Second Opinions For Cancer Patients The pathway to knowledge and satisfaction

Cancer is a new experience. You likely have no training or knowledge of the rules and pathways of making decisions about diagnosis, and especially about treatment. For everyone it is very upsetting, and for many, terrifying.

Sometimes.....usually, in fact......the patient is generally satisfied with their care, and simply wants another cancer doctor to review the case and reaffirm that everything that should be done is being done.

Sometimes a major treatment decision needs to be made: Surgery? What kind of surgery? What is the role of radiation therapy? Chemotherapy? Should they be given together? Separately? In what order? Are there other methods of treatment? Biological therapy? Vaccines? Experimental treatments?

It is not surprising that a surgeon, who knows that an entirely localized cancer can be cured by surgical removal, and who is well-trained to remove the cancer in the operating room, would advise this as the preferred method of treatment. In fact it usually is. On the other hand, some cancers are treated with radiation therapy. It is the preferred treatment for some types and stages of cancer. Sometimes both surgery and radiation are used. Other treatments are sometimes necessary: chemotherapy, hormones, biological therapy & vaccines. How do you find out which treatment to use? Or if more than one should be used, in which order or sequence? Lately, some cancers are being treated with radiation and chemotherapy together, to shrink the cancer before surgery is done.

Cancer research is looking at hundreds of new treatments for cancer. Some are not yet generally available, or are investigational. That means they are available only in certain treatment centers. These may be academic cancer centers or university hospitals, but special treatments also may be given in some local community hospitals by qualified cancer specialists. For each type of cancer, there is a known role for such new and investigational treatments. Some are used early; some are used late, after many types of standard therapy. Sometimes you and your physician could use some help in sorting out these pathways. Once in a while there is a request to direct a patient to a specific treatment center. Certain cancer centers are world-renowned for certain special treatments.....bone marrow and stem cell transplants for example.

Obtaining a second opinion fulfills this important role in helping to educate the patient about their disease and its treatment. Cancer practice is relatively well-known and standardized, so your physician is likely, in fact, to be generally aware of the appropriate pathways and choices of management. However, it is especially reassuring and comforting to have an independent cancer physician agree with and validate your doctor's thinking. And in case there is a new twist or angle, or a new pathway of treatment or management that your doctor may not have explained to you, it is even more important for you to know about this. Physicians want to do the very best for their patients....so they welcome second opinions. In case there is another treatment idea, you don't want them to say, someday, ``I wish I had thought of that!'' The most important person is you, the patient. You should not hesitate to get all the help you can. Your physician may also have considered various other types of treatment, and discarded them as not appropriate in your case. However, you may not know the details and reasons.

How do you get this help? Of course you can go to another cancer specialist, either referred by your doctor, or independently, on your own. Many patients do this. The other specialist is a treating physician, and if, in fact, you were dissatisfied with your care, and were actually trying out a new doctor, you would want to see someone for a second opinion who could take over if you chose to do so. Most often, however, you do not wish to change doctors. You need another viewpoint and another specialist to give you confidence that your doctor is on the right track and has not missed any important details. It is very important for the second opinion doctor to acknowledge and respect your important relationship with your own doctor, and to express her or his opinions in a positive and supportive sense. All that matters is that you get all the help you need, and all of the health care professionals need to work together to make that happen.

Dr. Dollinger's second opinion program features a cancer specialist who does only second opinions and consultations, and does not take over the care of the patient. Thus, the opinion is especially likely to be completely objective. There is no hidden agenda that favors a particular treatment that is used by the consultant. You can be assured that the second opinion is a complete and impartial discussion of the case, education about the treatment alternatives, answers to whatever questions may exist, recommendations regarding treatment types and priorities, and occasionally, if needed, referral to specific centers in case specialized treatments may be indicated (for example stem cell transplants; special treatments, drugs and vaccines).

Malin Dollinger, M.D. is an experienced cancer specialist who has been in the practice of cancer medicine since 1968. He has taken care of thousands of patients with all forms of cancer, and is trained in internal medicine and medical oncology. His special interest is communication and education, and thus he has been on numerous radio and TV shows, as well as the Larry King Show. He is the co-author of the best-selling book, Everyone's Guide to Cancer Therapy, sold across the USA and in many foreign countries as an educational tool for the general public. He also teaches at USC School of Medicine as a Clinical Professor of Medicine. His hope and wish would be to bring his years of extensive training and experience to you, for your direct benefit.

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