Some Cancer Centers Limit Option of Second Opinion

Some of the nation's most "prestigious" cancer centers are taking steps to limit patients' ability to receive second opinions on their treatment options, at a time when such consultations "are increasingly in demand," the Wall Street Journal reports. The growing trend is "partly a matter of dollars and cents," because reviewing "massive amounts of charts, X-rays, pathology slides and CAT scans for a patient with a complex and long medical history has become economically unfeasible." Medicare pays about $190 for a specialist's consultation and $265 for an in-depth visit, while private insurers pay $500 for a doctor's consultation. Second opinions generally cost about the same as first opinions, and hospitals might "not make a dime" on second opinions unless they perform "ancillary services" such as new X-rays or CAT scans, the Journal reports. Further, "second opinions rarely lead to further treatment by the consulting center," which "discourages hospitals from offering them," the Journal reports.

At Houston's M.D. Anderson Cancer Center, cancer patients who want a second consultation might "have to stand in line" while newly diagnosed patients who have come in for treatment without a second opinion are given "priority" appointments. M.D. Anderson's Dr. Thomas Burke said that limiting second opinion consultations "could turn out to be humane" because it "spare[s] a dying person another disappointment." He added, "It is really a disservice to lead those patients on, to bring (across the country) someone who has failed four or five regimens and has metastatic cancer." Other cancer centers, such as Memorial Sloan-Kettering and the Mayo Clinic, have also tried to limit second opinions, the Journal reports. Some other centers, however, are "resisting the trend." Vincent DeVita, who runs the Yale Cancer Center, said, "Cancer patients have a terrible time -- they are under extraordinary stress. How can you wait for a second opinion for a month? It is not good medicine." Second opinions can be a "major help" and save lives, DeVita added (Lagnado, Wall Street Journal, 5/31).