The Impact of Patient-Initiated Subspecialty Review on Patient Care

Coffey, Kristen; Mango, Victoria L.; Keating, Delia M.; Morris, Elizabeth A.; D’Alessio, Donna

doi:10.1016/j.jacr.2018.05.008

Cited by 7 publications

(10 citation statements)

References 14 publications

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“…The highly variable definitions of discrepancy complicate comparison of the present results with other previous findings in breast cancer, in which discrepancy rates between 3 and 43% were reported 1,4,5,7,19,23,26. The BCSO classification for discrepancy developed in the current study will enable detailed and reproducible comparisons between first opinions and SOs in the future.…”

Section: Discussionmentioning

confidence: 42%

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Impact of Second Opinions in Breast Cancer Diagnostics and Treatment: A Retrospective Analysis

et al. 2019

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BackgroundBreast cancer care is becoming increasingly complex, and patients with breast cancer are increasingly aware of the different treatment options, resulting in requests for second opinions (SOs). The current study investigates the impact of breast cancer SOs on final diagnosis and treatment in the Netherlands Cancer Institute (NCI) using a newly designed Breast Cancer Second Opinion (BCSO) classification system.MethodsPatients who visited the NCI for an SO between October 2015 and September 2016 were included. Demographics, diagnostics, and treatment proposals were compared between first and SO. Discrepancy was categorized using our BCSO classification system, categorizing SOs into (1) noncomparable, (2) identical, and (3) minor or (4) major discrepancy.ResultsThe majority of SOs (n = 591) were patient initiated (90.7%). A total of 121 patients underwent treatment prior to their SO, leaving 470 patients for assessment of discrepancies according to our BCSO classification system. More than 45% of these SOs resulted in at least one discrepancy, with comparable rates for physician- and patient-initiated SOs (42.5% vs. 45.6%, p = 0.708). Significantly more discrepancies were observed in patients with additional imaging (51.3% vs. 37.2%, p = 0.002) and biopsies (53.7% vs. 40.3%, p = 0.005). Almost 60% of all discrepancies were categorized as major (neoadjuvant systemic treatment instead of primary surgery, breast-conserving surgery instead of mastectomy, and proposing postmastectomy immediate breast reconstruction).ConclusionsOur findings show substantial differences in diagnostic and treatment options in breast cancer patients visiting the Netherlands Cancer Institute for an SO, thereby emphasizing more consensus for the indications of these treatment modalities.

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Section: Discussionmentioning

confidence: 42%

“…To address this complexity, all Dutch hospitals that provide breast cancer care have a multidisciplinary tumor board (MDT) where newly diagnosed breast cancer patients are discussed 6. Case review at a MDT is associated with improved breast cancer care 1 – 5. Additionally, these boards review second opinions (SOs) coming from different hospitals.…”

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confidence: 99%

Impact of Second Opinions in Breast Cancer Diagnostics and Treatment: A Retrospective Analysis

et al. 2019

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“…[7][8][9][10][11][12][13][14][15][16][17][18][19] Second-opinion review can prevent unnecessary biopsies while improving cancer detection, as was shown by a recent study that included 147 patients who self-referred for second-opinion readings of breast images. 20 On secondary review, 24 (25%) of 96 lesions originally reported as suspicious were downgraded to benign or probably benign, preventing biopsy in 21 patients, all of whom remained disease free on follow-up imaging. Furthermore, out of 87 biopsies performed, 28 (32%) were recommended only after second-opinion review, and eight of 28 (28%) yielded cancer.…”

confidence: 99%

Improving Cancer Diagnosis and Care: Patient Access to Oncologic Imaging Expertise

Nass

Cogle

Brink

et al. 2019

JCO

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“…Cancer patients are well represented among second opinion seekers, and there is a high potential for changes to the initial therapeutic strategy. Breast cancer, has been associated with a wide use of SMOs, especially at the early stage [ 4 , 8 , 10 ]. For example, in a breast cancer consultation study, 43 % of patients had a change of diagnosis and 23 % had an additional tumor found by a SMO [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…For example, in a breast cancer consultation study, 43 % of patients had a change of diagnosis and 23 % had an additional tumor found by a SMO [ 4 ]. Although self-referral to a second physician could be associated with higher sensitivity in cancer detection [ 10 ], targeted SMO referral strategies in breast cancer cases may have a more favorable profile in cost-benefit analyses [ 8 ]. The potential for therapeutic change is also clear for less frequent cancers.…”

Section: Introductionmentioning

confidence: 99%

Predictive factors of diagnostic and therapeutic divergence in a nationwide cohort of patients seeking second medical opinion

Sanchez¹,

Adamowicz²,

Chrusciel³

et al. 2021

BMC Health Serv Res

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Objectives The aim of this study was to describe the profile of patients who sought a second medical opinion (SMO) on their therapeutic or diagnostic strategy using nationwide data from a French physician network dedicated to SMOs. Methods An observational cohort study was conducted and the study population consisted of patients residing in France or in the French overseas territories who submitted a request for an SMO through a dedicated platform between January 2016 and October 2020. Patient characteristics were compared between convergent and divergent SMOs. The divergent rate for all patients excluding those with mental diseases were described. Logistic regression was used to estimate the probability of a divergent SMO according to patient characteristics. Results and discussion In total, 1,552 adult patients over several French regions were included. The divergence rate was 32.3 % (n = 502 patients). Gynecological [Odds Ratio (OR) and 95 % CI: 5.176 (3.154 to 8.494)], urological [OR 4.246 (2.053 to 8.782)] and respiratory diseases [OR 3.639 (1.357 to 9.758)] had the highest probability of a divergent SMO. Complex cases were also associated with a significantly higher risk of a divergent opinion [OR 2.78 (2.16 to 3.59)]. Age, sex, region and profession were not found to be predictive of a divergent second opinion. Conclusions Policymakers should encourage new research on patient outcomes such as mortality and hospitalization rates after a SMO. When proven effective, SMO networks will have the potential to benefit from specific public funding or even play a key role in national healthcare quality improvement programs.

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The Impact of Patient-Initiated Subspecialty Review on Patient Care

Cited by 7 publications

References 14 publications

Impact of Second Opinions in Breast Cancer Diagnostics and Treatment: A Retrospective Analysis

Impact of Second Opinions in Breast Cancer Diagnostics and Treatment: A Retrospective Analysis

Improving Cancer Diagnosis and Care: Patient Access to Oncologic Imaging Expertise

Predictive factors of diagnostic and therapeutic divergence in a nationwide cohort of patients seeking second medical opinion

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