Updated December 19, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
If you've recently been diagnosed with lung cancer, or if you've had a recurrence, it probably wasn't long before a meaningful friend or family member suggested that you get a second opinion. For that matter, you may have well offered this advice yourself in the past to family or friends who had been diagnosed with an illness. But giving advice is easier than heeding it, and many people find it's not as easy when they are the one being advised.
Why?
There are a few reasons people may be reluctant to ask for a second opinion. One is that people don't want to offend their doctors. They are worried that asking for another doctor's opinion will jeopardize the relationship they have with their doctor. Another is that people don't want to take the time. After all, if a tumor is growing in their body, they want to address it as soon as possible. Thankfully taking the time to get a second opinion rarely interferes with the timely treatment of cancer.
What is a Second Opinion?
A second opinion is a separate opinion from another doctor regarding the care and management of your cancer. Sometimes this is done in person, and sometimes another doctor is simply asked to review your records. In general, a second opinion refers to a consult with a doctor from a different clinic or cancer center rather than another doctor within a group practice.
How Do Lung Cancer Doctor's Feel About Second Opinions?
Not only do cancer doctors not feel offended when their patients request a second opinion, they usually expect it.
And when faced with cancer themselves, a good percentage of physicians seek out second opinions.
Where Should I Go for a Second Opinion?
There isn't a simple answer to this question, but here are a few thoughts to get you started.
Ask your oncologist. From reading the literature and attending medical meetings the oncologist you are initially seeing may be aware of an oncologist elsewhere who has particular expertise or interest in your type of tumor.
Some clinical trials are only available at certain cancer centers. Of course learning about clinical trials that may pertain to you can seem like a daunting task. But with lung cancer, there is help. Several of the lung cancer organizations have worked together in forming a lung cancer clinical trial matching service. Via this free service, patients are referred to nurse navigators who can match your particular type of cancer and personal information with clinical trials available in the United States and around the world.
Consider a second opinion at a large cancer center. Some of the larger cancer centers, for example Sloan-Kettering Cancer Center, MD Anderson Cancer Center, and the Mayo Clinic among others, may offer not only more clinical trials, but access to physicians that are more specialized. For example, rather than a general medical oncologist who may see people with all types of cancer, a larger medical center may offer access to physicians who specialize in lung cancer alone. There are plenty of community oncologists who provide excellent care, but when pursuing a second opinion a larger center may give more options. It's important to note that this does not necessarily mean that you would need to travel for treatment. A specialist at a large cancer center may simply make recommendations for treatment that you can receive at your home clinic.
- Choosing a Lung Cancer Treatment Center
- Lung Cancer Doctors: What Kind of Specialists are Involved in Lung Cancer Care?
- Finding Clinical Trials for Lung Cancer Treatment
7 Reasons to Get a Second Opinion
Even upon hearing that most lung cancer doctors (oncologists, thoracic surgeons, radiation oncologists etc.) do not begrudge their patients second opinions, many people still carry a fear that to do so will alter their relationship with their doctors. Will their doctors treat them differently because they sought out a second opinion? Doctors are human, are you sure they won't feel threatened? If any of these thoughts have hindered you, make sure to think about the following points.
1. No doctor can know everything. No physician can be on top of the daily findings of every single study and clinical trial at every university around the world looking at lung cancer. Doctors are human.
2. Your life could depend on it. Even with "evidence-based" guidelines becoming the norm in oncology, there are still people who fall through the cracks. An example to illustrate this is a fairly new guideline to do molecular profiling (genetic testing) on the tumors of anyone with advanced non-small cell lung cancer, particularly lung adenocarcinoma. For people who test positive for a few of these mutations (EGFR and ALK) medications are available that may improve progression-free survival. Despite this, genetic testing is underutilized in the United States.
3. Surgical outcomes from lung cancer surgery vary. Studies suggest that people who have lung cancer surgery at cancer centers that perform a high volume of these surgeries have better outcomes. In addition, some surgical procedures, such as the less invasive video-assisted thoracoscopic surgery (VATS procedures,) may not be available at all cancer centers.
