Is it appropriate for someone to receive a second opinion for their AML? It is always a good idea to get a second opinion. There is nothing anybody should feel slighted about. I am a leukemia expert and if I willingly tell patients, I discuss everything, I say you are free to seek a second opinion. Patients should feel comfortable that they get the right treatment, the right clinical trial. It is always a good idea to get a second opinion. These days, with all the telemedicine, which hopefully is here to stay for a little bit longer, you can get opinions quickly. You don't really have to wait for the records to be transferred and this and that. It is always a good idea to get a second opinion. Why should a patient get a second opinion before choosing a treatment option? What is different about AML from a lot of other cancers is that it is very intense. Often people are diagnosed in a hospital because they end up sick. Typically, smaller hospitals will not treat AML. They will transfer patients to larger academic centers. The most likely you will get an AML expert to treat you. What is also different from other cancers is that we don't have a lot of time. Often we need to start treatment fairly quickly. If you are in a hospital and you were diagnosed with AML, it is hard to get a second opinion at that time because that would involve a transfer to a different hospital. It is not impossible. It is difficult to arrange. Typically, depending on the presentation of AML, there are different situations. Usually, we want to start treatment fairly fast within days. A second opinion at that point is difficult. A second opinion is a good idea after you leave the hospital. When you are deciding about treatment options, that is going to happen next. If you are in a hospital and you are not sure if you can get a second opinion, you can reach out to a patient. You can reach out to a patient for consolidation, for example. That is a good time to seek a second opinion. Some big academic hospitals will do telehealth second opinions. That is an option. Another option is to reach out to these big places that are well known for AML and see if you are a member of a patient, if that is important to you. If you are somewhere in rural places, maybe there are not that many options. Historically, AML was always considered an emergency. If a community oncologist diagnoses AML, somebody comes in with low blood counts, they do a bone marrow biopsy, they diagnose an AML patient as not necessarily that sick, they would send patients to the emergency room immediately to be admitted. What we know now is that for a lot of patients, we have a little bit of time. We can wait, get all this information that we need. If a patient is stable, sometimes we can even keep them out of the patient. That is what we are learning now. There are definitely situations with AML where there is no time to wait. This is usually when the counts are high, when the white count is very high. These patients need treatment immediately. They have to go to the emergency room and get started on treatment immediately. In this situation, time is definitely precious and you don't have a lot of time. But even in the slower, progressive cases, it is different from other cancers. It needs to be treated quickly. Maybe not days, but a week or two is the maximum that we will wait usually. Thank you.
HealthTree • April 5, 2023
