Head and Neck Cancer: What Can Be Done to Mitigate Differences in Diagnosis Between Healthcare Providers?

Seeking a Second Opinion

Head and neck cancer is a complicated diagnosis, and some patients may feel more comfortable with a second opinion. Is there a time when it’s appropriate for otolaryngologists to recommend one?

“If it’s a complicated problem with serious consequences, if there are multiple treatment options, or if the treatments are high risk, then it’s probably good to get a second opinion,” said William B. Armstrong, MD, professor and department chair of clinical otolaryngology at the University of California, Irvine, who specializes in head and neck oncology. “If a patient asks me whether or not they should get a second opinion, the answer is, “If you feel like you need it, you should have it.’ Other physicians may have a different perspective, and it’s possible that I may miss something.”

Baran D. Sumer, MD, professor and chief of the division of head and neck oncology in the department of otolaryngology–head and neck surgery at the University of Texas Southwestern Medical Center in Dallas, believes that physicians should always encourage patients to seek a second opinion when it involves a complicated disease like cancer. “I always encourage my patients to seek out care at other centers and seek other opinions, as they may have different approaches that may be more suitable for them,” he said. “I would certainly seek out a second or even third opinion for a loved one if they had a complex diagnosis.”

Andrés M. Bur, MD, an associate professor and director of robotics and minimally invasive head and neck surgery in the department of otolaryngology at the University of Kansas School of Medicine (KU) in Kansas City, believes that it’s appropriate for a clinician to recommend a second opinion any time the clinician doesn’t feel comfortable that he or she is the best person to manage the condition. “The best opportunity to cure a patient of head and neck cancer is always that first shot,” he said. “Once the patient has had a surgery or radiation, if the cancer persists or recurs, it becomes much more difficult to cure.”

The bottom line, said Dr. Armstrong, is that it isn’t about the physician—it’s about what the patient needs to be comfortable. “I tell patients and family members that if someone says you don’t need a second opinion, you probably should run away and go somewhere else.”