Lung Cancer Patients Benefit from Second Opinions by Improvement of Diagnosis and Therapy

Purpose: To collect data from the initial evaluation of patients referred for a second opinion to a specialist pulmonary oncology clinic and compare these with the data of the re-evaluation (second opinion) conducted there to identify discrepancies in diagnosis, stage and therapeutic advice. Methods: Demographics and disease characteristics of 188 patients referred between January 2005 to December 2009 were collected from medical records, next to therapeutic advice. The data of both initial and second evaluations were compared with each other. Results: At time of referral, the (clinical/histopathological) diagnosis was known in 174 patients (92.6%) and the stage in 162 patients (86.2%). Forty-eight percent of the patients had received prior therapy and 73% a therapeutic advice. Next to data review, additional diagnostic procedures were performed in 68% of the patients. There were discrepancies between the initial and second opinion in diagnosis (17 patients, 9%), stage (24 patients, 13%) and therapeutic advice (70 patients, 37%). The second opinions led to a total of 91 discrepancies, 53 of these had a potential major impact on patient outcomes in terms of survival, morbidity and quality of life. For patients with advanced lung cancer, the results were similar but the number of changed stages, therapeutic advices and discrepancies with a potential impact on patient outcomes were slightly higher (15%, 40% and 51% respectively). Conclusions: Lung cancer second opinions referrals led to significant discrepancies in diagnosis and therapeutic advice in a substantial number of patients. This might be translated in better (palliative) care.