UICC staging guidelines in practice across Africa

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Published: 21 Nov 2017
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Dr Max Parkin - African Cancer Registry Network and University of Oxford, UK

Dr Parkin speaks with ecancer at AORTIC 2017 about applying UICC staging recommendations.

He describes the utility of staging information for individuals and health systems, noting that practical experience and training will improve application and outcomes. 

For more on UICC TNM staging, ecancer provides an online training module here.

The UICC session was about staging for cancer. I was just giving a general introduction to the importance of staging, not just for clinical care of patients but also for monitoring cancer control programmes, the idea of at what stage of the disease are cancer patients being diagnosed. Then going on from that the session was really concerned with how can we monitor that in low income settings. It’s a difficult thing to do. So we were talking partly about the tools that have come through the UICC Staging Group, the TNM Group, to come up with a simplified version of TNM that’s adaptable for cancer registries in low income settings. This is in the new UICC TNM book. We were talking about that and how this might be implemented in the cancer registries in Africa.

What sort of adaptations have you made?

It’s something called the essential TNM, it’s exactly equivalent to the TNM but a much simplified system that we feel that cancer registrars could abstract from the clinical record if the full TNM isn’t there, that’s the idea. We’re going to develop training programmes to help them do that. The idea being that then we will be able to get stage information on the great majority of cancer patients that we are registering, which we can’t at the moment, the information isn’t there.

What’s the end game with that information?

The end game is then we will have good information on the whole population in areas served by cancer registries so we can monitor what stage of disease people are being diagnosed at. Then if we introduce screening programmes can we improve the stage at diagnosis. When we want to calculate survival for the population we’ll be able to calculate survival specific for each stage, that’s why we want this information. So that’s what that session was concerned with.

What about the discussion surrounding feasibility?

It’s interesting, the roundtable discussion, it gave the audience a chance to give their experience about how difficult it was to get stage information on patients in Africa and who should be doing this. The clinicians should do it in every case, well they should but in the reality when you go to a case record they might have done it but they haven’t committed themselves to paper which we know very often happens. Clinicians will mentally stage a case but they don’t want to write it in case they’ve made a mistake or something. So all these issues came up in the discussion so it was very interesting.

So are the ways of dealing with this practical?

Yes, I think so. Like I said, we already tried testing this UICC essential TNM system in Africa and somebody presented the results of that. It went so-so and we learnt a lot from it, that it’s difficult for cancer registrars to be able to stage a case of cancer themselves based on what’s in the record without some extra training. OK, it seems a simple conclusion but it really shows that they need a bit more practice in medical terminology and so on and training to be able to read through a medical record to stage some cases. So we’re going to work on that, we’re starting with the IARC in Lyons, we’re going to hold a training course in December to start on the process of developing training tools for doing that.

Anything else to add?

That’s most of it. There was also a presentation of this new paediatric staging system based on the Toronto guidelines by Dr Gupta. That again is something that’s a very welcome development, it’s a simplified staging system for paediatric cancers that’s feasible to use in low income settings. So this is a really welcome development as well. We’re hoping also that some of our cancer registers that deal with children can test this system also over the next year.