Once a cancer has been diagnosed, the patient and doctor must plan an effective treatment. For many cancers, no one particular treatment is clearly the best for all patients.

Sometimes, asking another physician to review your case can help you feel confident about your treatment plan. This is called getting a second opinion.

Why are second opinions sometimes a good idea?

Keep in mind that doctors can use the common cancer-fighting tools — surgery, radiation and chemotherapy — in many different ways. Your doctor's treatment recommendation will depend mostly on the kind of cancer, the stage of the cancer, and your individual characteristics, like age and general state of health.

But other factors affect a doctor's recommendations, too. Physicians differ in their philosophies on treating patients and in their perceptions about how certain patients will cope with certain side effects. This is particularly true for patients with advanced cancers. For example, some doctors routinely recommend chemotherapy for patients with advanced (Stage 4) lung cancer. Other physicians almost never suggest that patients undergo chemotherapy for such an advanced malignancy.

As a patient confronted with different treatment options, you should decide what works best for you. Think about how well the suggested treatment is likely to work, but also consider the possible side effects, how long the treatment will take and whether it is practical for your daily life.

Patients may want to consult a second physician because cancer diagnosis and treatment are immense, complex medical fields. It is possible to reach different interpretations of the same set of facts and different solutions to the same problem. Also, no doctor knows everything about everything.

Moreover, cancer study and research are producing new theories, concepts, claims and methods all the time. It is possible that a doctor is not aware of some relevant new development.

If you want to seek a second opinion

First, make sure you fully understand the recommendations of your first doctor. Any confusion you have about your first doctor's recommended treatment may create uncertainty and distrust. Sometimes, asking your doctor to go over the recommended treatment plan will allay your fears and eliminate the need for a second opinion. "As a patient, you can never ask too many questions," says Daniel Weisdorf, M.D., a University of Minnesota medical oncologist.

When should you seek a second opinion?

Ideally, you should seek a second opinion after you have been diagnosed with cancer and before treatment has begun. Some doctors find it difficult to evaluate your situation and recommend options after treatment has begun.

That's because there's no way to judge the seriousness of the original problem or effectiveness of the treatment after treatment has begun. What's more, it's not always possible to change treatments after one has started.

So, what will my doctor think if I get a second opinion?

Some patients may find it difficult to seek a second opinion. They may fear their physician will be offended, but patients should understand that they have a right to a second opinion, and most health care professionals acknowledge that right. Physicians shouldn't be offended if patients request a second opinion. After all, second opinions affirm the first doctor's judgment most of the time, according to Dr. Weisdorf.

Patients should also know that doctors frequently consult other doctors. As Weisdorf notes, "Doctors seek behind-the-scenes second opinions and additional advice on a regular basis. We question our own opinions constantly by talking to each other. Second opinions are a way of life." Thus, most physicians are not apt to feel offended if you seek a second opinion, he adds.

At the same time, it's important to understand that second opinions should be based on scientific and medical facts, not simply what patients think they need. Dr. Weisdorf says, "Patients should never be encouraged to run from the facts."

How do you find a doctor who can give a second opinion?

Typically, you'll want a doctor who has at least as much expertise in treating your kind of cancer as your original physician. To find such a doctor, ask your primary care physician or cancer specialist for a referral.

If you feel uncomfortable asking your physician for a referral, seek advice from other professionals on how to talk to your doctor about getting a second opinion.

How can I help someone seek a second opinion?

To act on another's behalf, you must have the patient's permission. Some medical professionals may require that you obtain the patient's permission in writing before they will cooperate with you. This is true even if you are a friend or relative.

What does a second opinion entail?

Second opinions can include a physical examination and/or review of pathology reports, laboratory tests and notes from the doctor who diagnosed your cancer.

If you decide to seek a second opinion

Ask the second-opinion physician to specify exactly what information will be needed to properly evaluate your case. Some second-opinion physicians prefer that the information is in a specific form. For example, they may ask your original doctor to write a letter summarizing your case notes.

It's best to make sure the second-opinion doctor has all the information before you go for a physical examination. In fact, some physicians won't review your case until they have all the necessary documentation.

Will my insurance pay for a second opinion?

Most health insurance plans pay for second opinions. Exactly what your insurance company pays depends on your particular plan. Check with your carrier — before you have the second opinion — to determine if you will have any out-of-pocket expenses.

Questions to ask your insurer:

• What kind of health care plan do I have — a gatekeeper or open-network plan?
• Can I seek a second opinion without anyone's permission? If not, whose permission do I need?
• What expenses associated with a second opinion will my health care plan pay for?
• What expenses associated with a second opinion will my health care plan NOT pay for?
• If I need my primary care doctor's permission to get a second opinion and she or he refuses, how can I appeal?

What happens after you receive a second opinion?

In most cases, second opinions support the recommendation of the first physician. When physicians' opinions differ, the second-opinion physician may write a letter to you and to your doctor explaining how the second opinion differs from the first. But remember, it's your decision. Choose the treatment option that makes you feel the most confident about your care.

For more information about second opinions, contact the Masonic Cancer Center Information Line.