SEATTLE-"Staging of lung cancer by physicians is frequently
incomplete and often inaccurate," Scott B. Chelemer, MD,
said in an interview at the 1995 International Conference of the
American Thoracic Society and American Lung Association. He believes
that a computerized lung cancer database that included all clinical,
radiographic, and histologic data for every patient could improve
staging and possibly outcomes.
At the meeting, Dr. Chelemer reported results of his review of
data from the Cancer Registry at the Maine Medical Center, Portland,
for 1993. The study showed no recorded attempt at staging in 15
of 112 patients (13.4%). Although 264 staging attempts were recorded
in 97 patients, only 48 of the attempts (18.2%) were both complete
Dr. Chelemer said that stage IIIA cancers were the least likely
to be correctly staged while stage IV cancers were the most likely
to be correctly staged.
The study found that thoracic surgeons had fewer incomplete staging
attempts than did other disciplines. "Otherwise, there were
no meaningful differences in accuracy or completeness between
different disciplines," he said.
In all the specialties, small-cell lung cancer was more likely
to be staged completely than non-small-cell lung cancer, he said,
probably because it is easier to stage. He added that use of a
cancer registry staging form improved completeness, but not accuracy.
"The TNM system needs to be used because of its importance
in prognosis, and we need a better way of keeping track of the
data, including chest imaging and biopsy results, to improve staging
accuracy," he said.
At the Maine Medical Center, a computerized lung cancer database
is being created for just that purpose. "When a patient is
diagnosed with lung cancer, the physician will enter the pertinent
data, and another physician 6 months later can pull up that record,"
he said. He added that the Center hopes to spread the registry
statewide, coordinating it through the Center's lung cancer registry.