It is always a good idea to get a second opinion when diagnosed with mesothelioma.
Because it is a rare form of cancer, general oncologists may not see the number of
mesothelioma patients that a specialist sees, and may not have the most current information
on treatment options. Also, there is a possibility that you may have been misdiagnosed.
Since the final diagnosis determines the specific treatment a patient will receive, a second
opinion by a specialist is a good idea for patients facing major cancer treatment.
Many patients worry about telling their doctor they plan on seeking a second opinion, but
they should not. Most doctors are comfortable with the request, as it is common for patients
to seek a second opinion. Ask that your medical records, original x-rays, and tests results
be shared with the referral doctor.
Does Everyone Need a Second Opinion?
|
| by Ernest H. Rosenbaum, MD |
When a person comes
in for their initial consultation, they bring a multitude of problems.
Usually they come
for a diagnostic work up after they have already been given a diagnosis
of cancer. They arrive at an oncology office in a state of alarm and
fear. They also have grave questions about their future life. The first
problem I find is the way in which they were given the diagnosis. Usually,
it is through a follow-up call after a biopsy and/or test to tell them
that they have cancer. Receiving the diagnosis produces a strong emotional
reaction. Most people are shocked and devastated, needing more time
to fully comprehend the meaning of cancer.
|
Most cases are usually
straightforward. A diagnosis is made and treatments are initiated.
Thus, many patients
may not need a second opinion. But when a diagnosis of cancer is made,
there is much fear, misunderstanding, and many questions about therapy.
All these factors can determine whether a person may live or die-thus
it is not unreasonable to a patient to want to have another point of
view-what we call a second opinion.
|
After analyzing the
cancer data, the most important thing a physician can give to a concerned
patient or
family is to explain, in simple terms, all the pertinent issues. Patients
wish for state of the art medical care, but they may have doubts about
what is the best way to proceed. Although this is when a second opinion
can be very helpful, most patients are reluctant to offend their primary
physician by doing so. Many patients do not realize that getting a
second opinion is standard practice.
|
Unless emergency treatment
is needed, I feel it is very important for the patient and their
family/friends
to allow themselves time to learn exactly what the diagnosis means.
They need to gather information on how it can be treated (surgery,
radiation, or chemotherapy), weigh the options (such as watchful waiting
a few months for a less aggressive process vs. immediate treatment
in the next few days), and understand the prognosis and the chances
for a cure.
|
Most patients are
now well informed often having gathered information from the Web,
(Internet or PDQ Physician
Data Query/CancerNet), newspapers, magazines, or from their well-meaning
friends. This information is often very mixed and confusing
|
It often takes time
and several explanations going over the same questions for an anxious
and fearful patient to
understand and be satisfied with the medical recommendations. Often
there are several approaches to a problem and sometimes there is no
definitive answer, given the limitations of current medical science.
|
To help patients make
proper decisions; I make a point of informing them and their family/friends
at the initial
visit that I have two rules in my practice (included on the tape recording
that I do for all my consultations). If they are coming for a second
opinion, I clarify that they will continue their care with their primary
oncologist.
|
| |
· Rule 1. If
I am uncertain or have any questions on the diagnosis or treatment,
I will
advise them that I would like them to get a second opinion. I state
that I would be glad to recommend the person and place which I think
would offer the most beneficial consultation to add additional information
on how to proceed with their oncology evaluation or therapy.
|
| |
· Rule 2. If
at any time they wish to seek a second opinion, as is their right,
I would
be glad to provide my records, test results, x-rays and pathology report
to whomever they wish. If they would like me to select and help arrange
a second opinion consultant, I would be available to do so.
|
I can recall a case where mine was
the 9th opinion. This reflects how it may take multiple discussions
with your doctor or with another independent unbiased physician to
arrive at a conclusion that can give you peace of mind and satisfaction
about which is the appropriate therapy. Return to top>> |
| |
Source: Cancer Supportive Care |
|
| Second Opinion: A Valuable Part of Supportive Care |
| by Malin Dollinger, MD, FACP |
None of us are prepared
to be told that we have cancer. It's like a membership in a new club,
one we didn't
know existed, didn't apply for, and don't want to belong to. Everyone
seems to treat us differently. All of our old priorities and life suddenly
change. We need to know RIGHT NOW what is going on, how bad the cancer
is, where it is, where it has spread. What are the choices for treatment?
How successful is each one? What are the risks and side effects of
each treatment? Is one better than another? Why? What should I do?
How much time do I have to decide? For that matter, how much time do
I have? |
Thank God you have
never had to ask and answer these questions before. Somewhere in
the back of your mind,
you were worried about an auto accident or breaking a bone, or needing
an operation, but you have absolutely no training or experience in
having cancer. How do you make decisions about what to do? You find
a physician you trust. Usually a cancer specialist (Oncologist) is
involved in your care. This makes sense. Oncologists know about cancer.
