Cancer second opinions via telemedicine
October 23, 2018 6:02 AM Subscribe
This question is not seeking medical advice, but information about the medical system. YANMD, etc. A relative of mine was recently diagnosed with a kind of uterine cancer that has a poor prognosis. She is having surgery soon with a doctor she feels good about, who has a lot of experience with hysterectomies if not with the cancer in question, but would like a second opinion from an academic medical center that has more experience with her specific cancer. However, she is unwilling to travel to get it (I’m not sure why - perhaps just logistics due to her imminent surgery). She asked me to call my local academic center on her behalf and ask whether they do telemedicine for this, and I was not too surprised to hear a no. Does any cancer center do telemedicine for second opinions? Assume insurance is not a major issue (Medicare + broad supplemental is available and the patient is likely able to pay some out of pocket also).
This definitely exists. I am making plans to get a telemedicine consultation from a specialist in my cancer, but he's not part of a major cancer center. On the cancer forum I'm involved with, I've seen people mention centers that offer it.
Johns Hopkins has an office of telemedicine, I believe some departments at Mayo Clinic do as well. Basically, you'll need to look at the websites of cancer centers or call and see who makes this available.
It will almost certainly not be covered by insurance.
posted by FencingGal at 7:04 AM on October 23, 2018
Johns Hopkins has an office of telemedicine, I believe some departments at Mayo Clinic do as well. Basically, you'll need to look at the websites of cancer centers or call and see who makes this available.
It will almost certainly not be covered by insurance.
posted by FencingGal at 7:04 AM on October 23, 2018
Also, I would think the value of an in-person consult would depend on the individual situation. With my upcoming telemedicine consult (for multiple myeloma), I'm assuming that my pathology reports are all accurate, as will the doctor I'm consulting with. However, the major cancer center where I get most of my care insists on redoing pathology for second opinions, so they would not be able to do a consult by telemedicine alone.
posted by FencingGal at 7:08 AM on October 23, 2018
posted by FencingGal at 7:08 AM on October 23, 2018
Sorry to keep butting in, but you may be able to get specific recommendations by going to an online support group for her kind of cancer. I really like Smart Patients (for some reason, the website won't let me go to the home page rather than the myeloma page right now, which is why I'm not linking - but it's easy to find).
posted by FencingGal at 7:15 AM on October 23, 2018
posted by FencingGal at 7:15 AM on October 23, 2018
Massachusetts General Hospital also does this with a second opinion program.
posted by yes I said yes I will Yes at 7:15 AM on October 23, 2018
posted by yes I said yes I will Yes at 7:15 AM on October 23, 2018
Dana Farber appears to offer this service.
If it is a question of diagnosis/staging/grading, MD Anderson's pathology department will review already prepared slides and will consult with doctors remotely. But they will not recommend treatment options.
posted by muddgirl at 7:59 AM on October 23, 2018
If it is a question of diagnosis/staging/grading, MD Anderson's pathology department will review already prepared slides and will consult with doctors remotely. But they will not recommend treatment options.
posted by muddgirl at 7:59 AM on October 23, 2018
(Dana Farber does not have the household name recognition of some other large academic centers: It is consistently ranked in the top 5 cancer centers in the country).
posted by muddgirl at 8:03 AM on October 23, 2018
posted by muddgirl at 8:03 AM on October 23, 2018
I should also say that my understanding is that telemedicine/remote medicine laws depend on the state that the patient resides in. If your friend lives in a state that does not allow telemedicine, then her plan may not be feasible at all.
posted by muddgirl at 9:08 AM on October 23, 2018
posted by muddgirl at 9:08 AM on October 23, 2018
I'm a nurse and a big supporter of academic medicine for complex or unusual cancer treatment. I live in a large city with 4 academic medical centers. However, when my aunt was diagnosed with uterine sarcoma (cancer) she insisted on having all treatment, including surgery and chemo at her local suburban community hospital. We were appalled! Another niece, an OB/GYN at Hopkins was incredibly upset at her decision, but it was her decision. We shut up and were supportive.
Fast forward 5 years and she is still with the same oncologist in the same office, having had four different chemo series. Each worked for a while, but then the nodes would grow larger and the Oncologist would suggest a break from treatment, and then a switch. She's now 87, so no spring chicken, but she still lives in her same house, does her own shopping and cooking, and aside from hair loss is largely OK. I visit her every week or two and someone drives her to chemo treatments, but otherwise she is as independent as an 87 year old person could possibly be.
Two things that were in her favor are 1) no serious underlying medical illnesses - no diabetes, COPD, etc. She took no meds, and 2) she's a veteran and has excellent insurance, so no (I mean no) problem getting PET scans when her doc prescribes them to guide treatment.
I know this doesn't quite answer your question, but it might relieve you to realize that competent, even excellent cancer care is available in community practices. My cousin and I were certainly pleasantly surprised. Also, time spent anguishing potential treaters before surgery means more time for the cancer to spread. There will be time after surgery to interview different oncologists, if that is what your relative desires. If she is interested in clinical trials, she will almost certainly need academic oncology care, but that is different from surgery and they need not occur in the same medical center.
posted by citygirl at 10:04 AM on October 23, 2018
Fast forward 5 years and she is still with the same oncologist in the same office, having had four different chemo series. Each worked for a while, but then the nodes would grow larger and the Oncologist would suggest a break from treatment, and then a switch. She's now 87, so no spring chicken, but she still lives in her same house, does her own shopping and cooking, and aside from hair loss is largely OK. I visit her every week or two and someone drives her to chemo treatments, but otherwise she is as independent as an 87 year old person could possibly be.
Two things that were in her favor are 1) no serious underlying medical illnesses - no diabetes, COPD, etc. She took no meds, and 2) she's a veteran and has excellent insurance, so no (I mean no) problem getting PET scans when her doc prescribes them to guide treatment.
I know this doesn't quite answer your question, but it might relieve you to realize that competent, even excellent cancer care is available in community practices. My cousin and I were certainly pleasantly surprised. Also, time spent anguishing potential treaters before surgery means more time for the cancer to spread. There will be time after surgery to interview different oncologists, if that is what your relative desires. If she is interested in clinical trials, she will almost certainly need academic oncology care, but that is different from surgery and they need not occur in the same medical center.
posted by citygirl at 10:04 AM on October 23, 2018
My corporate job offers this as a service through Advance Medical. I've used it a couple of times and been very happy with it, and the doctors they've used have seemed well educated and thorough. I mention it because my job offers it not only to employees but to immediate family members as well, even if they aren't on an employee's insurance (so I could get a second opinion for my parents, who have their own plan). If she happens to have a close relative who works for a company that's known for perks, it's worth asking about.
posted by potrzebie at 4:44 PM on October 23, 2018
posted by potrzebie at 4:44 PM on October 23, 2018
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Furthermore, for something like cancer, I don't think many oncologists are going to offer any opinion without seeing her in person, particularly for an initial assessment.
Telemedicine is great, but it's typically used for things like therapy, follow-ups, that kind of thing. We occasionally use it for diagnostics, but only in cases where, for example, the person is at a critical access hospital without an expert in that diagnostic tool, and the expert will telemedicine to the critical access hospital and watch the results of test as it's administered by a nurse or similar.
So I would highly doubt if any academic medical center would do this.
That said, it's not in your friend's best interest to do this either. A second opinion on cancer is not something you want to get over Skype. Figure out what her travel anxieties are and address those, and then do whatever you can to make her travel comfortable and easy.
posted by Lutoslawski at 6:54 AM on October 23, 2018 [3 favorites]