4. Progress is being made in lung cancer treatment. After years of little change in the progress of lung cancer treatment, breakthroughs are being made. We now know that every lung cancer is different and have treatments that target some of those differences.
5. Comfort and confidence. Even if the second opinion doctor provides the same treatment recommendations, you may feel more comfortable and confident with the treatment you receive. You may also be less likely to second guess yourself down the line if things don't go as you would like.
6. To confirm or refute your diagnosis. To lower the risk of misdiagnosis. Statistics suggest that 1 in 8 cancer patients are misdiagnosed. It's not just treatment options you want to discuss with a second opinion doctor, but the diagnosis itself.
7. Finally, personality matters. Not every doctor meshes with every patient. This doesn't mean some doctors are good and some bad, or that some patients are easy to get along with and others not, just that some people connect with certain people better than others.
Questions to Ask Your Second Opinion Doctor
1. What treatment do you recommend and why?
2. For what reason do you recommend either the treatment my first doctor recommended, or a different treatment?
3. What clinical trials do you have available for my condition?
4. If the treatment is different, can you get the "second opinion treatment" close to home?
5. What is Plan B? For example, if the treatment the doctor recommends doesn't work, what would be the next option?
6. If I receive care at this facility, who will manage my care team? Who do I call if I experience problems? What other doctors and therapists will be involved in my care?
7. What "integrative therapies" are available to help with the symptoms of treatment?
8. Finally, do you agree with the diagnosis I have been given?
Other Tips When Getting a Second Opinion
1. Getting a second opinion doesn't mean that you need to "start over" or repeat endless tests. That said, many doctors will want their own specialists to review radiology scans you have had elsewhere, or pathology results that were done elsewhere. There is some cost to this, but certainly less than repeating the tests. You can think of it as having several second opinions -- second opinions on your scans and pathology results as well as your diagnosis and the treatment recommended.
2. Try to gather copies of everything - that is, clinic notes, radiology tests, lab results, pathology results, and bring them to your appointment. In some cases tests such as radiology scans can be transferred electronically, but more often you will need to bring a CD of the scan with you. Most second opinion doctors will want to see the actual scans you have had done, and not just a report typed by a radiologist. Check out these tips on how to get your medical test results. Having copies, and reviewing your medical records for errors, is another way to get the best care possible and avoid medical mistakes.
3.Prepare a list of questions before your appointment, and make sure they are answered. It can be very helpful to bring a family member or friend with you as well to take notes and ask questions you may have forgotten.
4. If you choose to transfer your care to your second opinion doctor, check out these tips on how to make a smooth transition when changing doctors.
Insurance Payment for Second Opinions
Most insurance carriers cover second opinions, though you need to check with your insurance company. Some carriers even require a second opinion before beginning treatment.
Next Steps
Whether you choose to stay with your original doctor or transfer your care to a second opinion doctor, being an active part of your health care team is your best insurance policy. Check out these tips on being a savvy and empowered patient:
- The Wise Patient's Guide to Being an Empowered Patient
- Your Role as a Partner on Your Healthcare Team
And if you've just been diagnosed with lung cancer, consider these steps first:
Sources:
Adamson, R. Biomarkers and molecular profiling in non-small cell lung cancer: an expanding role and its managed care implications. American Journal of Managed Care. 2013. 19(19 Suppl):s398-404.
American Cancer Society. Getting a Second Opinion. Updated 05/04/12. http://www.cancer.org/treatment/understandingyourdiagnosis/talkingaboutcancer/talkingwithyourdoctor/talking-with-your-doctor-getting-a-second-opinion
National Cancer Institute. How to Find a Doctor or Treatment Facility if You Have Cancer. Updated 06/05/13. http://www.cancer.gov/cancertopics/factsheet/Therapy/doctor-facility
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