Stage is a term to measure the extent of cancer when a patient first presents and it helps determine treatment but it also helps cancer registries measure survival and other such really important population based metrics. In childhood cancer collecting stage data by childhood cancer registries is actually quite challenging because childhood cancer is rare compared to adult cancer and there are multiple staging systems in use. So no-one has really come together and done a consensus process by which we say these are the staging systems that cancer registries should use.
So that was done through the support of a lot of organisations, including UICC, a few years back and those were published. What we need now is implementation and just to make sure that these guidelines actually are feasible in the real world. That has been done in Australia and it’s being conducted right now in many European registries; it hasn’t been done in low and middle income countries. So we want to make sure that some of the guidelines that we came up with specific for low and middle income countries are in fact feasible on the ground.
So what are some of the issues that might be faced?
There are a couple of theoretical problems. One is just resources, population based cancer registries, when they even exist in low and middle income countries, can be quite under-resourced and so having the time to collect additional data, if it’s going to take any significant amount of time, it just wouldn’t be feasible for most of these registries. Additionally, finding the medical charts and finding the information you need to stage a patient is also quite difficult. Finally, again, childhood cancer is rare so whether cancer registrars in any setting can be trained appropriately to be able to collect the data accurately is also a question. Now, all of those questions have been answered in high income countries but, again, we need to answer them in low and middle income countries as well.
So are there ways we can answer them?
In fact with the support of various organisations there is an initiative now that using the African Cancer Registry Network that is going to try to pilot some of these guidelines in select cancer registries across Africa and that will hopefully happen in the next six months or so.
Anything else important to add?
It will just be very exciting because in addition to making sure that these are feasible, as a by-product of these pilots we’ll actually get some population based stage data from these registries which will allow us for the first time to compare, for example, stage at diagnosis of various childhood cancers across regions in Africa and those data will be very interesting when they’re available.