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 and correct.
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.