IS A SECOND OPINION ADVISABLE?

There are 5 conditions in which a second opinion is usually requested: 

1. at the beginning, when the general approach to the case is being planned;
2. during “staging”, to confirm the extent of the disease;
3. after surgery, to decide whether adjuvant therapies should be administered;
4. in the advanced phase, to determine whether the prescribed treatments are the best;
5. in the very advanced stages, to determine whether or not other anti-cancer treatments should be administered and whether any suitable experimental trials are available. 

Of these 5 conditions, the most frequent are the 3^rd, 4^th and 5^th. 

There is no need for a second opinion in each of this cases: the plan drawn up by the reference center has been clearly understood; the objectives have been properly explained; the doctor responsible for the case has the trust of the patient and his family members; the center is equipped to carry out all the diagnostic tests and forms of therapy necessary. But, if any of these conditions is not met – or if the patient only wants to strengthen his trust in the doctor and in the center – it may be worthwhile asking for a second opinion. 

If a second opinion is requested, it should be requested openly, in full agreement with the doctor who is managing the case. 

Patients who want a second opinion will generally turn to a widely known specialist. If the proposed program is judged to be correct, the professionist should have no difficulty in confirming it; he will not need to say anything more  or more original, as this might confuse the patient and irritate the colleague who has drawn up the program. 

As in all trades, problems often have more than one correct solution: say X, Y and Z. Often, two of the solutions (let’s say X and Z) are both correct and optimal, while the third (Y), although correct, is not optimal. In such cases, these aspects should be discussed with the specialist who gives the second opinion. If the reference center has suggested one of these 2 optimal solutions, this should be confirmed by the specialist who is consulted. If this does not happen, the patient and his relatives must fully understand why a different option has been suggested, and the consultant must put his explanation in writing.

It must be clear whether the reference center is really failing to offer the optimal treatment, or whether the second specialist proposed something different only as an alternative to an option that is correct. 

Another situation in which a second opinion is often requested is when the reference center decides that no further anti-cancer treatment should be administered because the disease is too advanced. In such cases, there may be two advantages of having a second opinion: firstly, if the decision to discontinue the therapy is confirmed by the second opinion, this confirmation can offer the patient considerable consolation, in that everything possible has already been done. Secondly, the specialist who gives the second opinion might possibly be aware of an experimental treatment that the patient could try.

In general, it is the doctor responsible for the case who suggests requesting a second opinion; this is always a sign of professional maturity and humanity.