Childhood Cancer

Childhood Cancer

Getting a second opinion

There are times during your child’s treatment when a second opinion may be advisable. Parents are sometimes reluctant to request a second opinion because they are afraid of offending their child’s doctor or creating antagonism. Conscientious doctors will not resent a parent for seeking a second opinion. If your child’s doctor does resist, ask why. Second opinions are a common and accepted practice, and they are sometimes required by insurance companies.

There are two ways to get a second opinion: see another specialist or ask your child’s doctor to arrange a multidisciplinary second opinion. Many parents seek a second opinion at the time of diagnosis, but it is better not to do this in secret. Explain to your child’s pediatric oncologist or surgeon that, before proceeding, you would like an additional viewpoint. To allow for a thorough analysis, arrange to have copies of all records, scans, and pathology slides sent ahead to the doctor who will give the additional opinion.

Personally, I feel there is nothing wrong with getting a second opinion from another major center. If you like and feel comfortable with your current team, that’s great, but I definitely do not like when a doctor tells us there’s “no reason” to go elsewhere, that “they can’t do anything we don’t do,” and so forth. Many people choose to go elsewhere and have great results when a first doctor may have told them “no surgery,” “it’s hopeless,” whatever the case may be. Many people travel great distances to get treatment at another facility whose treatment philosophy they prefer. And, granted, that is their choice. Now, your second opinion doctor may look at your child’s MRIs and say, “Your team is doing exactly the right things; stick with them,” or he may tell you something totally different and then you can make your own decision on what to do.

Multidisciplinary second opinions incorporate the views of several different specialists. Parents who would like to get various viewpoints can ask to have their child’s case discussed at a tumor board, which usually meets weekly at major medical centers. These boards include medical, surgical, and radiation oncologists, as well as fellows and residents. Your child’s oncologist will present the facts of your child’s case for discussion. Ask him to tell you what was said at the meeting.

Doctors informally seek second opinions all the time. Residents confer with their fellows about complicated situations; fellows might confer with the attending when unusual drug reactions or responses to treatment occur. Attendings call colleagues at other institutions. Thus, parents should feel free to ask their child’s physician whether he has conferred with other staff members to gain additional viewpoints.

Brent developed a seizure disorder after a rare drug reaction, so he was on anticonvulsants as well as chemotherapy for 2 years. We worried about the interaction of all the drugs, as well as the advisability of his continuing on the more aggressive arm of the protocol. We asked the fellow to arrange a care conference, and she met with the clinic director as well as Brent’s neurologist to discuss how best to manage his case.