How to seek a second opinion when time is short?

A dear friend was diagnosed several years ago with head and neck cancer, which has since metastasised to multiple sites, including the brain. The prognosis is very poor, even with whole-brain radiotherapy, and his life expectancy is now extremely limited.

He was enrolled in a randomised trial of a novel drug at the Royal Marsden but was unfortunately allocated to the standard chemotherapy arm, which proved unsuccessful.

He is now at the point where he would be willing to try anything that might stabilise the brain metastases, as stability is a prerequisite for eligibility for most further trials. However, stereotactic radiosurgery (SRS) has been deemed inappropriate. He has two clusters of lesions, some in the cerebellum and others near the top of the brain.

He is emotionally exhausted, so I am trying to help by exploring what, if any, options might still be available. I cannot help wondering whether, at a major centre such as UCLH, there might be a consultant willing to consider a more experimental approach.

If such options do exist, how might one go about accessing them, given that time is quite literally of the essence? 

  • Hi R_S_R and thank you for your post.

     

    I’m very sorry to hear about your friend. He has been through so much, and it makes sense that you want to explore every possible option to help him.

    At this stage, treatments may be limited, especially when the cancer has spread to the brain. Some treatments, like stereotactic radiosurgery, may not be safe or suitable for him. Different hospitals may have different teams and equipment, but they all follow the same safety rules.

    If you would like to see whether a specialist centre such as UCLH might have anything else to offer, the quickest and safest way is to ask his current cancer team if they could make an urgent referral

    to the specialist centre. He could also ask his team about any clinical trials he may still be able to join. They can check this and contact other hospitals for you.

    His present team could also seek advice from the hospital’s Neuro-oncology team , as they can also deal with brain metastases.

     

    It’s important to know that even large hospitals may not be able to offer experimental treatment if it is not safe or not likely to help. But a referral from his current team is the fastest way to find out.

    You are doing a wonderful thing by supporting your friend. This is a very hard time, and it’s okay to ask both the medical team and support services for help.

    Please get back to us if you need any more information or support

    It might help to talk things through with one of our nurses on the helpline. You can call for free on 0808 800 4040, Monday to Friday, 9am to 5pm.

    Kind regards

    Tina