The science of second opinions: Advice from a surgeon

Clayton Lau Bio
Clayton S. Lau, M.D.

Diagnostic errors are far from uncommon. In fact, one recent study found that they affect about 1 in 20 patients in the U.S. each year.

With cancer, those errors in diagnosis can have a profound impact. A missed or delayed diagnosis can make the disease that much harder to treat, as the Agency for Healthcare Quality and Research noted in calling attention to the diagnostic errors research.

This means that patients who've been diagnosed with cancer shouldn't always assume that either the diagnosis or their options are precisely what they've been told. Sometimes a cancer has progressed more than the diagnostic tests suggest; sometimes it's progressed less. And sometimes the diagnosis is completely off-base.

Clayton S. Lau, M.D., the Pauline & Martin Collins Family Chair in Urology and chief of the Division of Urology and Urologic Oncology at City of Hope, explains the difference that second opinions can make in getting proper cancer diagnosis and care.

How important is a second opinion?

Second opinions are very important for any patient who has been diagnosed with cancer. The disease is one of the most life-changing events for individuals and their families. People shop around for material items like TVs and cars, so they should do the same for more important issues like general health and cancer. Second opinions are especially crucial for people with aggressive or complex cancers that may require multimodal (different types of) therapy and access to clinical trials. A research-based cancer center like City of Hope is an ideal place for these types of patients.

Even though medicine has made huge advances over the past several years, second opinions are not done as much as they should be. Medicine is still paternalistic and many patients just trust their doctor -- for them, whatever their doctor says goes.

Unfortunately, the treating physicians and their hospitals may not follow evidence-based medicine, or there may be a diagnostic error with tumor type or the aggressiveness (grade) of the tumor. Most of the time, the treatment recommendations and treatments themselves are correct, but sometimes they can be incorrect, or there may be other options to which patients are never exposed.

For example, at City of Hope, I see about 20 to 30 second-opinion patients per month. When a patient comes to me for a second opinion, I make sure we confirm the tissue diagnosis with our pathologist and ensure that the appropriate imaging studies have been done and interpreted correctly.

About once or twice a month, I get a second-opinion patient who was diagnosed with a specific cancer that is actually less or more aggressive than anticipated. This discovery will definitely alter treatment and the patient's prognosis. Taking that next step in getting a second opinion can make a huge difference.

What makes a cancer center like City of Hope the place to go for a second opinion?

City of Hope is one of only 49 comprehensive cancer centers in the nation, as designated by the National Cancer Institute. We practice evidence-based medicine and set standards and guidelines for cancer treatment. We conduct innovative basic and clinical research that is then put into practice for cancer care and treatment. It is our job to keep up – to be on the front lines of groundbreaking research and the latest cancer treatments.

We specialize in multimodal therapy, with the latest technologies and medications for advanced cancer. Also, at City of Hope we are greatly experienced in treating localized and locally advanced cancers with robotic surgery.

Primary care doctors are probably the best advocates for patients and have the patient’s best interest in mind in wanting them to get the best care. They will sometimes direct patients where to seek a second opinion, but remember that it is every patient’s right to ask for one.

What advice do you have for someone considering a second opinion?

  1. Learn about your disease. What it is all about? The severity? The prognosis and options? It's very important to educate yourself. Understanding the basics and history of the disease, as well as cancer staging, is valuable.
  2. If your disease is complex or aggressive and you have already been through standard therapies, ask your doctor if there are any clinical trials for which you can be considered.
  3. Ask if your case will be discussed with other specialists. At City of Hope, cases are reviewed at multidisciplinary tumor boards, with several specialists of different types reviewing a patient’s case.
  4. Besides learning about your cancer care options, take the time to research your treating physician or physicians and the facility with which they're associated.
  5. You have every right to get a second opinion. Be your own advocate.
Learn more about becoming a patient or getting a second opinion at City of Hope. You may also request an appointment online or call 800-826-4673 for more information. Our staff will explain what previous medical records we'll need for your first appointment and help you determine, before you come in, whether or not your insurance will pay for the appointment.