1 / 58

EUROCHIP-2

EUROCHIP-2 - The Action. EUROCHIP-2. Public Health Program EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL. www.tumori.net/eurochip. EUROCHIP2: INEQUALITIES IN CANCER MANAGEMENT. Gross Domestic Product (1997) and

gaille
Download Presentation

EUROCHIP-2

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. EUROCHIP-2 - The Action EUROCHIP-2 Public Health Program EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL www.tumori.net/eurochip

  2. EUROCHIP2: • INEQUALITIES • IN CANCER MANAGEMENT

  3. Gross Domestic Product (1997) and 5-year- age- and cancer site- adjusted relative survival (women) The area of the disk is proportional to the Total National Health Expenditure ($ PPP) in the country $ PPP: Parity Purchasing Power per capita (US $) Sources: OECD 2002 for GDP and TNEH; EUROCARE-3 for survival

  4. Relation between age standardised -prevalence (P), -incidence (I), and -relative survival for all malignant neoplasms in 17 European countries, 1992 (The area of the disk is proportional to the 5-year relative survival)

  5. OUR INDICATIONS MUST REFER TO THE BEST STRATEGY FOR THE DIFFUSSION OF BEST PRACTICE

  6. METHODS OF EUROCHIP-2 ACTIONS 1. Knowledge: finding data sources, improvement / standardisation of data collection 2. Choice: analysedata, compare data, find relations, find major deficiencies 3. Promotion: design, validate and finance initiatives to reduces cancer disparities These phases should be looked at as part of an iterative process

  7. EUROCHIP: THE ORGANISATION GS: Groups of specialists a) Promotion of the action at national level or b) International domain level (prevention, cancer epidemiology, screening care&treatment, macro-indicators) Standardised methods for collecting, checking and validating the data proposed for each indicator Steering Committee Working Team Operational work Methodological Group Methodological aspects of the indicators GS GS Panel of Experts GS care and treatment GS Cancer network GS GS GS

  8. THE PROCESS APPROACH (Eurochip-2 form) Module (columns) and profile (rows)

  9. AIMS OF EUROCHIP-2 • Extending the collaboration of networks on cancer (new participating countries) • Establishing multidisciplinary working groups in each country (through help of willing and determined people) • Analysing the behaviour of various indicators in relation to their utility as determinants of clinical outcomes, possibly leading to modifications (continuous consensus conference) • Promoting at least one important ACTION in each country (to improve the system of cancer information and to support the fight against cancer – i.e. reduce disparities) • Establishing/strengthening a health information system in co-operation with other chronic disease networks as for common risk factor or morbidity indicators

  10. MAIN PRESENT GOAL OF THE EUROCHIP-2 NETWORK • Organisation of national groups involving cancer experts, institutes and associations in all countries • Members of the national groups must believe in the project and have to be motivated in their work • These groups have to be multidisciplinary groups • Members of the National Groups have to identify specific problems at national levels and then make proposals on health planning • These proposals have to reach the maximum consensus possible in the country

  11. TASKS OF THE NATIONAL GROUPS • To check the availability of the Eurochip indicators in own country (Eurochip Questionnaire) • To promote data collection • To use and analyse already available data • To identify health system deficiencies at national level • To propose actions against these deficiencies • To reach the maximum consensus on actions

  12. THE ROLES OF DOMAIN GROUPS • To test the present quality of EUROCHIP indicators • To detect possible actions in their specific field • To answer specific questions at national level • To support actions related to their specific field • EUROCHIP WORKING GROUP IS PREPARING THE INDICATOR/ACTION MATRIX

  13. ACTIONS - e.g.: Poland • Knowledge: Poland is involved in the EUROCARE studies • Action: Application for funds in order to take part to Eurocare High Resolution Studies • Choice: • a) Poland has the lowest cancer survival in Europe • b) Delay of cancer treatment and type of treatment used • (Treatment Domain task: • Standard Protocols for these Studies) • Promotion • Action: Health planning documents suggesting the delay of treatment and non-modern treatment as cause of the lowest cancer survival in Europe

