets someone in there who can help tilt you toward one approach or another," she tells WebMD.

Will Your Doctor be Angry If You Get a Second Opinion?

You may worry that asking for a second opinion will offend your oncologist. Isn't it rude to second guess your doctor?

Experts say absolutely not. In fact, if your doctor reacts negatively to you getting a second opinion, it could be a bad sign. "I tell patients that if a physician seems at all bothered by your asking for a second opinion, then you absolutely need one," says Buckner.

Instead, doctors should welcome people getting a second opinion. Good doctors want you to feel confident in their care. They don't want you to feel like you were bullied into working with them.

"When you ask for a second opinion, your doctor should say, 'Good idea -- here's a list of names,'" says Burstein. "That's how he or she should react."

So never be afraid to ask for a second opinion. In the end, getting a second opinion will probably improve your relationship with your doctor rather than undermine it. You'll be able to start your treatment with new confidence in your doctor, knowing that you're getting the best care possible.