Will my doctor be offended if I seek a second opinion before treatment? What steps should I take?
Richard Bleicher Associate Professor of Surgical Oncology and Director of the Breast Fellowship Program at Fox Chase Cancer Center in Philadelphia
RICHARD BLEICHER: Second opinions can give you confirmation and confidence for your treatment course. They can even shed light on new treatment possibilities. Your doctor should not be offended or upset if you request one. Some clinicians will even encourage you to seek out a second opinion.
The best way to obtain a second opinion is to simply ask your doctor. A physician is usually happy to recommend someone. If you do make an appointment for a second opinion without consulting your doctor, you should let your doctor know there might be some delay before proceeding with your treatment plan.
Check with your insurance provider to determine how much of the office visit is covered. Also, make sure the specialist accepts your insurance plan prior to your visit. When seeking a second opinion, bring your medical records, including copies of all X-rays, scans and pathology slides, to the doctor’s office. The doctor will need the actual images and slides, and not the reports, to offer a well-informed assessment. Just as it is difficult for you to accurately picture what a person looks like simply by having his face described, a surgeon or other physician cannot have an accurate understanding of your disease based upon someone else’s description. If you don’t have this essential documentation, the doctor may ask you to come back with it—which can delay treatment.
Also, be clear in your own mind what you are looking for. For example, you may just want confirmation that the treatment plan is correct or you may want to explore other possible treatment options. Be sure to tell the doctor why you are there and whether to send a copy of the recommendations to your original doctors.
In most cases, a second opinion is for extra confidence. If you do choose to transfer care to another doctor, make sure to let your original physician know.
The most important thing is that you are confident with your next treatment steps. If you feel the need for extra reassurance or clarity, don’t ever be afraid to ask your doctor, “Can I get a second opinion?” If your doctor seems angry or uncomfortable, that may be a warning sign to explore other options.
Getting a Second Opinion // The National Cancer Institute provides resources for choosing a doctor. // The Centers for Medicare & Medicaid Services (Adobe Acrobat Reader required) offers a how-to guide for getting a second opinion. // The American College of Surgeons allows you to search for Commission on Cancer–accredited cancer facilities, which meet multidisciplinary collaboration and quality-of-care standards.
I have an upcoming job interview. Should I mention that I am a cancer survivor?
Jen Flory Director of the Cancer Legal Resource Center, a project of the Disability Rights Legal Center at Loyola Law School Public Interest Law Center in Los Angeles
JEN FLORY: You are not required to tell a prospective employer that you have had cancer and federal and state laws prohibit any employer from asking you if you have had cancer or other medical problems. Even general questions such as “Have you ever been hospitalized?” are illegal.
The one thing that is relevant during the application process is that you can do the job. Just because you fear that the cancer might come back at some point does not mean that you are not qualified to do the job right now. No one knows what the future holds.
Many cancer survivors prefer not to mention their medical history during the application process to avoid possible discrimination. If you are worried about a gap in your work history, you only need to be truthful and not go into detail. You can say you had a medical problem that is resolved or that you had a family medical emergency to attend to.
Should an interviewer press for details, you can provide a gentle reminder of your privacy rights, stating, “I’m sure you don’t mean to be asking me something that is not permitted during a job interview, so I would prefer for both of our sakes not to answer.” From there, refocus the discussion on your skills.
For some people, not saying anything might not be an option. Perhaps you work in a tightly knit industry or you documented your cancer experience online in social media, making it easy for potential employers to learn of your diagnosis. Or perhaps, as a result of your treatment, there are physical signs such as hair loss, scarring or weight loss that might make an employer assume you have or have had cancer.
If you are in this position, you might prefer to discuss your experience with cancer rather than have your prospective employer make unfounded assumptions. Even so, the interview should center on your ability to do the tasks required for the job, not your health history. You can also request that any medical information discussed be kept confidential.
If you do feel that you have been discriminated against during the job application process due to your history of cancer, you have options. The U.S. Equal Employment Opportunity Commission, which has offices all over the country, enforces anti-discrimination laws for state and local governments, and for private employers with 15 or more employees. Most states also have fair employment practices agencies, and many state laws have statutes that extend anti-discrimination protections to people who work at businesses with fewer than 15 employees.
Your Rights and the Job Interview // The Equal Employment Opportunity Commission has a fact sheet regarding federal employment protections for people with cancer. // Cancer and Careers offers resume reviews, advice on managing your online identity for professional purposes, and practical tips on dealing with cancer in the workplace. // The Cancer Legal Resource Center provides legal services, support and resources.
My spouse is a cancer survivor. Can stress in our marriage make the cancer come back?
Jimmie Holland Psychiatrist at Memorial Sloan-Kettering Cancer Center in New York City
JIMMIE HOLLAND: It is natural that you and your partner worry that the cancer might come back. In fact, fear of recurrence is the most common source of distress in cancer survivors. It does get better over time, but traces of this fear can still alter your relationship dynamics, even the way you fight.
All normal relationships have their share of friction and unpleasant exchanges. You may find yourself avoiding an argument out of fear that you will upset your partner. However, extensive studies have not confirmed a link between cancer and stress.
Several studies have analyzed variables, such as stress and personality type, using an extensive registry that included thousands of people in Denmark. A study published April 24, 2012, in the British Journal of Cancer used this registry to follow the habits of more than 21,000 women diagnosed with breast cancer between 1994 and 2006. The women all lived with a partner for four years prior to diagnosis. Using the death of a partner as an objective measure of stress, researchers found no increased risk of recurrence in women who lost a partner compared with those who did not.
Although it may be natural to feel bad if you have an argument with your spouse, don’t feel that you can hasten cancer’s return with a few blunt words. In fact, you may find that a good argument is a sign that things are finally returning to normal.
Your Marriage and a Cancer Diagnosis // The American Psychosocial Oncology Society helps cancer patients and their caregivers find counseling services in their communities. 1-866-276-7443 // CancerCare offers counseling and educational workshops for those affected by cancer. // The Cancer Support Community provides tips for dealing with stress and survivorship. 1-888-793-9355
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