How to get a second opinion on your cancer treatment

When your doctor diagnoses you with a sinus infection, you likely accept that diagnosis and follow the recommended course of treatment. But a cancer diagnosis is not always so straightforward—based on the specific details of your cancer, like stage and grade, the prognosis and treatment options laid out by one doctor might be different from another. To feel confident that your diagnosis is accurate and your treatment plan is the best one for you, consider getting a second opinion.

When to seek a second opinion

Getting a second opinion means asking another cancer specialist, or a team of specialists, to review your medical records and test results, give an opinion about your diagnosis, and suggest treatment options. The American Cancer Society recommends a second opinion in the following circumstances:

• Your doctor can’t make a definitive diagnosis
• You have a rare or unusual cancer
• You want to explore other treatment options
• Your doctor is not a specialist in your specific type of cancer
• Your doctor gives you a few different treatment options, with no clear recommendation
• There are communication difficulties with your doctor or members of the cancer care team
• You want confirmation of your doctor’s diagnosis and treatment plan
• Your insurance company asks you to get another opinion before you start treatment

Listen to your gut

The biggest reason to get a second opinion, however, is your intuition. If you feel like something doesn’t sit right with you about the information you’ve received at your first diagnosis, a second opinion can help you feel confident that you have explored all options. Whether you’ve read about treatment options that you’re not being offered or you think your doctor is underestimating how serious your cancer is, a second opinion can answer lingering questions you may have after your diagnosis and help you get to a place where you feel confident proceeding with a treatment plan.

Set yourself up for success

You might also seek out a second opinion to see if someone is a better fit for you. Just because a doctor made a cancer diagnosis doesn’t mean he or she is permanently assigned to treating it. It’s okay to seek out another doctor or treatment center that is a better fit for you. You might prefer a doctor with a different temperament, or a cancer center that offers support services for your loved ones. Perhaps your initial cancer center is small and doesn’t have many resources, or you’re interested in working with a different doctor who truly specializes in a specific type of diagnosis or treatment. You might also be interested in clinical trials or cutting-edge technology and/or treatments. All of these are good reasons to get a second opinion. That said, getting a second opinion isn’t necessary, so only do it if you have concerns or need additional information.

Second opinions usually either confirm that the first doctor was telling you what "any" doctor would have told you, or will uncover additional options that you might want to explore (in one study of breast cancer patients, 40 percent of people who asked for a second opinion had a change in diagnosis, which in most cases changed the treatment plan; in another study, 66 percent of medical diagnoses were deemed partially correct, but refined by a second opinion). Some people get a third opinion, too, to see if they will receive recommendations that match one of the first two. There is nothing wrong with doing your due diligence to ensure you have the best care for you.

Talking to your doctor about a second opinion

It might feel awkward to tell your doctor you’d like a second opinion, but rest assured this is a common—and, in many cases, appreciated—request. In fact, this is a common practice in oncology so your doctor won’t be surprised. You are a consumer of the healthcare you receive, and as such, you have the right to be informed before embarking on a potentially life-changing course of treatment. You should never feel guilty asking for a different doctor or confirming your diagnosis with someone in a different healthcare system. A good doctor will encourage you to ask questions, seek out information, and become empowered in your treatment.

A good way to tell your doctor you’d like a second opinion is to ask your doctor who they feel is the utmost expert in treating your specific diagnosis, down to the cytogenetics. Cancer specialists are a small world, and a good and honest oncologist will instantly be able to list off their top-ranked peers locally, regionally, and nationally, as well as welcome the opportunity to have these experts review your records. If they are reluctant to tell you who to see or share information with another doctor, that's a sign that they may not always be working for the best interest of their patients. 

If you can't get a referral, or if you are unsatisfied with the answer your doctor gives you, consider asking to be assigned to a different oncologist in the practice or find another in-network oncology practice. You can find the top oncologists for treating the type of cancer you have by looking up the diagnosis-specific foundation for your diagnosis (for example, the Colorectal Cancer Alliance or International Myeloma Foundation). You may also use the “Find an Oncologist” database search from the American Society of Clinical Oncology or schedule a remote consultation through second opinion telehealth programs like Dana-Farber Cancer Institute, Barrow Neurological Institute, Yale Medicine, or Stanford Medicine.

Will my insurance pay for it?

The initial stages of a cancer diagnosis can be confusing, particularly when it comes to deciphering health insurance policies or understanding your Medicare plan. Most (but not all) insurance companies will approve payment for a second opinion - in some cases, your insurance company may even require a second opinion before approving treatment. Check to see if the doctor you wish to visit accepts your particular insurance plan. You are also able to use health savings accounts (HSAs) toward paying for these consultations.

Your insurance may pay for a second opinion, but not agree to you receiving treatment at the second opinion cancer center. This is especially true for providers who are out-of-network. If you prefer the treatment plan laid out by that second care center, but can’t get insurance approval for that provider, ask them for a referral to an oncologist who is in-network, who would be willing to communicate with the second opinion doctor and follow the plan outlined.

What happens during a second opinion visit?

Your first doctor will provide you with all documents related to your diagnosis, including:

• Radiology images
• Pathology reports from biopsies or surgeries
• Operative reports (if surgery was performed)
• Hospital records
• Medications prescribed
• A summary of the first doctor’s treatment plan

Most doctors and treatment centers will have these records available through an online patient portal, which will make it easier to share with other doctors.

At your second opinion consultation, a new doctor will review your records and note any concerns you might have about the diagnosis or treatment plan outlined by the first doctor. Once all background information and medical records are received, the new specialist will write a consultation report. The information in this report may confirm the first doctor’s diagnosis and treatment plan, or it may refine certain elements for improved outcomes. Some may present alternative treatment strategies, such as new medications or clinical trials. In some cases, the second opinion doctor or health system may ask you to repeat certain labs or procedures, to ensure results are read on their own equipment, giving them accurate readings.

When opinions diverge

Sometimes, a second opinion will be widely different from the first. When that happens, the American Cancer Society recommends asking both doctors how they arrived at their treatment plan and what research studies and professional guidelines they consulted. You can also compare their recommendations to the latest treatment guidelines outlined at the National Comprehensive Cancer Network (NCCN) and the National Cancer Institute’s PDQ® Cancer Treatment Summaries. You may also ask a third specialist for an opinion, if you wish. With these additional perspectives, you can take an informed approach to deciding your next steps.

The bottom line

It's normal and expected to get a second opinion to confirm the exact diagnosis or recommendations for treatment. Sometimes someone who specializes in the exact type of cancer you have, especially if it is a rare one, is the best person to see. They will have more experience, and more oncologist experience almost universally leads to better outcomes for patients.

If your doctors agree, your decisions regarding your treatment may be clearer. If their information doesn’t line up exactly, that doesn’t mean the first doctor was wrong – it means there are multiple treatment options available, and you can choose a treatment and provider that fits your needs. The final choice is always yours.

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