By Emma Hitt, PhD

When her son Hunter was 9‚ Pam Herr‚ a business owner in Chattanooga‚ Tennessee‚ took him to a pediatrician with concerns that he was not tall enough for his age. According to Herr‚ the pediatrician “patted her on the head” and told her that puberty was “right around the corner.” Over the next few years‚ several other physicians gave her the same response. Puberty never arrived. Hunter also started to have unexplainable headaches.

In January 2001 Herr took Hunter‚ now 13 and still small for his age‚ to an endocrinologist‚ who discovered a benign tumor on his pituitary gland that was interfering with hormone production. The deficiency was responsible for his stunted growth‚ but‚ worse‚ the tumor also threatened to blind him. Fortunately‚ with treatment‚ Hunter is expected to reach his normal height by age 18. Herr says her advice‚ which comes from seeking a second opinion‚ is to be aggressive and be your own best advocate. She attributes her success to “a combination of asking people who had been through similar problems‚ searching the internet‚ and finding a doctor who was willing to go the extra mile.”

Not all patients should seek a second opinion but “patients should be convinced that their physicians have the requisite knowledge and experience to deliver the best possible care‚” suggests Sandra Horning‚ MD‚ an oncologist at Stanford University Medical Center‚ Stanford‚ California.

“A second opinion should also be sought when the patient has concerns about the recommendation for treatment‚ or if the patient would simply be more comfortable with the consensus of two opinions‚” she explains.
Although some patients might worry about offending their physician if they want to seek a second opinion‚ Dr. Horning says most physicians are comfortable in facilitating second opinions and welcome confirmation of their recommendations.

In fact‚ the physician who gives you your first opinion is probably the best person to help you find a physician to give a second opinion‚ according to Joseph S. Bailes‚ MD‚ past president of the American Society of Clinical Oncology.

“The treating physician may even have a list of physicians with expertise in a particular area‚” he says.

James O. Armitage‚ MD‚ a cancer specialist at the University of Nebraska Medical Center‚ Omaha‚ recommends that patients definitely not be concerned about asking their physicians for a second opinion. “If a physician does anything other than say‚ ‘How can I help you?’ or‚ ‘Would you like me to give you advice about whom to see?’ then it œs somebody you should fire‚” he says.

But if a patient is apprehensive about asking his or her physician for a referral‚ regional cancer centers and‚ in some cases‚ local hospitals have physician referral services.

“In the case of a large medical center‚ often a nurse coordinator can talk to a patient and put them in touch with an appropriate physician for a second opinion‚” says Michael P. Kosty‚ MD‚ a cancer specialist at the Scripps Clinic‚ La Jolla‚ California.

Anyone interested in seeking a second opinion at Memorial Sloan-Kettering Cancer Center in New York City‚ can call their toll-free referral number (800-525-2225). The oncology nurse who answers the call will be able to judge from the type and stage of the patient’s cancer which specialist would be most suitable.
Similarly‚ at the M. D. Anderson Cancer Center in Houston‚ Texas‚ patients complete a self-referral form online at www.mdanderson.org >. Then‚ a referral specialist calls the patient directly to confirm an appointment. But be aware that well-known cancer centers far from home may not accept insurance‚ and the wait may be longer.

“In the case of a local physician‚ their opinion can be just as valuable‚” Dr. Kosty explains.

One option is to call the National Cancer Institute’s (NCI) Cancer Information Service at 800-4-CANCER‚ or access the NCI web site at www.cancer.gov >. Dr. Kosty also suggests calling a local chapter of the American Cancer Society or other appropriate organization. Other options include joining a cancer support group and searching the internet.

One outcome of seeking a second opinion may be winding up more confused because of receiving two differing opinions‚ says Gregory Curt‚ MD‚ clinical director‚ National Cancer Institute‚ Bethesda‚ Maryland.

“The response you get might depend on the type of expert you visit‚” he explains.

For example‚ in the case of prostate cancer‚ both surgery and radiation therapy have excellent long-term cure rates. But a surgeon who specializes in cancer might be more inclined to suggest surgery than another type of cancer specialist.

“So‚ the decision really has to be made based on how a patient views the side effects and the treatment‚” Dr. Curt explains.

Another option is to seek out information about ongoing clinical trials. “Patients should always consider getting treatment in the context of a clinical trial‚” Dr. Curt says. “Some clinical trials evaluate new approaches in newly diagnosed patients‚ as well as in patients who have exhausted the standard therapies.”
Dr. Curt says that before seeking a second opinion‚ cancer patients have an obligation to themselves and to their families to get information about how their disease “is diagnosed‚ how it is staged‚ how it is treated‚ and how recurrence might be prevented.”

Dr. Kosty agrees. “I think a lot of the literature that’s available—books and information‚ particularly for the layperson—may be useful. It is never harmful for a patient to understand their disease as much as they can before seeking a second opinion‚” he says.