Do second opinions matter in prostate cancer care?
A new analysis indicates that many men with prostate cancer obtain second opinions from urologists before starting treatment, but surprisingly, second opinions are not associated with changes in treatment choice or improvements in perceived quality of prostate cancer care. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings also explore motivations for seeking second opinions, and suggest that second opinions may not reduce overtreatment in prostate cancer.
Cancer societies encourage patients with cancer to obtain second opinions prior to starting treatment to help them understand their disease and to thoroughly weigh the risks and benefits of their options. Given the ongoing debate concerning whether prostate cancer patients are being overtreated, second opinions in this context are important because management options vary widely from surgery and radiation therapy to active surveillance programs. However, the study did not find that second opinions affected treatment among low-risk men—the most likely candidates for active surveillance—casting doubt on whether second opinions are sufficient to reduce overtreatment among this group.
Archana Radhakrishnan, MD, MHS, of Johns Hopkins University, in Baltimore, and her colleagues sought to assess the frequency of and reasons for second opinions for localized prostate cancer, and the characteristics of those who seek them. They also evaluated whether second opinions are associated with certain treatment choices or perceived quality of prostate cancer care.
The investigators surveyed men as part of the Philadelphia Area Prostate Cancer Access Study (P2 Access). A total of 2386 men who were newly diagnosed with localized prostate cancer in the greater Philadelphia area between 2012 and 2014 responded. Forty percent of men obtained second opinions, commonly because they wanted more information about their cancer (50.8 percent) and wanted to be seen by the best doctor (46.3 percent). Overall, obtaining second opinions was not linked with receiving definitive treatment or with perceived quality of cancer care.
Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. Men who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to by family or friends were more likely to ultimately receive surgery. The authors suggest this could indicate that for some men, second opinions represent a way to pursue the treatment they already plan on receiving, rather than to explore other treatment options
"Patients often report getting second opinions for prostate cancer. Their impact on care that patients receive remains uncertain," said Dr. Radhakrishnan.