Impact of oncology review meetings on second opinions for patients with gastrointestinal cancer.

Abstract

Purpose: Second opinions are increasingly sought by patients, particularly in complex and life-altering conditions such as gastrointestinal (GI) cancers, to ensure confidence in their diagnosis and treatment plans or to seek therapeutic trials.

Methods: This retrospective study analyzed second-opinion requests handled by the GI oncology team in our institution between January and March 2024, examining the types of questions raised, patient characteristics, and their impact on clinical decision-making.

Results: Of 261 eligible patients, 259 were included in this analysis. Most patients had metastatic disease (86%), and 51% had received at least two lines of prior treatment. Requests were predominantly submitted by oncologists (63%), with a significant proportion (41%) coming from outside academic centers. General practitioners (GPs) accounted for 37% of the submissions, often with incomplete records (86% completeness vs. 99% for oncologists; p < 0.01). The median age at diagnosis was 60 years, with younger patients being more frequently referred by oncologists (57.0 vs. 62.5 years, p < 0.001). The most common diagnoses were pancreatic (29%) and colorectal (27%) cancers. Second-opinion requests focused on therapeutic management (73%) and access to clinical trials (60%). Therapeutic decisions were in line with the standard of care in 93% of the cases, while 15% received alternative recommendations, such as intrahepatic arterial infusion or targeted therapies. However, participation in therapeutic trials (1.2%) and molecular screening (2.7%) was seldom offered to patients, highlighting the need for better tools to access trials. Importantly, palliative care decisions were upheld in 95% of the specific requests.

Conclusion: This study demonstrates the potential value of structured second-opinion pathways in ensuring adherence to evidence-based care and addressing patient concerns. However, improving GP support, reducing referral delays, and optimizing access to trials remain critical for improving outcomes in patients with advanced GI cancer.