title: Second opinions from urologists for prostate cancer: Who gets them, why, and their link to treatment.
abstract: Cancer patients are encouraged to obtain second opinions before starting treatment. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care.
  
  
  
  We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Men were asked if they obtained a second opinion from a urologist, and the reasons why. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care.
  
  
  
  A total of 2386 men responded to the survey (adjusted response rate, 51.1%). After applying exclusion criteria, the final analytic cohort included 2365 respondents. Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion.
  
  
  
  Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. Cancer 2017;123:1027-34. © 2016 American Cancer Society.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Archana
authors.initials: A
authors.lastname: Radhakrishnan
authors.affiliation: Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Grande
authors.affiliation: Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.affiliation: Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Justin
authors.initials: J
authors.lastname: Bekelman
authors.affiliation: Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christian
authors.initials: C
authors.lastname: Stillson
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland.|Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Craig Evan
authors.initials: CE
authors.lastname: Pollack
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D019468:Disease Management; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D017060:Patient Satisfaction; D010414:Pennsylvania / Q000453:epidemiology / Q000208:ethnology; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011787:Quality of Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D011795:Surveys and Questionnaires; D000072178:Urologists
keywords: prostate cancer; quality of health care; second opinion; specialists; treatment