Why a Multidisciplinary Team and Second Opinion Are Essential in Cancer Care

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• The Importance of Second Opinions
• Access to Cancer Expertise
• The Multidisciplinary Team Approach
• Overcoming Treatment Bias
• When to Seek a Third Opinion
• The Role of Major Cancer Centers
• Full Transcript

The Importance of Second Opinions

Seeking a second medical opinion is critically important after a new cancer diagnosis or when a cancer is suspected. Dr. Bruce Chabner, MD, confirms that expert review of a patient’s specific medical problem is vital because initial treatment decisions are often time-sensitive and can determine the course of a patient's life. A personal experience shared by interviewer Dr. Anton Titov, MD, highlights this perfectly: two highly experienced thoracic surgeons offered completely different assessments for his mother’s lung tumor, ranging from no treatment to a potentially curative surgery.

Access to Cancer Expertise

A significant barrier to optimal cancer care is the uneven global distribution of specialized oncology expertise. Dr. Bruce Chabner, MD, notes that while major academic hubs like Boston offer access to sub-specialists for specific cancer types like non-small cell lung cancer or neuroendocrine tumors, patients in rural hospitals or remote areas often lack this access entirely. This disparity is even more pronounced in developing nations, creating a global challenge in ensuring every patient receives care from the best-fitting experts for their particular diagnosis.

The Multidisciplinary Team Approach

The gold standard for modern cancer treatment is the multidisciplinary team (MD T) approach. Dr. Bruce Chabner, MD, emphasizes that at leading cancer centers, a patient is not evaluated by a single doctor but by a team of experts. This team typically includes a medical oncologist, a surgeon, a radiation oncologist, a radiologist, and a pathologist. These specialists collaborate to review all aspects of the case and develop a unified, consensus treatment plan that is in the best interest of the specific patient, rather than offering a perspective limited to one specialty.

Overcoming Treatment Bias

A key benefit of the multidisciplinary team is that it mitigates the inherent bias that can occur when a patient sees only one type of specialist first. Dr. Anton Titov, MD, illustrates this with the example of prostate cancer, where the first specialist consulted can heavily influence the treatment path—be it surgery, radiotherapy, or active surveillance. A multidisciplinary clinic ensures all relevant oncology experts evaluate the case together from the outset, preventing a siloed view and leading to a more balanced and evidence-based treatment recommendation.

When to Seek a Third Opinion

In cases where the first two expert medical opinions are directly conflicting, seeking a third opinion may be a necessary step. Dr. Bruce Chabner, MD, acknowledges this reality but cautions that time is a critical factor in many cancer diagnoses. The urgency to begin effective treatment quickly must be balanced against the need for diagnostic certainty. To save precious time, he suggests seeking opinions in parallel or utilizing a multidisciplinary team from the start, which is designed to provide a comprehensive assessment and eliminate conflicting advice from individual specialists.

The Role of Major Cancer Centers

Major cancer centers provide a concentration of sub-specialized expertise that is often unavailable elsewhere. As explained by Dr. Bruce Chabner, MD, these institutions offer deep knowledge not just in broad categories like lung cancer but in the specific molecular and histological subsets of the disease. For a patient or family, accessing these centers may require extensive research, professional networking, and travel, which can be a significant financial and logistical burden, but the potential impact on treatment quality and outcome can be profound.

Full Transcript

Dr. Anton Titov, MD: Cancer diagnosis becomes ever more precise. Cancer treatment becomes more sophisticated. My mother was diagnosed with a lung tumor. I had a deeply personal experience.

Two highly knowledgeable and experienced thoracic surgeons gave completely different assessments of her situation. One said, "There's nothing you can do. She is an elderly patient." Another surgeon said, "We could do a curative surgery now."

We were able to identify what would be the best treatment in her particular situation. We did it by searching the medical literature. We found the best therapy by asking for opinions in our professional network.

Many cancer patients are not being treated by the best-fitting experts for their particular diagnosis!

Dr. Bruce Chabner, MD: Yes, of course it's true in cancer. But it is true not just in cancer.

