In November 2012, when she was 52 years old, Shannon Semple was diagnosed with a disease she didn’t have. She credits getting a second opinion with saving her life.
Semple, a physician assistant at a regional hospital in
New Bern, North Carolina, had developed a persistent
fever and high blood pressure. She spent a few days as
a patient in the same hospital where she works, but her
condition puzzled her doctors. They ultimately diagnosed her with a tick-borne illness. Antibiotics helped
at first, but her symptoms returned.
“I had an overwhelming sense of unwellness,” she
recalls. Later, she would learn that blood tests failed
to show any signs of tick-borne diseases. In January
2013, weighed down by uncertainty, Semple returned
to work at the hospital. There, she examined the CT
scan of her abdomen that her doctors had ordered
and spotted a large lesion on one of her vertebrae.
Her radiologist had dismissed it as benign.
Additional tests performed later revealed a
large mass in her chest, and that led her to
go to the hospital at the University of North
Carolina (UNC) in Chapel Hill, about three
hours away from New Bern.
The news wasn’t good,
but it was accurate. Semple
had metastatic cancer of the
thymus, a small organ behind
the sternum and between the
lungs that produces a hormone
to help stimulate the production of T cells—white blood cells
in the body’s immune system.
The thymus is only active until
a person starts puberty. Then
it goes quiet—most of the time.
Thymic cancer is exceedingly
rare; only about 400 people are
diagnosed each year in the U.S.
By the time Semple was diag-
nosed, the cancer had invaded
surrounding tissue, including
lymph nodes and bone. Her diag-
nosis in April 2013 was followed
by years of difficult treatments,
but if she hadn’t checked in with other doctors, she
says, she wonders if she’d still be alive today.
Though seeking a second opinion is common, it may
not be the norm among people diagnosed with cancer.
Recent surveys have found that many, and probably
most, cancer patients do not seek out another opinion.
They may be missing out. Though few studies have
rigorously examined the impact of second opinions,
those that have been done suggest getting another
perspective can help improve cancer care, change a
treatment plan, bolster a patient’s confidence and, in
some circumstances, even alter a diagnosis.
More Information, More Assurance
A cancer diagnosis brings a barrage of information about
both the disease and its treatment, and it’s normal for
patients to want to learn more or to wonder if another
doctor would make the same recommendation. That’s
where a second opinion comes in: It can help patients
feel more secure in their decisions or get more information about their options.
“Patients need to have enough information and
comfort with the people that are stakeholders in
their clinical care,” says urologic oncologist Michael
Poch at the Moffitt Cancer Center in Tampa, Florida.
“Sometimes it takes additional input from another
physician or another institution to be comfortable.”
Poch and his colleagues see many patients seeking
second opinions and help them confirm their plan of
care. “It provides some reassurance,” he says.
But not everyone seeks a second opinion. In a study
published in Cancer Investigation in January 2017,
for example, a team of researchers from the J. W.
Goethe University in Frankfurt, Germany, surveyed
106 cancer patients and found that only about one-
third had received second opinions. Of those patients
who sought a second opinion, 80 percent wanted to
confirm their diagnoses and roughly half said they
wanted to better understand the diagnosis. The vast
majority said they were reassured by the experience.
A second look may also change the direction
of care. In 2005, researchers in the Netherlands
analyzed data from more than 300 patients who
had sought care at a second-opinion clinic in the
Erasmus University Medical Center Rotterdam.