Virtual Second Opinions Recommend Changes in Around Half of Cancer Treatment Plans

Among cancer patients seeking a second opinion through a virtual platform, more than halfwere advised to change treatment. These findings were reported in a study published on 11 February 2025 in JCO Oncology Practice .

Virtual Health Care

In this retrospective study, researchers tested a cloud-based platform that allowed patients to participate from anywhere in the world, provided that they had a local treating physician. The platform was offered by Included Health . Included Health collected patient records, prepared a summary and sent it to a case manager at Stanford. The case was then referred to the relevant disease specialist.

From November 2018 to August 2020, a total of 657 cancer patients received second opinions. The median age of platform users was 60. Most patients were women (58%), lived in the United States (75%) and resided outside California (62%).

Which Cancers Most Often Prompted Second Opinions?

The most common cancer type was breast cancer (25%), followed by gastrointestinal cancers (22%), genitourinary cancers (12%) and gynecological cancers (8%).

Disease was stage I in 6% of patients, stage II in 5%, stage III in 9% and stage IV in 26%. However, the disease stage was unknown for more than half of the patients (54%).

Most second opinions (68%) were provided by hematology/medical oncology specialists. Recommendations also came from various other specialists, including gynecological oncologists (7%), urologists (5%) and radiation oncologists (5%). The average wait for a recommendation after specialist assignment was 4 days.

Treatment Changes Were Recommended for 54% of Patients

A treatment change of any kind was recommended in 54% of cases ;

• 34% involved minor changes,
• while 20% involved major changes .

Treatment changes were recommended in 45% of stage I cases, 64% of stage II cases, 45% of stage III cases and 54% of stage IV cases.

Examples of major changes included hormonal intensification with androgen signaling inhibitors for metastatic prostate cancer, or recommending, on the basis of genomic risk testing in early-stage breast cancer, the omission of adjuvant chemotherapy. Examples of minor changes included adjustments to supportive care and to the duration of adjuvant endocrine treatment.

Conclusion and Commentary

In an increasingly digital world, virtual health services are expanding rapidly. The COVID-19 pandemic highlighted the importance and necessity of remote health care. Telemedicine has enabled patients to overcome geographical barriers to care while saving time and money.

Artificial intelligence applications have led to revolutionary advances in health care. Advanced language models such as ChatGPT are being used in patient counseling, diagnostic support systems and medical research.

However, wider adoption of digital health services also brings risks and challenges. Data security and patient privacy are particularly important issues that require careful attention. Protecting health data transmitted through virtual platforms should be supported by both legal regulations and technological safeguards. It should also be remembered that remote health care may not be suitable for every condition and, in some cases, cannot replace an in-person examination.

Digital and remote health services are becoming indispensable components of modern medicine. Strengthening technological infrastructure, updating legal regulations and training health professionals in this area are crucial to delivering these services effectively and safely.