Second Opinions

Mesothelioma is considered a rare cancer, and because of this, seeking a second opinion may be important. Most second opinions for mesothelioma come from doctors at the larger, NCI-designated cancer centers. These institutions have multidisciplinary teams of doctors, including surgeons, oncologists and radiation oncologists, and so different treatment options can be explained by the various team members. By gathering information from each specialist, you will better understand each treatment option, and it will help you make an informed decision on the treatment that is most appropriate for you.

In many cases, a local doctor may recommend referral to a specialist, however, many second opinions are initiated by the patients themselves. You should not worry that your doctor will be offended if you opt for a second opinion. It is not uncommon for patients with rare cancers to take this extra step, and it can provide peace of mind for the patient and their family knowing they have looked into all possible therapies. Most primary doctors welcome the opportunity to have another consultant review their treatment recommendations, or perhaps, suggest a better treatment.

One of the potential problems with obtaining a second opinion is that some insurers may not cover the expense, although many health care companies do acknowledge the importance of such opinions. HMO's, for example, usually want to diagnose and treat patients within their own system. This may cause friction between the patient and the HMO, especially if expensive, specialized treatment is available only outside of the HMO network. HMO members may also be discouraged from expensive treatments that have only a marginal chance of success. Although in most cases, reputable HMO's can deliver adequate care, it is important, especially when considering surgical options, to inquire as to the number of procedures performed per year by the HMO, and the results of those procedures.

Second opinions should be considered:

When you have a rare cancer.
Mesothelioma is a rare form of cancer. By definition, "rare" cancers are those affecting 200,000 people or less. There are approximately 2,000 cases of mesothelioma diagnosed each year according to the National Cancer Institute.
When surgery may be possible as a first-line treatment.
If any doubt exists as to whether or not a patient is an eligible surgical candidate, a second opinion is in order. As mesothelioma progresses, there will come a point where surgery is no longer a viable option. Patients are encouraged to seek second opinions at cancer centers where larger numbers of mesothelioma patients are treated.
When specialized treatment may not be available locally.
Surgeries for both pleural and peritoneal mesothelioma often include the use of heated chemotherapy administered at the time of the surgery. Not all medical centers may offer this option. Newer approaches such as gene therapy may not be widely available.
When patients are given a lack of treatment options.
Patients who are told there is no appropriate treatment for their cancer, and/or no relief for their symptoms may wish to get a second opinion from a specialist at a larger institution who treats mesothelioma on a regular basis. They may be able to suggest clinical trials that are geared toward either treatment or symptom control.
When clinical trials are given as the only option.
If a doctor offers a clinical trial as the only possible option, a second opinion should be obtained. Patients normally prefer to try standard treatments that have a proven track record first. Alimta/cisplatin is currently the chemotherapy "standard" for pleural mesothelioma.
When diagnosis or treatment options are not fully understood.
It is important for patients have a complete understanding of their diagnosis and the treatment options they are given, but sometimes for various reasons, open communication between doctor and patient is lacking. Another physician may be able to communicate in a way that the patient better understands or accepts.

Second opinions, although not imperative, may be appropriate for certain patients. When seeking a second opinion for mesothelioma, it is always best to look for doctors who are well-versed in the field, and can provide a variety of options. In most cases, these specialists will be located at major cancer centers throughout the country. Your primary doctor may be able to provide a referral, or you can contact doctors and/or facilities on your own. Many large cancer centers also have "self-referral" information and/or forms available on their websites that can help begin the new patient appointment process.

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