Patient-driven second opinions in oncology: a review

Patient-initiated second opinions have become increasingly common in recent years. However, the frequency, motivations and advantages/disadvantages of this approach remain unclear. This study assessed the incidence and impact of patient-initiated second opinions in oncology patients.

Literature searches of PubMed and Google Scholar were performed to identify peer-reviewed publications on patient-initiated second opinions in oncology patients published between 06/01/2004 and 06/01/2024. Selected publications evaluated the frequency, patient characteristics and motivating factors of patient-initiated second opinions and their impact on diagnoses, treatment, prognoses and patient satisfaction.

Sixty peer-reviewed publications were included in the analysis. Data showed highly variable rates of second-opinion seeking. Younger age, female gender, higher educational level, advanced disease, socioeconomic status and having health insurance were associated with an increased likelihood of this approach. The most common patient-reported reasons for seeking a second opinion were to gain more information, seek reassurance, access expert guidance, and check the accuracy of proposed treatments. Patient-initiated second opinions led to changes in diagnosis, treatment, or prognosis in up to 69% of cases and a greater likelihood of guideline-compliant recommendations; however, wide variability in reported rates precludes drawing firm conclusions. Patient satisfaction with second-opinion consultations was high and these were deemed helpful and reassuring in most cases.

Increasing numbers of cancer patients are seeking second opinions, and these may have a considerable impact on diagnoses, outcomes and patient satisfaction. Improved patient education and further research regarding the impact of patient-initiated second opinions and barriers to access would be beneficial.