["Good advice is precious." The second opinion from the point of view of an interdisciplinary cancer therapy center].
OBJECTIVE
The setting up of an interdisciplinary tumor treatment center together with a "tumor board" has resulted in early specialty-bridging assessment and therapeutic decisions of cancers, some of them complex, in hospitalized patients with visceral tumors. It was the aim of this study to compare the use and value of the decisions of the tumor board ("second opinion") with those of the original assessment made elsewhere after primary surgical treatment.


METHODS
Information on the tumor board's database, recorded explicitly as "external comments" or "second opinion" were accessed. The data were then classified according to organs or organ systems and further divided into those cases in which the primary tumor had not been treated, those with tumor recurrence and those with metastases or recurrence of metastases.


RESULTS
8298 cases were evaluated during a five-year period. There were 373 "second opinions" (4.5%), most of the referrals relating to tumors of the upper gastrointestinal tract, corresponding to the focus of our institution. Previously untreated primary tumors amounted to 53.6% of cases, local recurrences in 14.7% and initial evidence of metastases of a visceral tumor in 9.9%. In 21.7% progression of a known metastasizing tumor was the main reason for requesting a second opinion. The second opinion agreed with the external decision for surgery alone in 16.4% of all enquiries. Minor modifications of the external therapeutic decisions were recommended in 5.9% of referred cases, while in 47.2% major changes were recommended. 28,7% of enquiries could not be evaluated because essential data were not available.


CONCLUSIONS
Requests for a second opinion in the treatment of visceral tumors are still rare in Germany. Good and current findings are requisites for giving a reliable second opinion. In fewer than a fifth of cases was there agreement with regard to a primarily surgical intervention. The concept of multimodal forms of treatment are usually given priority, which underlines the need for establishing interdisciplinary advisory panels.
Schuhmacher
C
C
Chirurgische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar. schuhmacher@chir.med.tu-muenchen.de
Lordick
F
F
Bumm
R
R
Tepe
J
J
Siewert
J R
JR
D000008:Abdominal Neoplasms / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D026683:Advisory Committees / Q000592:standards; D002173:Cancer Care Facilities / Q000592:standards*; D003131:Combined Modality Therapy; D005858:Germany; D006801:Humans; D033183:Interdisciplinary Communication; D008485:Medical Audit; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D011320:Primary Health Care; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data