Virtual Second Opinions Drive Meaningful Treatment Changes for One-Third of Cancer Patients

A virtual second opinion program at Memorial Sloan Kettering Cancer Center查看公司主页 helped identify meaningful changes in diagnosis or treatment for roughly one-third of patients with cancer (搜索)搜索该疾病, according to new research that underscores the potential of telemedicine to expand subspecialty expertise into community settings.

In a cohort of 231 individuals who received virtual second opinions from cancer (搜索)搜索该疾病 subspecialists, approximately a third received feedback that oncologists perceived as meaningfully improving the expected prognosis, survival, morbidity and/or quality of life.

"These second opinions could be a powerful way to expand subspecialty expertise into the community," Allison Lipitz-Snyderman, PhD, a health services researcher at Memorial Sloan Kettering, told Healio.

Study Design and Patient Population

The researchers evaluated 231 virtual second opinion cases reviewed as part of the program between December 2023 and November 2024. The cohort was 59% aged 50–64 years, 55% women, and 56% from the South. In all, 76 unique subspecialists reviewed patient cases, most of which involved solid tumors (83%).

The most common malignancies included breast cancer (搜索)搜索该疾病 (20%), gastrointestinal and mixed tumor (19%), and prostate cancer (搜索)搜索该疾病 (11%). Feasibility of the program, including subspecialists' views on how much their reviews led to changes in both diagnosis and treatment, served as the primary endpoint.

Meaningful Change in One-Third of Cases

Subspecialists reported their second opinions would likely result in "meaningful change" in 32% of cases. Perceived meaningful changes occurred at higher rates in hematologic malignancies than solid tumors (48% vs. 30%).

Cancer (搜索)搜索该疾病 types with the highest rates of recommended changes included lymphoma (搜索)搜索该疾病 (57%), thoracic cancer (55%), gastrointestinal and mixed tumor (47%), prostate cancer (搜索)搜索该疾病 (40%), and myeloma (40%).

Overall, subspecialists perceived their second opinions could result in better prognosis or survival for 21% of patients; improved long-term morbidity, quality of life, or toxicity for 21%; and improved short-term morbidity, quality of life, or toxicity for 16%.

Additionally, 23% of second opinions resulted in referrals for genetic testing and 9% for clinical trials. "Trial opportunities seem to be a big part of what the second opinion program could offer," Lipitz-Snyderman said.

Building on Prior Evidence

The findings extend earlier work by Lipitz-Snyderman and colleagues. In a previous investigation of 120 patients with cancer (搜索)搜索该疾病 who sought second opinions, 35% had "clinically meaningful" changes in their treatment plan, ranging from 23% in colorectal cancer and multiple myeloma (搜索)搜索该疾病 to 57% in head and neck cancer.

That earlier cohort had a mean savings of $15,015 per patient, ranging from $2,517 for lung cancer (搜索)搜索该疾病 to $43,437 for multiple myeloma (搜索)搜索该疾病. Nearly half of the treatment changes involved reducing or eliminating surgery.

Between 6.5% and 36% of patients with cancer (搜索)搜索该疾病 seek out second opinions, according to study background.

Program Origins and Feasibility

In 2016, Memorial Sloan Kettering implemented a virtual second opinion program as part of a national employer benefit solution to broaden access to subspecialist care. The process, from patients submitting their medical information to subspecialists sending back second opinions, takes between 2 and 3 weeks.

"It was really intended to reach people who couldn't receive care at Memorial Sloan Kettering, to people from all over the country who might not have access to subspecialty expertise," Lipitz-Snyderman said. "We asked the question: Would we see as much change as we saw in the in-person setting in the virtual setting?"

Limitations and Future Directions

Researchers acknowledged study limitations, including not following patients after their second opinions. "We don't know what happened to these patients," Lipitz-Snyderman said. "We don't know if their doctors followed the treatment plans recommended by these second opinions, but if they were [acted on], we deduced that it's likely they could have had benefit both in morbidity and prognosis."

Lipitz-Snyderman described the potential for virtual second opinion programs as "really promising," but highlighted several areas of future research needed to capitalize on their impact, starting with translating second opinions into real-world action.

"How does communication between clinicians play out?" she asked. "Do [community oncologists] have to send patients to other more comprehensive cancer (搜索)搜索该疾病 centers, or do they have the resources to do those types of activities in-house?"

Other potential barriers to implementation exist as well. "One is clinicians' time," Lipitz-Snyderman said. "These experts have their own panel of patients they're taking care of, and it could be burdensome to be responsible for second opinions for a high volume of patients."

Identifying patients who may benefit most from second opinions could alleviate some volume concerns. "There were certain disease areas that seemed to have a lot of activity and a lot more suggested changes in treatment approaches [such as hematologic cancers]," Lipitz-Snyderman said. "For future research, we can think about tailoring these programs specifically for high-risk groups."

Ultimately, she would like to see other institutions develop virtual programs like the one at Memorial Sloan Kettering. "There's now a growing body of literature showing that second opinions are making an impact on either diagnosis or treatment approaches for patients," she said. "I think there are a lot of exciting opportunities building on that work and thinking about how we could test these programs at a larger scale to reach more people."