However, there is so much information about cancer. Some of it is really
valid and reliable, in books and medical literature, and from your
doctors. Some of it may not be reliable: what your friends or the Internet
tells you. How do you tell the difference? |
First, believe what
your doctor tells you. She or he has spent years training, learning,
and understanding
this process we call cancer. Second, read all you can. However, making
these vital and critical decisions about your cancer care is different
from most decisions we have made in our lives. Almost always we choose
between two things we like: steak or chicken? A Ford or a Chevy? Buy
this house or that one? Fact is it wouldn't be the end of the world
no matter which of these decisions we made. Both choices, then, are
in a sense positive. |
When making a decision
about cancer treatment, our choices are things we don't want, instead
of things
we do want. I don't want an operation (no matter which one you suggest).
I also don't want radiation therapy. I don't want chemotherapy. I don't
even want a biopsy!! Much less the blood tests and CAT scans and all
the doctor visits. So we are not used to making choices about things
we don't want. It feels strange, and it is strange. |
That's why it is so
important to be able to talk to a health care professional about
these choices. Best
is someone who knows what the choices mean good and bad. Often your
main-MD - perhaps your oncologist can explain all these choices to
you. You may be quite happy and satisfied with these discussions. However,
you have no prior experience with making these choices, or making this
kind of choice, about things you don't want. |
So a second opinion
is one way of exploring the choices. It's an important one, to help
you be very sure
that you understand what the choices mean. Some choices in life are
very clear: it does not require a second opinion to know the significance
of pulling a parachute ripcord or not pulling a ripcord. However, before
you go up in an airplane, to do skydiving, would it be important to
know which brand of parachute (and parachute packer) is reliable. Of
course!! You do this before the plane takes off. |
In cancer treatment,
even though there is a great emotional need to get going - I want
the treatment yesterday,
there is rarely an emergency medically. Most of the time, nothing bad
will happen if a few weeks go by while you make sure you understand
the difficult decisions that you need to make. If you have a need for
additional discussion (and maybe you aren't even sure if you do), a
second opinion is one way of being sure you understand the choices. |
This should not be
a threat to your regular doctor. You should be partners in your care,
and you can simply
explain that, "Yes, I am really pleased with your care, and I want you to continue to take care of me and I would also love to have some additional input from someone who maybe has a different perspective or angle." |
After all, who is
the one that is most important to please and be satisfied? You are!
Do not worry about
hurting the doctor's feelings. He/she is a professional, and this is
not the first time another physician has looked over her/his care.
It begins in early training, and happens every day, in some way. As
a matter of fact, your physician should welcome the opportunity to
have another consultant review and approve your care decisions, or
perhaps suggest a new, clever, or novel idea that might be to your
benefit. Either way, you win. Yes, there are some instances when you
have some basic disagreement with your physician, or there isn't the
fit that there should be. Sometimes you do need to change physicians.
But that isn't the usual reason for a second opinion. Most of the time
you simply want to be sure that there is no stone left unturned in
your care. Few people change oncologists-he or she becomes a really
important person in your life. |
What does the second
opinion consultant do? He or she wants to know everything about your
previous diagnosis
and treatment. You usually bring copies of all your x-ray films, and
all your records. It's a good idea to have a copy of all your records
anyway, in case you travel and are away somewhere and become ill. Often
the consultant will wish to look at the pathology slides to verify
the type of cancer that is present. You need to have copies of your
previous consultations and opinions, hospital records and discharge
summaries, and especially the pathology reports (that give the cancer
diagnosis) and the operative reports of any surgery you have had for
the cancer. The consultant reviews all this material and examines you.
Often you will bring your spouse, significant other, family members,
or a close friend with you, to share in the discussion and to help
you remember the discussion and make decisions. It may be helpful to
bring a pad to take notes, and a tape recorder to keep a record. The
consultant will then go over all of the findings with you and especially
discuss and emphasize the current and future decisions to be made.
It would be especially helpful if you bring questions of your own;
to be sure you have no unanswered questions or problems when you are
done. The consultant will then prepare a written report, which will
be sent to your physicians, and often to you as well. She may call
your doctor on the phone to have an immediate discussion of your findings,
especially important if you are about to have surgery or begin a new
treatment program, and are waiting for agreement. |
Should you tell your
present physician about the second opinion? Yes!! It is in your best
interest that all
of your doctors know all the facts and opinions. Your health is at
stake, and unless you have had a major disagreement with your physician,
and are using the second opinion as a pathway toward changing doctors,
it is to your advantage to share all the information. Your physician
is your partner in the pathway toward success. |
Specialists usually
make Cancer treatment decisions, and their training is relatively
uniform and sophisticated.
There are seldom any major differences in the standard ways of treating
various cancers, and cancer specialists generally know what the choices
are and what the risks and complications are. There may be advantages
and disadvantages of each treatment choice. What a consultant may help
with is: |
| |
1.
