For decades, cancer care has advanced through new therapies, technologies and molecular insights. But beneath every treatment decision, prognosis and research breakthrough sits a quieter constant: staging.
Rick Greene, MD, FACS, emeritus chair of surgery at Carolinas Medical Center and medical director of cancer data services at Atrium Health Levine Cancer Institute in Charlotte, N.C., has spent much of his career safeguarding that foundation. As a surgical oncologist and longtime leader of the global Tumor Nodes Metastasis cancer staging system, Dr. Greene has focused less on individual innovations and more on ensuring that cancer data itself is accurate, consistent and usable for clinicians, researchers and patients alike.
“When you sit down with cancer patients and their loved ones, what’s the first thing they do when they leave the office? They go to the Internet,” Dr. Greene said during an interview with the “Becker’s Healthcare Podcast.” “They go to the Internet to try to figure out what’s going on, how long they’re going to live, and, of course, there are so many things on the Internet that are incorrect.”
That reality has only heightened the stakes of getting staging right. The TNM system — which classifies cancer by tumor size, lymph node involvement and metastasis — shapes nearly every downstream decision in oncology from treatment planning to survival estimates to eligibility for clinical trials. Errors then ripple outward.
Dr. Greene has led the TNM staging system through multiple iterations, helping guide it from its origins as a purely anatomical framework into a more nuanced model that incorporates biological and molecular markers. Yet he is careful to preserve the system’s global applicability.
“If you’re a surgeon working in sub-Saharan Africa, where all you have is a surgeon and a pathologist, you don’t have an academic center that can do all of the testing that you need,” he said. “You still need the anatomical system as well as the molecular system that we’ve developed. This is really key and why we have to keep adding genetic markers in cancer. They will be added to many of the different sites in the future.”
That balance of precision without exclusivity is central to equity in cancer care. Staging must be sophisticated enough to support personalized medicine, yet standardized enough to ensure patients receive comparable care regardless of where they are treated.
At Levine Cancer Institute, Dr. Greene’s work now centers on cancer registries and data quality. Every patient’s cancer data feeds not only local decision-making, but state registries and the National Cancer Database, which underpins much of U.S. oncology research and benchmarking. The registry needs strong stewards to improve outcomes.
“Accuracy is the key,” he said. “You have to have accurate data put in because if you don’t, you won’t know how these prognostic factors will work using the TNM system.”
Accreditation plays a parallel role. As former president of the Commission on Cancer, Dr. Greene has pushed for standards that reduce variation between institutions so patients treated at smaller community hospitals receive care comparable to that of major academic centers.
“When a patient goes to a small community hospital that’s accredited, we want to make sure that they get the same care as going to an academic center,” he said.
While much of the industry’s attention is drawn to new drugs, AI tools and genetic breakthroughs, Dr. Greene sees progress as inseparable from the integrity of the underlying data. Research, prevention strategies and quality improvement efforts all depend on it.
“Stage is the bedrock, the absolute bedrock, and that’s what we call the most important part of what goes on in the cancer diagnosis,” he said. “That’s why we want all clinicians to be well aware of the stages of cancer they work with.”
Even as oncology grows more complex, that principle has not changed since the TNM system was first introduced in the 1940s. What has changed is the volume of information, and misinformation, surrounding cancer. In that environment, the responsibility to get the basics right has only intensified.
“The role of a physician and especially somebody in surgery is to make sure that they’re giving good advice to people on how to live healthy lives,” said Dr. Greene. “That’s what we try to do and the important thing.”
The post Oncology’s bedrock remains vital as healthcare changes appeared first on Becker's Hospital Review | Healthcare News & Analysis.
Source: Read Original Article
