Our ultimate goal is to see that every newly diagnosed cancer patient must receive a qualified second opinion prior to any treatment or no treatment. We believe that this could save more lives today than eliminating tobacco!
In a speech to the National Coalition of Cancer Survivors, Sandra Day O'Connor stated, "Let me tell you my dream...to have a consultation with all the experts available at the same time, who've already looked at everything and they are all in the same place and there to help you through the process of what to do. I think that would be terrific."
Dr. John Glick at the University of Pennsylvania Cancer Center states in Readers Digest that breast cancer and lymphoma patients who consult specialists on his staff have a major change in treatment plan in 20% of cases and a minor but significant change in another 25%.
The critical factor in properly treating any kind of cancer is that the patient make an informed decision. The only way for this to be done is for the patient to be honestly told everything that could effect their condition directly from the person most knowledgeable in that field. A surgeon should not elaborate on the effects of radiation and a radiation oncologist should not describe the problems with drug treatments. Each physician must honestly tell all the statistics and side effects of the therapy they are personally most familiar with. Then, and only then, can the patient make an informed decision.
Our goal is so ambitious that the chance of it succeeding is remote, but the rewards are so great that we must try. Our code has always been, "To achieve excellence, attempt perfection. Less is unacceptable." How is this going to be accomplished? The only way I know of is the slow, hard way, one step at a time. We will enlist some 400 to 500 institutions around the U.S. to offer a multidisciplinary second opinion with all physicians whose specialty could possibly treat a patient present simultaneously. They will explain to the patient what each could do and what the side effects are and the statistics and what they would recommend. This must be available in every town in America.
At lunch with a medical oncologist, I asked how often he treated a patient for cancer without a second opinion. This man, in his sixties, replied that he had never in his career treated a cancer patient without a second opinion. Furthermore, he always insisted on a second opinion from someone other than an associate of his. This was for four reasons:
1. Cancer is a very serious disease that grows geometrically. If it is not treated properly in the first time, there is often no second chance.
2. He is human and could make a mistake.
3. Someone else could see something that he doesn't see.
4. Someone else could know something that he doesn't know.
I thought this was a profound statement. I wished that every doctor treating a cancer patient could hear this. My conclusion from this statement is that any doctor treating a cancer patient without a second opinion is not practicing medicine, but trying to play God. I thought it was only God who was supposed to be perfect, know everything and never make a mistake.
These thoughts were substanstiated in the draft of the May, 1985 publication of the National Institutes of Health entitled Cancer Control Objectives for the Nation 1985-2000. It states, "The application of the state of the art treatment is complex. At all levels of the health service delivery system-from the primary care physician who has initial contact with the patient to specialists directing the cancer treatment-physician knowledge is not yet optimal. That knowledge should include an appreciation for state-of-the-art treatment information and an interest in ensuring early multidisciplinary decision making....For about 70 percent of cancers, optimal therapy derives from multidisciplinary discussions. The relative rarity of some of the most responsive tumors means that proficient treatment can be maintained only at some major cancer centers....Malpractice considerations may result in physicians selecting "safe" therapy, which neither offers significant risk nor the chance of cure....A major determinant of outcome for most newly diagnosed cancer patients with curable disease hinges on early multi-disciplinary treatment planning and the availability of expertise and resources to carry out such a treatment plan."
The purpose of the panel is to review the referring doctor's proposed treatment and approve it or recommend additions or alternatives. The recommendations of the panel, in addition to being fully discussed in front of the patient, are wiritten down and sent to the referring doctor, with a copy for the patient.
This idea of holding all discussions openly and frankly in front of the patient and any relatives or friends he cares to bring is unique in the medical world. Not only do a majority of patients leave with a recommended improved medical treatment, but every patient leaves with an improved state of mind. They all feel better and have more confidence about what is ahead of them.
The following institutions have advised that they will, when specifically requested, provide a panel of physicians representing all speacialties that could possibly treat the specific cancer to recommendations for treatment.