Deciding for you which choice makes the most sense. |
| |
2. Reassuring
you that your own doctor has made the best choice for you at this time. |
| |
3. Outlining
some of the future choices that need to be made later, should there
be a need for other
or different treatment.
|
| |
4. Defining
a new treatment or pathway that may not be generally known or available,
such as a center or physician
with special research in your cancer, or with a special program, protocol,
or clinical trial or promising new treatment.
|
Many insurance and health care companies,
who will pay for such opinions, have acknowledged the importance of
second opinions. It is becoming the normal and appropriate thing to
do. My experience is that second-opinion consultants are very respectful
of the hard work and dedication of your principal doctor, and are careful
to be entirely professional and to give appropriate credit and validity
to those decisions already made. After all, their patients have obtained
second opinions, too!! Return to top>> |
| |
Source:
The Cancer Answer |
|
| Multidisciplinary Second Opinion Fundamentals |
| by Richard & Annette Bloch |
Doctors other than
oncologists diagnose most cancers. They are diagnosed by family doctors,
gynecologists,
ear-nose-and-throat doctors, and so on. Some of these doctors do not
encourage their patients to seek second opinions. These doctors may
be afraid of losing revenue, threatened by having their patient believe
some other doctor is more knowledgeable, or just do not want to bother
consulting with other physicians. The patients of these doctors probably
are most in need of the second opinion. |
The critical element
in successfully treating cancer is in promptly receiving the proper
treatment. We know
that cancer comes in a hundred different varieties. There is no relationship
between breast cancer and brain cancer other than the term cancer and
the fact that they are both involve rapidly dividing cells. It is impossible
for one primary physician to be informed on the latest and best treatment
for every type of cancer. Furthermore, it is impossible for one specialist,
such as a surgeon, radiotherapist or oncologist, to know the very latest
and best treatment in his own specialty for every one of the more than
one hundred different types of cancer. |
At lunch with a medical
oncologist, I asked how often he treated a patient for cancer without
a second
opinion. This man, in his sixties, replied that he had never in his
career treated a cancer patient without a second opinion. Furthermore,
he always insisted on a second opinion from someone other than an associate
of his. This was the rationale: |
| |
1. Cancer
is a very serious disease that grows exponentially. If it is not
diagnosed properly the first
time, there is often no second chance.
|
| |
2. The
doctor is human and could make a mistake. |
| |
3. Someone
else could see something that one doctor doesn't see. |
| |
4. Someone
else could know something that one doctor doesn't know. |
I thought this was
a profound statement. I wished that every doctor treating a cancer
patient could hear this.
My conclusion from this statement is that any doctor treating a cancer
patient without a second opinion is not practicing medicine, but trying
to play God. I thought it was only God, who was supposed to be perfect,
know everything and never make a mistake. |
These thoughts were
substantiated in the draft of the May, 1985 publication of the National
Institutes
of Health entitled cancer control Objectives for the National 1985-2000.
It states, "The application of the state of the art treatment is complex. At all levels of the health service deliver system-from the primary care physician who has initial contact with the patient to specialists directing the cancer treatment-physician knowledge is not yet optimal. That knowledge should include an appreciation for state-of-the-art treatment information and an interest in ensuring early multidisciplinary decision-making. For about 70 percent of cancers, optimal therapy derives from multidisciplinary discussions. The relative rarity of some of the most responsive tumors means that proficient treatment can be maintained only at some major cancer centers. Malpractice considerations may result in physicians selecting safe therapy, which neither offers significant risk nor the chance of cure. A major determinant of outcome for most newly diagnosed cancer patients with curable disease hinges on early multi-disciplinary treatment planning and the availability of expertise and resources to carry out such a treatment plan." |
A multi-disciplinary
panel is an excellent way to obtain other opinions as well as advice
for treatment planning.
The purpose of the panel is to review the referring doctor's proposed
treatment and approve it or recommend additions or alternatives. The
recommendations of the panel are discussed in front of the patient.
The panel's comments are written down for the patient and a copy is
sent to the referring doctor. |
This idea of holding all discussions
openly and frankly in front of the patient and any relatives or friends
she/he cares to bring is unique in the medical world. Not only do
a majority of patients leave with a recommended course of medical treatment,
but every patient also leaves with an improved state of mind. They
all feel better and more confident about what is lies ahead of them. Return
to top>>
|
| |
Source: Cancer Supportive
Care |
|
| The Importance of a Second Opinion |
It is always a good
idea to get a second opinion when diagnosed with mesothelioma. Because
it is a rare
form of cancer, general oncologists may not see the number of mesothelioma
patients that a specialist sees, and may not have the most current
information on treatment options. |
Also, there is a possibility
that you may have been misdiagnosed. Since the final diagnosis determines
the specific treatment a patient will receive, a second opinion by
a specialist is a good idea for patients facing major cancer treatment. |
Many patients worry about telling
their doctor they plan on seeking a second opinion, but they should
not. Most doctors are comfortable with the request, as it is common
for patients to seek a second opinion. Ask that your medical records,
original x-rays, and tests results be shared with the referral doctor.
Return to top>> |
|
Click here for
a list of questions to ask when choosing a doctor.
Click here to
find a mesothelioma specialist near you.
*For articles regarding treatment of mesothelioma and other asbestos-related illnesses, as well as links to related web sites, please see our Articles and Resources section.
Disclaimer
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