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Second opinions from urologists for prostate cancer: Who gets them, why, and their link to treatment

Authors

  • Archana Radhakrishnan MD, MHS,

    Corresponding author
    1. Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
    • Corresponding author: Archana Radhakrishnan, MD, Johns Hopkins University, Division of General Internal Medicine, 2024 E. Monument Street Suite 2-300C, Baltimore, MD 21287. Fax: (410) 955-0476; aradhak3@jhu.edu

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  • David Grande MD, MPA,

    1. Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Nandita Mitra PhD,

    1. Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Justin Bekelman MD,

    1. Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Christian Stillson MPH,

    1. Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Craig Evan Pollack MD, MHS

    1. Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
    2. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • We thank Linda Crossette, Jane Seymour, Enny Oyeniran, and Katelyn Ward for assistance with data acquisition and data management. We also thank Xinwei Chen for assistance with statistical analysis.

Abstract

BACKGROUND

Cancer patients are encouraged to obtain second opinions before starting treatment. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care.

METHODS

We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Men were asked if they obtained a second opinion from a urologist, and the reasons why. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care.

RESULTS

A total of 2386 men responded to the survey (adjusted response rate, 51.1%). After applying exclusion criteria, the final analytic cohort included 2365 respondents. Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion.

CONCLUSIONS

Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. Cancer 2016. © 2016 American Cancer Society.

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