searchable hospital database on cancer experience; 2nd medical opinion advisement

[Guest guest]

" Web site - http://www.cancer.org/asp/search/ftc/ftc_global.asp - provides a

searchable database of just how many cases of, say, Stage 3 pancreatic cancer,

that hospitals in different areas treat in a year... Over half of breast cancer

patients had their initial treatment changed when they sought a review at a

specialty center. "

(Fair Use Notice)

Doctors Back New Approach on 2nd Opinion

By n Neergaard (AP Medical Writer) From Associated Press January 01, 2007

EDITOR'S NOTE - n Neergaard covers health and medical issues for The

Associated Press in Washington.

WASHINGTON - Reluctant to get a second opinion?

Consider this: Over half of breast cancer patients had their initial treatment

changed when they sought a review at a specialty center. But the question

remains whether everybody with cancer really needs to go shopping for a second

opinion. And if the first two doctors disagree, do you need a tiebreaker?

Better than serial doc-shopping may be what Dr. Sabel, a University of

Michigan breast cancer surgeon, calls the team approach. It's where specialists

in different aspects of cancer care - the radiologist and pathologist, surgeon,

medical oncologist and radiation oncologist - all get together, usually with the

patient, to reread all the tests and hash out the best treatment.

That, not run-of-the-mill second opinions, is what Sabel set out to study when

he examined what happened to 149 breast cancer patients who, in one year alone,

came to Michigan's Comprehensive Cancer Center after being diagnosed, biopsied

and getting a treatment recommended from a doctor elsewhere.

" This was very eye-opening, " he says of the results. Now he wonders, " Is there

a benefit to the multidisciplinary approach upfront, rather than seeing a

surgeon, then going to the next doctor, then to the next doctor? "

The study examined just recommendations for initial surgical treatment, not

later chemotherapy or radiation - yet 52 percent of the women had one or more

changes urged by the specialty tumor board, Sabel reported in the journal

Cancer.

Sometimes it was because the original doctor didn't follow national treatment

guidelines. Five patients, for example, had been told to get a mastectomy when

they were good candidates for breast-conserving lumpectomy instead.

Sometimes the original advice didn't take into account newer techniques, such

as using chemotherapy to shrink the tumor before operating so the breast could

be saved.

Sometimes surgeons thought women were good lumpectomy candidates - only to

have an oncologist determine they couldn't tolerate the radiation that's

required afterward, and these surgeons ended up recommending a mastectomy

instead.

And in 29 percent of the patients, the Michigan pathologists interpreted

biopsy results differently than the original doctors, leading to a change in

diagnosis - cancer instead of benign breast disease for one - and a change in

the aggressiveness of treatment.

Doctors have long known the value of a second set of eyes examining

mammograms, biopsies and other types of cancer tests. At many cancer centers, an

in-house recheck is routine.

The new study provides a broader look at other areas where doctors can

legitimately disagree on the best treatment, or may have missed something, says

Dr. Ted Gansler of the American Cancer Society.

It was that team approach that gave Carol Pitz the confidence that her mother

should follow the more aggressive treatment recommended by Michigan's tumor

board, rather than what her hometown doctor several hours away had recommended.

Pitz was worried by a remark in one of her mother's many medical records

suggesting that her 1999 lumpectomy may not have been big enough to get all the

cancerous cells. So Pitz insisted on a second opinion.

" The experience was amazing, " Pitz, of Minneapolis, recalls of the tumor board

meeting.

The recommendation: more aggressive chemotherapy to shrink any remaining

tumor, followed by another cut at the original incision site to remove any

lingering traces of cancer. Seven years later, Pitz's mom, now 66, remains

healthy.

" We really have spread the word to everybody we know about the importance of

getting a second opinion, " Pitz says.

Still, " the question is whether everybody needs a second opinion, " Gansler

notes - especially if they originally sought care at one of the many hospitals

officially designated by the National Cancer Institute or the American College

of Surgeons as comprehensive cancer centers and that use the team approach.

The cancer society has no official recommendation on that, although many

patient advocacy groups do suggest a routine second opinion.

But anytime there's uncertainty about a diagnosis or best treatment, or if you

have a more rare form of cancer, it's probably a good idea, he says.

Another reason: If your doctor or hospital hasn't cared for lots of other

patients with your type and stage of tumor. The cancer society's Web site -

http://www.cancer.org/asp/search/ftc/ftc_global.asp - provides a searchable

database of just how many cases of, say, Stage 3 pancreatic cancer, that

hospitals in different areas treat in a year.

It's " always a good idea just to say, 'Have you treated many patients in a

situation similar to mine? Is my case unusual in any way? Is there any reason

you think I might benefit from a second opinion?' " Gansler advises.

A good doctor won't be offended by a patient seeking a second opinion, Sabel

stresses, saying they're used to it. Nor will it hurt to postpone treatment a

few weeks to get that review. " A few weeks is very reasonable. Patients

shouldn't feel pressured. "

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EDITOR'S NOTE - n Neergaard covers health and medical issues for The

Associated Press in Washington.

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