BALTIMORE, Nov 9 — Though many men diagnosed with prostate cancer seek a second opinion before beginning treatment, second opinions are unlikely to change their treatment decisions, according to a US study.
Prostate cancer management options range from surgery and radiation to “watchful waiting.” Most men with prostate cancer are over age 65 and do not die from the disease, so treatment may not improve health or lengthen life in all cases, according to the Centres for Disease Control and Prevention.
“We were surprised by the relatively large percentage of men who obtain second opinions for their prostate cancer,” said lead author Dr. Archana Radhakrishnan of Johns Hopkins University in Baltimore.
“We had thought that men who received second opinions, in general, may receive different treatment than men who did not,” she told Reuters Health by email. “What we found was that overall, men who got second opinions had similar treatments to those who did not.”
The researchers surveyed about 2,000 men who were newly diagnosed with localised prostate cancer in the Philadelphia area between 2012 and 2014. Forty per cent sought a second opinion after diagnosis, often to get more information about the cancer. Only 20 per cent of men who sought another opinion said they were not satisfied with their first doctor.
About 80 per cent of the men received definitive treatment, including surgery or radiation. Those who sought a second opinion were no more or less likely to get definitive treatment.
“It is evident here and in other studies that people seek second opinions for a variety of different reasons, not all about looking for a different doctor who will offer different treatments,” said professor Jenny Philip of St. Vincent’s Hospital Melbourne in Australia, who was not part of the new study. “The need for reassurance, the need to be sure of having all the information and provided in a way that is understood may all be a means of confirming the approach suggested by the first doctor.”
The men also rated the quality of their cancer care on a scale of one to five, and responses were similar regardless of having a second opinion, according to the report published in the journal Cancer.
“The results tell us that we need to investigate the motivation for men receiving second opinions to better understand how they may relate to treatment decisions,” Radhakrishnan said.
“For example, men who said they got a second opinion because they wanted more information, wanted treatment from the best doctor or because their friends and family were encouraging them to get treatment were more likely to get surgery,” she said.
Patients must understand their disease and the options that are available to them before making treatment decisions, she said.
Even if treatment decisions do not change, second opinions can be a useful and important exercise, Philip said. But second opinions require clinical and financial resources that some areas may not support, she said.
“To the extent that second opinions help patients and their loved ones become more informed and feel more comfortable with their decisions, then second opinions can be important — even if they don’t end up changing patterns of treatment,” Radhakrishnan said. — Reuters
