Purposes, Problems, and Proposals for Progress in Cancer Staging

OBJECTIVE: To learn the opinions of selected members of the American Society for Head and Neck Surgery about the purpose of cancer staging and the problems with the current system, and to use these opinions to suggest improvements. DESIGN: Questionnaire survey. PARTICIPANTS: One hundred one physicians, based on their prominence in the field of head and neck cancer, selected from the society membership directory. OUTCOME MEASUREMENT: Responses to the six questions and other comments provided by the responding physicians. RESULTS: Sixty-six physicians returned the questionnaire. Of the six purposes of cancer staging, comparing end results was rated most important. Considerable variation existed among the respondents in the rank order of importance of the six purposes. The TNM strengths were its simplicity, low cost, relative accuracy, objectivity, universal acceptance, and lack of need for special technology. Weaknesses included inconsistencies, inaccuracies, observer variability, and problems with various T, N, and M classification criteria. Most believed that the TNM system should be expanded to include host factors, such as functional status, severity of comorbidity, immunocompetence, and symptom severity. CONCLUSIONS: These results suggest a wide range of opinion about the purpose of cancer staging. Several problems with the present TNM system, such as the exclusion of additional prognostic factors, limit the usefulness of the system. Progress in cancer staging will occur when the current system is augmented by these prognostic factors.