Virtual Second-Opinion Delivery for Oncology Patients

Patients with cancer face increasing difficulty securing access to timely, quality oncologic care. A virtual consultation program at a tertiary academic center could eliminate physical barriers while providing treatment recommendations that could be executed locally.

We evaluated an Online Second Opinions Program to increase access to expert care via a cloud-based platform through Included Health. This program was open to any patient globally who had a local treating physician. Patient records were compiled and sent to a disease expert at Stanford Healthcare. A report detailing an assessment and treatment recommendation was then returned within 3 days. We analyzed the characteristics of the patient base and the frequency with which treatment change was recommended.

Between November 2018 and August 2020, 657 patients participated in the program. The majority of patients were female (58.4%) with a mean age of 60 years. A majority lived out-of-state (62%, with 24.7% of total patients from outside the United States) and had advanced disease (77.2% diagnosed at stage III or IV). Breast cancer was the most common diagnosis (24.7%). Physicians providing the virtual service were primarily medical oncologists (67.6%) and reported to have recommended a treatment change in more than half of the cases reviewed (53.8%). A treatment change was most often recommended for patients with stage II disease (64%), and least often for stage I and III disease (both 45%).

To our knowledge, this is one of the first studies to describe patients who use virtual second-opinion programs for oncology, showing that more than half of the patients were recommended to have a treatment change. Although patients most often had advanced disease, those with stage II disease most often received a treatment change recommendation.