Computerized Database Could Lead to Improved Staging of Lung Cancer

SEATTLE-"Staging of lung cancer by physicians is frequentlyincomplete and often inaccurate," Scott B. Chelemer, MD,said in an interview at the 1995 International Conference of theAmerican Thoracic Society and American Lung Association. He believesthat a computerized lung cancer database that included all clinical,radiographic, and histologic data for every patient could improvestaging and possibly outcomes.

At the meeting, Dr. Chelemer reported results of his review ofdata from the Cancer Registry at the Maine Medical Center, Portland,for 1993. The study showed no recorded attempt at staging in 15of 112 patients (13.4%). Although 264 staging attempts were recordedin 97 patients, only 48 of the attempts (18.2%) were both completeand correct.

Dr. Chelemer said that stage IIIA cancers were the least likelyto be correctly staged while stage IV cancers were the most likelyto be correctly staged.

The study found that thoracic surgeons had fewer incomplete stagingattempts than did other disciplines. "Otherwise, there wereno meaningful differences in accuracy or completeness betweendifferent disciplines," he said.

In all the specialties, small-cell lung cancer was more likelyto be staged completely than non-small-cell lung cancer, he said,probably because it is easier to stage. He added that use of acancer registry staging form improved completeness, but not accuracy."The TNM system needs to be used because of its importancein prognosis, and we need a better way of keeping track of thedata, including chest imaging and biopsy results, to improve stagingaccuracy," he said.

At the Maine Medical Center, a computerized lung cancer databaseis being created for just that purpose. "When a patient isdiagnosed with lung cancer, the physician will enter the pertinentdata, and another physician 6 months later can pull up that record,"he said. He added that the Center hopes to spread the registrystatewide, coordinating it through the Center's lung cancer registry.