Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations
Abstract Background Data on the clinical value of second opinions in oncology are limited. We examined diagnostic and treatment changes resulting from second opinions and the expected impact on morbidity and prognosis. Methods This retrospective cohort study included patients presenting in 2018 to a...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.5598 |
| _version_ | 1797838351824322560 |
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| author | Allison Lipitz‐Snyderman Susan Chimonas Sham Mailankody Michelle Kim Nicholas Silva Anuja Kriplani Leonard B. Saltz Smita Sihag Carlyn Rose Tan Maria Widmar Marjorie Zauderer Saul Weingart Wendy Perchick Benjamin R. Roman |
| author_facet | Allison Lipitz‐Snyderman Susan Chimonas Sham Mailankody Michelle Kim Nicholas Silva Anuja Kriplani Leonard B. Saltz Smita Sihag Carlyn Rose Tan Maria Widmar Marjorie Zauderer Saul Weingart Wendy Perchick Benjamin R. Roman |
| author_sort | Allison Lipitz‐Snyderman |
| collection | DOAJ |
| description | Abstract Background Data on the clinical value of second opinions in oncology are limited. We examined diagnostic and treatment changes resulting from second opinions and the expected impact on morbidity and prognosis. Methods This retrospective cohort study included patients presenting in 2018 to a high‐volume cancer center for second opinions about newly diagnosed colorectal, head and neck, lung, and myeloma cancers or abnormal results. Two sub‐specialty physicians from each cancer type reviewed 30 medical records (120 total) using a process and detailed data collection guide meant to mitigate institutional bias. The primary outcome measure was the rate of treatment changes that were “clinically meaningful”, i.e., expected to impact morbidity and/or prognosis. Among those with treatment changes, another outcome measure was the rate of clinically meaningful diagnostic changes that led to treatment change. Results Of 120 cases, forty‐two had clinically meaningful changes in treatment with positive expected outcomes (7 colorectal, 17 head and neck, 11 lung, 7 myeloma; 23–57%). Two patients had negative expected outcomes from having sought a second opinion, with worse short‐term morbidity and unchanged long‐term morbidity and prognosis. All those with positive expected outcomes had improved expected morbidity (short‐ and/or long‐term); 11 (0–23%) also had improved expected prognosis. Nine involved a shift from treatment to observation; 21 involved eliminating or reducing the extent of surgery, compared to 6 adding surgery or increasing its extent. Of the 42 with treatment changes, 13 were due to clinically meaningful diagnostic changes (1 colorectal, 5 head and neck, 3 lung, 4 myeloma; 3%–17%) . Conclusions Second‐opinion consultations sometimes add clinical value by improving expected prognoses; more often, they offer treatment de‐escalations, with corresponding reductions in expected short‐ and/or long‐term morbidity. Future research could identify subgroups of patients most likely to benefit from second opinions. |
| first_indexed | 2024-04-09T15:40:31Z |
| format | Article |
| id | doaj.art-10ae402ba98547979699cff1e9bf523b |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-04-09T15:40:31Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-10ae402ba98547979699cff1e9bf523b2023-04-27T10:12:43ZengWileyCancer Medicine2045-76342023-04-011278063807210.1002/cam4.5598Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendationsAllison Lipitz‐Snyderman0Susan Chimonas1Sham Mailankody2Michelle Kim3Nicholas Silva4Anuja Kriplani5Leonard B. Saltz6Smita Sihag7Carlyn Rose Tan8Maria Widmar9Marjorie Zauderer10Saul Weingart11Wendy Perchick12Benjamin R. Roman13Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York New York USADepartment of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York New York USADepartment of Medicine Memorial Sloan Kettering Cancer Center New York New York USAStrategy and Innovation Memorial Sloan Kettering Cancer Center New York New York USAStrategy and Innovation Memorial Sloan Kettering Cancer Center New York New York USADepartment of Medicine Memorial Sloan Kettering Cancer Center New York New York USADepartment of Medicine Memorial Sloan Kettering Cancer Center New York New York USADepartment of Surgery Memorial Sloan Kettering Cancer Center New York New York USADepartment of Medicine Memorial Sloan Kettering Cancer Center New York New York USADepartment of Surgery Memorial Sloan Kettering Cancer Center New York New York USADepartment of Medicine Memorial Sloan Kettering Cancer Center New York New York USARhode Island Hospital and Hasbro Children's Hospital Providence Rhode Island USAStrategy and Innovation Memorial Sloan Kettering Cancer Center New York New York USAStrategy and Innovation Memorial Sloan Kettering Cancer Center New York New York USAAbstract Background Data on the clinical value of second opinions in oncology are limited. We examined diagnostic and treatment changes resulting from second opinions and the expected impact on morbidity and prognosis. Methods This retrospective cohort study included patients presenting in 2018 to a high‐volume cancer center for second opinions about newly diagnosed colorectal, head and neck, lung, and myeloma cancers or abnormal results. Two sub‐specialty physicians from each cancer type reviewed 30 medical records (120 total) using a process and detailed data collection guide meant to mitigate institutional bias. The primary outcome measure was the rate of treatment changes that were “clinically meaningful”, i.e., expected to impact morbidity and/or prognosis. Among those with treatment changes, another outcome measure was the rate of clinically meaningful diagnostic changes that led to treatment change. Results Of 120 cases, forty‐two had clinically meaningful changes in treatment with positive expected outcomes (7 colorectal, 17 head and neck, 11 lung, 7 myeloma; 23–57%). Two patients had negative expected outcomes from having sought a second opinion, with worse short‐term morbidity and unchanged long‐term morbidity and prognosis. All those with positive expected outcomes had improved expected morbidity (short‐ and/or long‐term); 11 (0–23%) also had improved expected prognosis. Nine involved a shift from treatment to observation; 21 involved eliminating or reducing the extent of surgery, compared to 6 adding surgery or increasing its extent. Of the 42 with treatment changes, 13 were due to clinically meaningful diagnostic changes (1 colorectal, 5 head and neck, 3 lung, 4 myeloma; 3%–17%) . Conclusions Second‐opinion consultations sometimes add clinical value by improving expected prognoses; more often, they offer treatment de‐escalations, with corresponding reductions in expected short‐ and/or long‐term morbidity. Future research could identify subgroups of patients most likely to benefit from second opinions.https://doi.org/10.1002/cam4.5598diagnostic changemorbidity and prognosisoncologysecond opiniontreatment change |
| spellingShingle | Allison Lipitz‐Snyderman Susan Chimonas Sham Mailankody Michelle Kim Nicholas Silva Anuja Kriplani Leonard B. Saltz Smita Sihag Carlyn Rose Tan Maria Widmar Marjorie Zauderer Saul Weingart Wendy Perchick Benjamin R. Roman Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations Cancer Medicine diagnostic change morbidity and prognosis oncology second opinion treatment change |
| title | Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations |
| title_full | Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations |
| title_fullStr | Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations |
| title_full_unstemmed | Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations |
| title_short | Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations |
| title_sort | clinical value of second opinions in oncology a retrospective review of changes in diagnosis and treatment recommendations |
| topic | diagnostic change morbidity and prognosis oncology second opinion treatment change |
| url | https://doi.org/10.1002/cam4.5598 |
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