Improving quality of care for cancer patients through oncological second opinions in a Comprehensive Cancer Center: adherence to second-opinion therapy recommendations.

Purpose: Receiving treatment in certified oncological centers and obtaining a second medical opinion has been proven to enhance both the quality and cost-effectiveness of care for oncological patients. Interdisciplinary care optimizes the treatment of oncological patients by validating the diagnosis and treatment recommendation, emphasizes translational research, and applies oncological therapies in a more target-oriented manner. This study aims to examine the extent of patient adherence to second medical opinions provided at the Comprehensive Cancer Center Erlangen-Metropolitan Area Nuremberg (CCC Erlangen-EMN) and investigates how specific patient characteristics such as age, gender, and type of cancer diagnosis influence the likelihood of adhering to a second opinion.

Methods: This is a prospective, single-center observational study supported by the local statutory health-insurance body (Allgemeine Ortskrankenkasse, AOK). A total of 584 male and female patients with cancer in the fields of urology, gynecology, gastroenterology, or sarcoma, seeking a second medical opinion were assessed for their adherence to the second opinion. Levels of adherence in patient subgroups were compared using appropriate statistical tests. Correction for multiple testing was not performed, due to the exploratory nature of the study.

Results: Almost 75% of the patients adhered to the second opinion recommendations and an additional 10% partially followed them. Men adhered to the second opinion recommendation slightly more often (79.1%) than women (70.7%; chi-square test, P = 0.01). At 83%, second-opinion adherence was highest among patients who had received an incomplete but guideline-compliant first opinion. If the first opinion was not guideline-compliant, about 67% adhered to the second opinion. Adherence to second opinions was not significantly influenced by whether the initial therapy recommendation adhered to guidelines (Fisher's test, P = 0.16 for all departments, P = 0.27 for the gynecology department). Most patients adhered to the second opinion after primary therapy (92.9%).

Conclusions: More than two-thirds of patients ultimately followed the recommendation provided in the second opinion. The results of this study enhance our understanding of patient adherence to medical advice and treatment regimens. This study demonstrated that the majority of patients adhere to second opinions and highlighted the feasibility of easy access to second opinions from a certified cancer center. Women adhered slightly less to second opinions than men. More detailed and comprehensive therapy recommendations could potentially enhance adherence rates in the future.