Getting a Remote Second Opinion From a Cancer Specialist

This page is for people with cancer who want a specialist's view without traveling to see one. It explains the two kinds of remote second opinion, what each is good for, and what to send.

"Remote second opinion" can mean two things. They differ in cost, in coverage, and in what you get. Ask each program for details.

A telehealth consultation is a new-patient visit by video with an oncologist at a cancer center. It may lead to in-person care at that center if you decide to go. Ask about licensing and scheduling.

A records-only virtual second opinion is a review of your records. You submit your material. A specialist reviews it. You receive a written report, sometimes with an optional video call. Some of these services are paid out of pocket. Ask what is included and what it costs. Also check whether your employer or insurance plan offers one.

NCI notes that after you talk to a doctor about the diagnosis and treatment plan, you may want another doctor's opinion before you begin treatment.

Neither format includes a physical examination. So match the question to the method. These are general guides, not rules.

Remote review can help with several things:

• Confirming the diagnosis and subtype.
• Re-reading pathology slides.
• Re-reading scans and restaging.
• Checking whether biomarker testing was complete.
• Choosing between systemic therapy options, meaning drugs that travel through the whole body.
• Deciding what order to do things in.
• Finding clinical trials.

It can help less with anything that depends on examining you. That includes:

• whether surgery can remove the tumor
• reconstruction planning
• wound problems
• how well you are functioning day to day
• symptoms that need to be felt by hand

For those, a remote opinion can narrow the question and tell you whether an in-person visit is worth the trip. That is often its real value.

Doctors are usually licensed state by state. So a center may have rules about where you must be during a video visit. Ask about this when booking, rather than discovering it on the day. If a video visit is not possible, ask whether a records-only review is offered.

The quality of the opinion is set by the quality of the material.

• Glass slides from your biopsy or surgery, or the paraffin block, from the pathologist or hospital that did your biopsy or surgery (NCI). Request these first, because they can take time to arrive.
• Imaging in DICOM format, the standard file format for medical images, on disc or via an image-sharing link. Include prior studies for comparison. The report is not a substitute.
• Pathology report, operative notes, oncology clinic notes, and any molecular or genomic testing report in full.
• A treatment summary and medication list with doses and dates.

Many programs will collect these for you once you sign an authorization. That helps. Still, confirm receipt yourself before the review date.

1. Decide your question in one sentence. "Is surgery the right first step, or should I have chemotherapy first?" produces a better answer than "what do you think?"
2. Check employer benefits and insurance coverage for second opinions. Medicare Part B covers a second opinion for medically necessary, non-emergency surgery, and a third if the first two differ. You pay 20% of the Medicare-approved amount.
3. Pick the reviewer for subspecialty fit, not brand. A sarcoma specialist for a sarcoma. NCI's list of cancer centers is a place to start.
4. Book, then request slides and imaging the same day.
5. Ask that the final report go to your treating oncologist. Ask whether the two doctors can speak.
6. Bring the report to your next appointment and ask your oncologist directly: "Does this change anything?"

A second opinion that agrees with your plan has done its job. A second opinion that disagrees is the start of a conversation, not the end of one. Take it back to your team. Ask for your case to go to a tumor board, which is a meeting where specialists review a case together. And get the reasoning for each option in writing.

Coverage and Medicare rules described here are US-specific.

• NCI: Finding Health Care Services
• Medicare.gov: Second Surgical Opinions
• NCI: Pathology Reports