Dr. Anton Titov, MD: How important is it to seek a review of a situation by an expert who is knowledgeable in that exact medical problem that the patient has? How important is it to get a second medical opinion, especially when a new diagnosis of cancer is made or suspected?

Dr. Bruce Chabner, MD: It is important. Unfortunately, medical expert opinion is not always available. In the United States, we spend so much money on healthcare, but we still have patients in rural hospitals in the countryside. They don't have easy access to an expert opinion.

Cancer patients often do not have access to a cancer center. So that's ideal. If you live in Boston, you have three or four hospitals that have very large faculties who subspecialize.

It's not only lung cancer, but it's in the little subsets of lung cancer. It’s non-small cell lung cancer, small cell lung cancer, squamous carcinomas, neuroendocrine tumors. It's the expertise that's available in a place like this hospital, or in our partner hospitals, the Brigham and Women’s Hospital and the Dana-Farber Cancer Institute.

We are unusual and different than what you would find in a rural setting. So unfortunately, not everybody has access to this cancer therapy expertise. It's an issue.

Then even beyond cancer treatment in the United States, I work in outreach efforts in Africa. They would be thrilled to have even what's available to us here in cancer diagnosis and treatment, what we already have in our more remote hospitals in the countryside. It's a problem.

The distribution of cancer treatment expertise is not even worldwide. Cancer therapy expertise certainly might not even be even within the top academic communities in Boston.

Dr. Anton Titov, MD: Because medicine is so siloed, my mother's situation actually developed in Boston. It took a literature search to find who is the patient. We had to find who really dedicated his professional life to that particular type of lung tumor. That's how we got the better tumor treatment result.

Dr. Bruce Chabner, MD: That's correct! You did a very good job, obviously. You're in a sense lucky that you were living in this community. Sometimes you've been living in some much more remote area where there was no expertise. How would you know? You'd have to travel 500 or 1000 miles to find out about the best cancer therapy.

It's not easy. Many patients can't afford that. So it is a real problem, the variability of cancer therapy expertise that's available to patients.

I guess, in general, the other thing is this: for a very serious kind of cancer, you have to get an expert medical opinion. In cancer, a patient's life is at stake. Often the initial decisions have to be taken fast about what to do, how to treat a cancer patient.

It is always reasonable to seek a second medical opinion.

Dr. Anton Titov, MD: Sometimes you need a third expert medical opinion!

Dr. Bruce Chabner, MD: Well, yeah! Sometimes you find conflicting expert medical opinions from the first two opinions. Then you may want to go to a third opinion. Of course, you don't want to waste too much time, because in some cancer diagnoses time is extremely important.

Getting cancer treatment fast and taking care of it is crucial. That's why the multidisciplinary approach works best. You have to do expert medical opinions in parallel. You have to use a panel of experts. Each medical expert might evaluate the cancer situation independently. This could be one option.

You bring out one other important aspect of going to a cancer center. When we see a patient here with prostate cancer or pancreatic cancer, it's not just one doctor that sees the patient. It is a multidisciplinary team: a medical oncologist, surgeon, radiation oncologist, radiologist, the pathologists.

Radiologist takes the X-rays and interprets them. All of the oncologists and experts have to work together to come up with a reasonable cancer therapy plan, what is best for that particular patient with cancer.

Dr. Anton Titov, MD: Because in prostate cancer, the factor that determines the type of prostate cancer treatment is the type of specialist that the patient sees first. Prostate cancer is treated with surgery or radiotherapy or watchful waiting even.

There's an expert that I discussed it with in London. That's correct! If you first see the surgeon, you may be advised to have surgery for prostate cancer. It is best that you see the group of medical experts together. It is a multidisciplinary team.

This is what we do here. They're called multidisciplinary clinics. They have at least one expert from each of the relevant oncology fields. You may get a consensus opinion on how to treat cancer.

This is very different from the opinion that a surgeon would offer, or a medical oncologist or radiation therapist if they see the patient by themselves only. That is the value of multidisciplinary assessment of every cancer patient.

Dr. Bruce Chabner, MD: Yes.