The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
Diagnosing cancer can be complex. Determining the best treatment option for your cancer may be overwhelming. Cancer patients rely heavily on their doctors to build treatment plans that provide the best chances for positive outcomes. While this trust is an important component of cancer care, patients shouldn't shy away from seeking second opinions before beginning treatment.
This is the advice of David Cohn, MD, MBA, chief medical officer of The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James). Cohn treats patients with gynecologic cancers and encourages them to seek second opinions. He also provides second opinions for patients diagnosed at hospitals throughout Ohio and beyond.
"Because there is no routine cancer, and there are so many more treatment options available, second opinions have become more important and more common," Cohn says. "Every patient has the right to ask for a second opinion, and every oncologist should feel comfortable making a referral."
The Basics: What is a Second Opinion
Cohn considers a patient's primary oncologist to be the "cancer quarterback." "This physician diagnoses and explains what type of cancer the patient has and comes up with a treatment plan," he says. "A second opinion is reaching out, after the original diagnosis, to another oncologist, to make sure that what was initially found is accurate and that the treatment plans are consistent with the current standard of care."
How and Where
To provide a thorough second opinion, the new oncologist must review a patient's medical history. "This involves a review of the biopsy of the cancerous tumor, the actual slide on glass or a digital copy," Cohn says. "And it's the same for X-rays and scanning tests. We need to see everything."
A patient can travel to another hospital for the second opinion, or in some cases it can be done remotely via teleconference. "If someone has a more frequently diagnosed type of cancer, I often try and have them see someone here in central Ohio for a second opinion. It's easier and less stressful," Cohn says. "But if someone has a rare type of cancer and there are only a few cancer centers with expertise in this area, it's important to meet face-to-face, so I'll send them there."
Health Care Coverage
Many health care policies cover second opinions.
"Many insurers actually require a second opinion before the start of treatment," Cohn says. "So, it's important to work with your health care provider to make sure you're covered. At the OSUCCC – James, our staff helps with that."
A Difference of Opinion
What if the second opinion differs from the first one?
"This brings us to the art of medicine," Cohn says. "In most cases, the two physicians have the same general idea for treatment, but perhaps in a different order or sequence."
When a difference of opinion occurs, the two oncologists confer "and figure out a way to get on the same page," Cohn says. "Because we now have so many more treatment options, there's often not a single answer, and it's become a more nuanced conversation about the risks and benefits of different approaches. You explain the pros and cons of each option to your patients so they are part of what we call shared-decision making."
Be an Advocate
Cancer patients and their family members should play an active role in treatment decisions and be advocates for their care. Asking for a second opinion is part of this process.
"Physicians should feel comfortable with their diagnosis and treatment recommendation, so much so that they are comfortable with their patients asking for a second opinion," Cohn says. "If a physician doesn't recommend a second opinion or declines a patient's request, that's a good signal that the patient should seek care elsewhere."