Field trials of essential TNM staging in Africa

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Published: 22 Nov 2017
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Dr Steady Chasimpha - Malawi National Cancer Registry, Blantyre, Malawi

Dr Chasimpha speaks with ecancer at AORTIC 2017 about supporting cancer registries in collecting patient data with a pilot staging scheme.

He details how the participating centres encountered some hurdles to staging management in data management and staff training, with those who employed full time staff performing better in staging assessments.

For more on cancer staging, watch interviews with Prof James Brierly and Dr Max Parkin.

This is a new staging scheme that has been developed with the sole purpose of helping population based cancer registries to enhance data collection on stage. My talk was just to briefly introduce the two and share the results of tests or trials that we have done in three centres in Africa.

So where were these centres?

Two hospitals in Zimbabwe, Harare, one hospital in Blantyre, Malawi and one hospital in Abidjan, Ivory Coast.

So what did you find?

Without training we just gave the tool to cancer registrars in the cancer registries in these cities and then they traced their case records and staged the cases. The same material was provided to trained oncologists to stage the disease so we are simply comparing the results from these cancer registrars and the oncologists. Overall we’ve seen that this tool has a potential, that it can really help in trying to bridge the gap as far as data stage is concerned in cancer registries but we think they still need more training so that we can get to the level that we want.

What were some of the issues you were finding?

First of all, most of the times we think that clinicians do stage cases, it might be that they do but then it’s not reflected in the case notes. So that’s one thing that we want to bring out, if we can encourage the clinicians to document the stage in the clinical notes. Secondly, we faced the challenge of case finding. In Blantyre and in Harare they only managed to get about 70% of the allocated cases whereas in Abidjan, Ivory Coast, they went as far as 95%. So it’s a way of also telling us that we need to improve on our filing so that we are able to actually find the cases for the staging.

Then the other thing that we also noted is that we had a problem of staff. For Blantyre and Harare most of the staff are part-time which reflected in the similarity scores that we were calculating, they were a bit lower than in Abidjan where mostly it’s the oncology nurses that are part of the cancer registry. So it’s the message to countries, the Ministry of Health, to try and at least commit to move the cancer registration forward by at least maybe providing permanent staff for the cancer registries. Because it’s really difficult if you’re working with part-time staff they come, they go, so you train some today, tomorrow they are not there. So that’s the other thing that we actually saw from this exercise.