PURPOSES, PROBLEMS, AND PROPOSALS FOR PROGRESS IN CANCER STAGING

Objective: To learn the opinions of selected members of the American S ociety for Head and Neck Surgery about the purpose of cancer staging a nd 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. Outc ome Measurement: Responses to the six questions and other comments pro vided by the responding physicians. Results: Sixty-six physicians retu rned the questionnaire. Of the six purposes of cancer staging, compari ng end results was rated most important. Considerable variation existe d among the respondents in the rank order of importance of the six pur poses. The TNM strengths were its simplicity, low cost, relative accur acy, objectivity, universal acceptance, and lack of need for special t echnology. Weaknesses included inconsistencies, inaccuracies, observer variability, and problems with various T, N, and M classification cri teria. Most believed that the TNM system should be expanded to include host factors, such as functional status, severity of comorbidity, imm unocompetence, and symptom severity. Conclusions: These results sugges t a wide range of opinion about the purpose of cancer staging. Several problems with the present TNM system, such as the exclusion of additi onal prognostic factors, limit the usefulness of the system. Progress in cancer staging will occur when the current system is augmented by t hese prognostic factors.