As patients explore their treatment options following a cancer diagnosis, many ask us, “What’s the difference between an oncology second opinion and a tumor board review?”
It’s a good question and it’s critical to understand the answer if you have just received a cancer diagnosis. While there are many similarities, there are also some big differences between second opinions and tumor board reviews which may make one or the other better suited in your specific case.
What is an Oncology Second Opinion?
An oncology second opinion allows patients and providers access to specialist consults for complex cases, often without the need for in-person encounters. When an individual receives a complex diagnosis, as is typical with oncology, there are often several paths forward. Rather than relying on the singular opinion of the doctor or facility who gave the initial diagnosis, an oncology second opinion allows individuals to obtain an additional review of their diagnosis and treatment plan from at expert, typically at a hospital specializing in the unique diagnosis.
A study from the Mayo Clinic found that 88% of second opinions lead to a refined or distinctly different diagnosis than the original diagnosis. Stated another way, of the 286 patient diagnoses reviewed in the study, only 12% of specialists agreed with the initial diagnosis. With this level of disparity, seeking a second opinion for your cancer diagnosis is an essential part of ensuring you are receiving proper care.
However, one common misconception around oncology second opinions is that their sole purpose is to confirm or refine the diagnosis. While this is an important component, perhaps even more important is that oncology second opinions also confirm, modify, or refine recommended treatment options.
I recently had a conversation with a patient who did not seek a second opinion after her initial breast cancer diagnosis. She told me that she thought at the time, “I don’t need a second opinion to tell me it's cancer, they already know it's cancer?” However, after multiple surgeries and treatment complications she was able to clearly articulate exactly why, in her words, “not getting a second opinion was a big mistake.” “In hindsight,” she explained, “I wish I had a second opinion to discuss treatment options.”
In a field as dynamically changing as cancer research, it is often the case that specialists and experts for a specific form of cancer may be aware of or have access to treatment options that might not yet be commonplace. A rural or community hospital, for instance, might not have a specialist on staff who is familiar with a rare form of cancer. They might recommend surgery that could have been avoided if an expert opinion was sought out. We know a patient who was told surgery was needed to remove a tumor. In this case, the individual sought a second opinion from a leading cancer facility and was informed that the cancer could be treated with a new form of advanced radiation called Proton Therapy. The treatment was successful and the patient avoided a surgery that almost definitely would have led to lifelong side effects including lymphedema.
Many leading cancer hospitals offer second opinion programs that come in different shapes and sizes. Some facilities require a patient to come onsite for review and request that patients either mail their prior medical records or drop them off at the facility in advance of the meeting. More progressive hospitals offer remote second opinion programs that allow patients to aggregate their records digitally in advance of an appointment. These records are then organized into a case that is reviewed remotely by an expert. The expert either confirms, modifies, or refines the diagnosis and returns a report to the patient or their physician with a recommended treatment plan, all without the patient having to visit the doctor in person.
After receiving a second opinion, some patients may choose to become inpatients of the facility which provided the second opinion. We often see this when the facility is able to offer cutting-edge treatments or access to clinical trials not available to the patient locally. In other cases, patients take the second opinion back to their original doctor, which helps to inform the treatment plan administered at the local facility. In both cases, the patient receives more specialized care, often leading to better medical outcomes.
What is a Tumor Board Review?
A tumor board review, sometimes referred to as a multidisciplinary team meeting (MDT) or round table, is a meeting of doctors and other healthcare professionals across various specialties to discuss the diagnosis and treatment options for patients with complex cancer cases. The objective of these meetings is to aggregate various perspectives on the best course of action in a peer-reviewed environment. Rather than relying on the singular opinion of the doctor who gave the initial diagnosis, tumor board reviews enable other points of view from doctors who specialize in different approaches. These tumor boards typically meet on a regular cadence, sometimes weekly, to discuss unique or challenging cases identified at a given hospital. The members are usually from the same hospital, however, some tumor boards incorporate physicians from affiliated hospitals as well.
A tumor board can be comprised of various individuals including but not limited to pathologists, medical oncologists, radiation oncologists, surgical oncologists, and even relevant nurses or social workers. Some of the doctors, such as surgical oncologists, may have particular expertise in surgical options while others, such as medical and radiation oncologists, may have expertise in other forms of cancer treatments. The tumor board may also include advocates for other aspects of the specific patient’s physical and mental health based on their unique case.
As an example, a patient I recently spoke with had his case go in front of a tumor board for review to determine a plan of attack for his melanoma. Since his case had some complexities, it was raised by the patient’s surgical oncologist to the tumor board to get the opinions of various doctors across two affiliated hospitals’ cancer departments. The patient told me that the doctors were, “torn about which way to go” for his treatment. Some believed they should perform a full Lymph Node Dissection (LND) and remove all lymph nodes to eliminate the chance of relapse while others thought that was too risky as it can cause bad side effects including lymphedema. However, another doctor on the board was aware of a new treatment being offered called microscopic lymphatic bypass that could alleviate some of the risks of surgery. In the end, the patient’s surgical oncologist brought this information back to the patient. While the tumor board ultimately did not recommend one approach over the others, they did inform the patient with enough information on alternative options that he felt comfortable choosing a treatment plan best suited to his specific needs and outcome desires.
A tumor board can provide skilled opinions that help a patient make informed treatment decisions. However, a tumor board review might not be available to every cancer patient. An important thing to remember with tumor board reviews is that not every case is brought in front of the panel. Typically, only complex or challenging cases are raised, while cases a doctor believes to be more standard may never receive this level of peer review. While a cancer patient should always ask for their case to be seen by a tumor board if one exists at their hospital, it ultimately is up to the facility whether the case will be seen due to the limited number of cases that are reviewed. It is also important to note that tumor boards typically only exist at hospitals that specialize in cancer and even some of these facilities may not have one in place.
Which is Right for Me?
Understanding the difference between an oncology second opinion and a tumor board review can be immensely beneficial to a patient who has just received a cancer diagnosis. Both options provide confirmation, modification, and refinement of diagnoses as well as treatment options. That said, tumor board reviews may not be available to everyone, specifically if your hospital is not a cancer specialty hospital, doesn’t have an established tumor board, or if your case is not selected to be reviewed by a tumor board. In these cases, seeking out a second opinion from an expert at a specialty hospital should be your next step.
Any cancer patient can submit a request for a second opinion from a hospital offering a second opinion program catering to their form of cancer. Even patients who have been seen by a tumor board can seek out an oncology second opinion should they desire an additional review. That said, it will ultimately be up to the hospital offering the program to accept your second opinion request. Also, be sure to check with your insurance providers to understand if your plan covers second opinions or if this will end up being an out-of-pocket expense.
Whether you have access to a tumor board review or choose to have an oncology second opinion performed, it is highly recommended to have your initial diagnosis and treatment plan reviewed by additional, skilled physicians before taking the next steps if you receive a cancer diagnosis.
