title: Second Opinions From Medical Oncologists for Early-Stage Breast Cancer: Prevalence, Correlates, and Consequences.
abstract: OBJECTIVE
  Advances in the evaluation and treatment of breast cancer have made the clinical decision-making context much more complex. A second opinion from a medical oncologist may facilitate decision making for women with breast cancer, yet little is known about second opinion use.
  
  
  OBJECTIVE
  To investigate the patterns and correlates of second opinion use and the effect on chemotherapy decisions.
  
  
  METHODS
  A total of 1901 women newly diagnosed with stages 0 to II breast cancer between July 2013 and September 2014 (response rate, 71.0%) were accrued through 2 population-based Surveillance, Epidemiology, and End Results registries (Georgia and Los Angeles County, California) and surveyed about their experiences with medical oncologists, decision making, and chemotherapy use.
  
  
  METHODS
  Factors associated with second opinion use were evaluated using logistic regression. Also assessed was the association between second opinion and chemotherapy use, adjusting for chemotherapy indication and propensity for receiving a second opinion. Multiple imputation and weighting were used to account for missing data.
  
  
  RESULTS
  A total of 1901 patients with stage I to II breast cancer (mean [SD] age, 61.6 [11.0] years; 1071 [56.3%] non-Hispanic white) saw any medical oncologist. Analysis of multiply imputed, weighted data (mean n = 1866) showed that 168 (9.8%) (SE, 0.74%) received a second opinion and 54 (3.2%) (SE, 0.47%) received chemotherapy from the second oncologist. Satisfaction with chemotherapy decisions was high and did not differ between those who did (mean [SD], 4.3 [0.08] on a 1- to 5-point scale) or did not (4.4 [0.03]) obtain a second opinion (P = .29). Predictors of second opinion use included college education vs less education (odds ratio [OR], 1.85; 95% CI, 1.24-2.75), frequent use of internet-based support groups (OR, 2.15; 95% CI, 1.12-4.11), an intermediate result on the 21-gene recurrence score assay (OR, 1.85; 95% CI, 1.11-3.09), and a variant of uncertain significance on hereditary cancer genetic testing (OR, 3.24; 95% CI, 1.09-9.59). After controlling for patient and tumor characteristics, second opinion use was not associated with chemotherapy receipt (OR, 1.04; 95% CI, 0.71-1.52).
  
  
  CONCLUSIONS
  Second opinion use was low (<10%) among patients with early-stage breast cancer, and high decision satisfaction regardless of second opinion use suggests little unmet demand. Along with educational level and use of internet support groups, uncertain results on genomic testing predicted second opinion use. Patient demand for second opinions may increase as more complex genomic tests are disseminated.
authors.affiliation: Department of Medicine, Stanford University, Stanford, California2Departments of Health Research and Policy, Stanford University, Stanford, California.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Kurian
authors.affiliation: Department of Systems, Populations, and Leadership and Institute for Healthcare Policy and Innovation, University of Michigan School of Nursing, Ann Arbor.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Friese
authors.affiliation: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor.
authors.forename: Irina
authors.initials: I
authors.lastname: Bondarenko
authors.affiliation: Department of Radiation Oncology, Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor.
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.affiliation: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor.
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles.
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
authors.affiliation: Department of Health Management and Policy, University of Michigan, Ann Arbor9Department of Internal Medicine, School of Public Health, Division of General Medicine, Univeristy of Michigan, Ann Arbor.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000208:ethnology / Q000235:genetics; D003657:Decision Making; D004358:Drug Therapy / Q000706:statistics & numerical data; D005260:Female; D005820:Genetic Testing / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008495:Medical Oncology; D008875:Middle Aged; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018426:SEER Program; D055815:Young Adult