Program provides free second opinions to help adults with cancer better understand their disease, treatment options
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A nonprofit program provides adults in California who have cancer with free multidisciplinary second opinions.
The program — called thesecondopinion — relies on volunteer physicians who specialize in cancer care to help patients better understand their disease and treatment options.
“Patients hear of us through word of mouth, their own physicians, referral from cancer coordinators, support groups, the internet and the American Cancer Society, among other sources,” Howard B. Kleckner, MD, medical director of thesecondopinion, said in a press release. “In 2017 alone, we helped 250 individuals and family members during our in-person panel sessions and by phone for those who cannot participate in person.”
HemOnc Today spoke with Kleckner about the program, the benefits it provides and how physician champions could establish something similar in other parts of the country.
Question: Can you describe the rationale for this program ?
Answer: Thesecondopinion — formerly known as the San Francisco Regional Tumor Foundation and the Regional Cancer Foundation — was founded in 1969 by the late William Lester Rogers, MD. He convened a group of physicians to address an unmet need — the lack of cancer specialists in the San Francisco area. When a physician had a patient with cancer, there were few programs to which he or she could be referred to obtain expert opinion. The purpose of thesecondopinion is to provide a free community service to address this problem.
Q: How does the program work?
A: In the beginning, the program involved weekly meetings or tumor boards at which physicians presented their cases to a panel of cancer experts from Stanford University, University of California, San Francisco and the community. As time went on, more cancer-trained specialists entered community practice, making a central San Francisco area tumor board unnecessary. The program subsequently changed and became patient-directed. Patients can self-refer by phone or email and request an appointment, with no physician referral necessary. If approved, an appointment is set, case materials are obtained, and a panel of three to five specialists among our more than 70 physicians assemble. We meet weekly and review three cases each time. We offer lunch for the patients and their families while the expert panel meets in a separate room to review the background information. After lunch, each patient and their family go into the room with the expert panel to ask any questions they have about diagnosis, treatment or prognosis. The session is recorded, the recording is given to the patient and a consult letter is sent to the patient’s treating physician. We also perform telephone consults for patients who live too far to meet in person, or those who must make decisions quickly.
Q: How many patients has the program served?
A: We handle about 120 patients per year in person and an equal number by phone with physician call back. We also direct patients to community resources. We accept all patients, but we strive to reach the most medically underserved. We provide interpreters when needed.
Q: What do you consider the program’s greatest accomplishments?
A: We have sustained a service for 50 years that is respected and valued in the community. During this time, we have provided clarity, compassion and choice to hundreds of patients with cancer, as well as their families. Our aim is to help physicians care for their patients while providing patients a better understanding of their disease and treatment options.
Q: Do you plan to expand the program?
A: We recently expanded our reach. In addition to meeting three times each month in San Francisco, we opened a satellite location in Oakland where we meet once monthly. We also started using telemedicine to reach individuals in more rural counties in California.
Q: Can something like this be implemented easily elsewhere?
A: As far as I am aware, there is nothing like this elsewhere in the country. The program offers a free second opinion by a group of specialized volunteer physicians who can provide an independent review and opinion of a case. Our physicians are licensed to provide care only in California, so we can only provide our service to state residents. However, there is no reason that similar programs could not be established in other states. It takes a physician champion, along with the funding, to set up such a program. It would require a board, a small staff and a group of physicians who see the value of providing such a community service. We do not bill insurance companies or Medicare. Our funding comes from foundations, corporations, fundraisers and a solid base of donors who believe everyone should have access to a second opinion. – by Jennifer Southall
For more information:
Howard B. Kleckner , MD, can be reached at thesecondopinion, 1200 Gough St., Suite 500, Mezzanine Level, San Francisco, CA 94109; email: hbkleckner@thesecondopinion.org.
Disclosure: Kleckner reports no relevant financial disclosures.