• Catherine Steele

When to Ask for a Second Opinion

Doctor examining brain scan

Progressing to a new line of treatment is scary and upsetting because there are only a limited number of treatment options that your cancer will respond to and the goal is to stay on each one as long as possible. As you progress through the available therapies they tend to get less effective and there is a feeling that you are running out of options.

My first line of treatment was called Kadcyla - a targeted therapy that can penetrate cancer cells without affecting normal healthy cells. Targeted therapies have a very favourable side effect profile and I had virtually no side effects. I kept my hair, had very little fatigue and had no sickness or diarrhoea. I desperately wanted to stay on this drug, but it wasn't to be. After almost a year on this treatment, my cancer progressed and I couldn’t risk the cancer spreading further.

The treatment that was recommended was a combination of two other targeted drugs called Herceptin and Perjeta and a standard chemotherapy drug called Docetaxel. Whilst the targeted drugs were unlikely to cause many side effects, the Docetaxel is renowned for being a very difficult treatment to be on. It had also been part of the treatment regime for my primary cancer and I remember feeling very ill on it. To top it all, it causes hair loss, and this made me very upset.

With such a daunting prospect looming, I decided that it was time to seek a second opinion. My oncologist was visibly rattled by my request as I think he felt undermined and challenged, but he reluctantly agreed to my wishes. Many people believe that patients have a right to a second opinion, but that’s actually not the case. You have a right to ask your GP or consultant to refer you to another professional for a second opinion, but they are not legally obliged to grant this request. In practice though, it would be very unusual for your request to be denied.

"Sometimes we are so desperate to succeed in eliminating the cancer, that we blindly ignore the huge compromises that the treatments force us to make to our quality of life"

I actually sought second opinions from two consultants, both of whom agreed with my oncologist that I should move on to a new treatment. The only difference between the second opinions and my own oncologists recommendation was they recommended a slightly different chemotherapy drug called Paclitaxel. Paclitaxel belongs to the same family of drugs as Docetaxel but is delivered weekly rather than every three weeks. It generally causes fewer side effects, but the weekly schedule means that you have little time to recover between treatments.

In the end I decided to reject the choice of drug recommended by the second opinion consultants and go with the recommendation of my own consultant. I felt that it suited my lifestyle better. A weekly schedule would mean that I would be unable to travel to Spain and I would feel like I was constantly receiving treatment. Although I was aware that I would probably suffer more physically from the Docetaxel, I felt that I would cope much better emotionally.

I don’t consider getting a second opinion to be a waste of time. To me, it did two things. Firstly it gave me confidence that the combination of a Taxol, Herceptin and Perjeta was likely to be the most effective way to control my cancer at this point. Secondly, by recommending a slightly different variation of the Taxol drug, it forced me to consider what was best of my lifestyle.

If you are at a crossroads with your treatment options and feel that you lack the confidence to follow a particular path, I would highly recommend getting a second opinion.

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