2 Models for Providing Rapid Second Opinions in Cancer Care

CMOs can learn from these two healthcare organizations that have different approaches to providing second opinions in cancer care.

A second opinion in any profession is the best practice.

That's why Karmanos Cancer Institute implemented a streamlined process to provide patients with second opinions within seven days of an initial diagnosis.

At Karmanos, a second opinion results in a revised treatment plan or even a new diagnosis up to 20% of the time, according to George Yoo, MD, CMO of the comprehensive cancer center.

"The second opinion allows for a more comprehensive and expert review by a multidisciplinary team of doctors who specialize in a cancer type," Yoo says. "This review includes reviewing the pathology slides and the radiology images."

Providing a second opinion also boosts the patient's peace of mind, according to Yoo.

"A second opinion can confirm and validate the treatment plan that the patient has been given," Yoo says. "This reassures the patient that they have made the right choice."

When a patient receives a cancer diagnosis, getting a second opinion is beneficial, according to David Peter, MD, MBA, CMO of The Clinic by Cleveland Clinic, which specializes in virtual second opinions.

"Cancer is a complex and, of course, life-changing condition," Peter says. "If you've received a cancer diagnosis, it's important to confirm your diagnosis promptly and ensure you're on the right path for your treatment. You owe it to yourself to leave no stone unturned."

Regardless of the result of a second opinion in cancer care, the patient benefits, Peter explains.

"A recommended change to your diagnosis or treatment plan can set you on a promising path," Peter says. "Alternatively, confirmation that you're already doing everything you should can help clear your doubts about the next steps in your journey."

George Yoo, MD, is CMO of Karmanos Cancer Institute. Photo courtesy of Karmanos Cancer Institute.

How Karmanos provides second opinions

Karmanos has implemented a four-step process to facilitate providing rapid second opinions.

First, Karmanos has made it easy for patients to contact the comprehensive cancer center for second opinions. Patients can either call 1-800-KARMANOS or fill out a form online.

Second, Karmanos has trained specialized oncology navigators who guide patients through every step of receiving a second opinion—getting records, arranging insurance coverage, and setting up appointments. The oncology navigators relieve stress for the patients and make the process easier.

Third, there is a pre-intake appointment involving a nurse practitioner, who calls the patient and makes sure all information has been gathered.

Fourth, the patient has an on-site appointment with an oncologist who specializes in the patient's type of cancer. The work of the oncology navigator and the nurse practitioner tees up the appointment with the oncologist, so it is easy for the doctor to communicate with the patient.

"We have a rapid process keyed by the oncology navigator gathering all the information," Yoo says. "We have a pre-appointment intake, where a nurse practitioner will talk with the patient and organize all the information. We make sure we have open appointment slots with our specialized oncologists, so patients can get in within seven days."

For cancer centers interested in replicating Karmanos' second opinion model, having oncology navigators is crucial, according to Yoo.

"You need to train your oncology navigators to focus on the information that is important to treat an oncology patient," Yoo says. "The navigators should be empowered to advocate for the patients."

The Clinic's approach

The Clinic by Cleveland Clinic makes it easy for cancer patients to receive a second opinion from an expert physician quickly and from the comfort of home, according to Peter. After a brief online registration, patients can quickly schedule a video visit with a nurse. During that intake visit, their nurse gets an understanding about their diagnosis, treatment plan, concerns, and questions.

"With the patient's consent, we then do the work of collecting their medical records and any relevant imaging or pathology on their behalf, which can save the patient significant hassle and anxiety," Peter says.

In the next step, The Clinic by Cleveland Clinic's clinical team identifies the cancer specialist at Cleveland Clinic who is best suited for the patient's particular case. That physician then reviews all of the relevant information to provide a thorough second opinion report, which is delivered typically a few days after records are collected.

"If the cancer specialist is licensed in the patient's state, the patient has the option to have a video call with the physician," Peter says. "Patients also have the opportunity to ask follow-up questions after their opinion is delivered."

In particularly complex cases, the cancer specialist assigned to the patient may determine the need to re-interpret the patient's pathology or consult with advanced subspecialists for additional insight.

"While not every case requires it, the opportunity for a deeper and multidisciplinary review can provide greater clarity and certainty about a patient’s diagnosis and treatment options," Peter says.