[dlaxague]

Hi Pinkgirl and all,

Great question.

I didn't get a second opinion. I could talk to my smalltown onc, I liked his blunt and quirky style (not all do - it's a personality not competence thing). Plus I was in an NSABP clinical trial so that increased my confidence in my treatment plan (in 2001, it was the standard - A/C then Taxol). The hardest blow for me was not getting the Herceptin in that trial, which a second opinion would not have helped. Winning the California lottery to pay for the Herceptin outside of trial, that might have helped. But then again, I'm still here. Crap shoot!

Still, my first recommendation to almost every woman who asks my opinion is that she does get a second opinion, if possible from a Comprehensive Cancer Center. I don't think that the second opinion will be different in most cases, but in a few it may be, and in those few it may make a difference. Plus, a second opinion gives peace of mind, no matter what the ultimate outcome. It gives the comfort of knowing that a person did the best that they could, at the time they were making these decisions. It minimizes that painful coulda-woulda-shoulda questioning if something happens later.

As for whether a second opinion is more important for primary or mets diagnosis - I have to disagree with those who are saying it's more important for a stage IV diagnosis. I think that it's important for everyone. For those who don't have garden-variety primary diagnoses, that second opinion could make the difference between recurrence or not (life or death).

For a stage IV diagnosis, the "best" plan is often less clear, and the opinions about treatment are likely to be different for opinion 2 right on thru, say, 5. But it never hurts to have as much information as one can gather, before making a decision. For body mets, one style of thinking is that it's probably less about which particular treatment comes first and more a case of having a toolbox-full (of a fairly-finite number of options), and so it makes sense to use the tools in a judicious manner so as to get the longest run possible out of each one of them, beginning with hormonals and Herceptin or Tykerb if applicable. Then there's the other school of hit-mets-hard-initially thought - but that uses up options (and often, bone marrow function) more quickly. It's more a matter of personal style than of a clear "best practice". It does seem to me that brain mets are in a different category and I always strongly encourage women to get at least a 2nd expert opinion before deciding what to do in that instance.

Each time a new study is done, especially when there are subgroups included in the trial design, we come closer to tailoring treatment and getting even better responses - but there's a lot to learn yet

Debbie Laxague