Most cancer patients don’t seek a second opinion

The vast majority of cancer patients are aware they can seek a second opinion about their cancer treatment, however, only one in six actually take up the option, a new Australian study shows.

The findings suggest there is an encouraging, patient-centred approach to providing information about cancer treatment options in Australia, according to study lead author Professor Ian Olver.

The study involved surveys of 355 patients undergoing cancer treatment at three medical oncology clinics in public hospitals in regional NSW, metropolitan Queensland and Tasmania.

Patients were asked whether they had ever consulted another doctor for a second opinion about their cancer treatment. They were then asked to nominate their reasons for either seeking a second opinion, or not doing so.

Only 57 study participants (16.5%) had sought a second opinion, most frequently for reassurance (49%) or due to the need to consider and discuss the range of treatment options (42%), according to findings in BMC Palliative Care.

One in four of those who sought a second opinion did so because family or friends asked them to, 16% because they weren’t comfortable with the first doctor, and 15% because they didn’t trust the first doctor.

Among those who didn’t seek a second opinion, the most common reason – cited by 89% of participants – was that they were confident with their first doctor, with only 3% of patients saying they didn’t know they could seek a second opinion.

“This suggests that second opinions form part of a patient-centred approach to information provision about care options,” the study authors wrote.

One in four participants said they didn’t have enough money to seek a second opinion, 3.4% said they wanted to start treatment straight away, and a small number (1.4%) said they didn’t want to upset their doctor.

Professor Olver, medical oncologist and Professorial Research Fellow in the School of Psychology at the University of Adelaide, said the option of seeking a second opinion had become more accessible in Australia in recent years due to the establishment of regional cancer centres, as well as the increased uptake of telemedicine.

“This has made a difference and most people can access a second opinion,” he said.

It wasn’t surprising that most patients had not sought a second opinion, despite knowing they could do so, he suggested.

“If all bases are covered, they probably don’t want to question it because in cancer, there is a feeling that people want to get on with it [treatment],” he said.

The use of evidence-based guidelines and multidisciplinary clinics to provide cancer care in Australia also meant that patients were likely to be given the same opinion on treatment options, no matter where they entered the system, Professor Olver said.

However, he said doctors should always enable patients to seek a second opinion if they wished, either by referring them to another specialist or to their GP for an independent referral.

And he suggested that in some cancers such as head and neck cancers where there were two possible treatment modalities – surgery and radiotherapy – it could be advisable for patients to hear from specialists in both fields so they could make an informed choice.

While the study findings were reassuring, Professor Olver said there remained a gap in the research about whether patients who did seek a second opinion on cancer treatment had improved outcomes compared with those that didn’t do so.

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