  14. ACTIONS - e.g. (1): Switzerland • Knowledge: Surveys exist, yet with no questions on screening • Action: Introducing questions on screening in the surveys • Choice: data are available, yet no specific analysis is carried out • Action:To promote analysis and publication of the data • Promotion: Disparities in cancer information due to Canton health system • Action: To promote the creation of a National Institute of Epidemiology

  15. ACTIONS - e.g.(2): Switzerland • Knowledge: There are no real data to evaluate cancer treatment, except for the Eurocare data in Geneva and Basel • Action: To create a database analogous to Eurocare for all Swiss Cancer Registries • Promotion: Disparities in fund and organisation • Action: To guarantee the long-term work of all cancer registries

  16. Computed Tomography Scanners and 5-year- age- and cancer site- adjusted relative survival (F)

  17. EUROCHIP-2 POSSIBLE FUND USE • The funds for partners have to be used only for personnel costs • The possible various uses for these funds are: • Organisation of the national group • Involvement in the Eurochip pilot studies • Collection of available data • Analysis of data • Creation of writings of health planning • Connection with health planners and politicians

  18. EUROCHIP-2 - The Action PANEL OF EXPERTS’ Meeting – April 11th,2005 INDICATORS ON CARE & TREATMENTEuropean benchmarking in cancer careDr Ian Kunkler Public Health Program EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL

  19. Care and treatment • list of approved indicators • Definitions of datasets required • Guidelines for modus operandi and timelines for national and regional european working groups • Use of EUROCHIP resources for project deliverables (data collection and analysis) • Next steps

  20. EUROCHIP 2 – care and treatment parameters • Provision of CT scanners • Provision of megavoltage RT units • Delays in diagnosis and treatment • Compliance with best practice

  21. CTS EQUIPMENT Number of diagnostic CT (Computed Axial Tomography or computed tomography scanners) systems per 1 000 000 population WHAT? Level of availability of diagnostic facilities WHY? HOW? Health Ministry or Surveys

  22. Computed Tomography Scanners – ITALY - MACROAREAS Note: South Italy => Low survival Source: Health for all - Italy

  23. RADIATION EQUIPMENT Number of linear accelerators per 1 000 000 population WHAT? WHY? Availability of treatment facilities HOW? Health Ministry or Surveys

  24. RADIATION EQUIPMENT and CTS EQUIPMENT PROCESS APPROACH • KNOWLEDGE • Identification of availability in European countries • Comparison of equipment information collected in different countries • CHOICE • Analysis of the European differences • Finding relations with cancer outcomes • ACTION • To promote acquisition of new equipments

  25. Requirements for modern radiotherapy service • 5.5.6.0 linear accelerators per 106 pop’n • 3-dimensional planning computer and multileaf collimator for 3D conformal RT and/or intensity modulated radiotherapy (IMRT) • CT simulator • Full complement of radiographers, physicists, clinical oncologists to allow waiting targets to be met Royal College of Radiologists, London,2004

  26. How much radiotherapy is needed and provided • ESTRO QUARTS PROJECT (QUAntification of Radiation Therapy Infrastructure and Staffing Needs

  27. QUARTS project • Aim : provide estimates of staffing and infrastructure requirements for RT in EU • Transparent link between epidemiological data and indications for RT based on best available evidence • 53% of patients with cancer have indication for radical/palliativeRT (Delaney et al,2003)

  28. Linac throughput • 450 treatment courses per year • Australia Health Technology Advisory Committee,1996 • Swedish audit 350 courses per year • Throughput varies with complexity, number of fractions, tumour type and stage

  29. National recommendations on linacs per 0.5 million population • UK 2.0 • Spain 2.5 • France 3.6 • Czech Republic 1.4 Bentzen (2004)

  30. QUARTS – data for estimates of megavoltage RT units per countryBentzen et al • Proportion of patients with given type of cancer • Incidence of cancer types in country • RT retreatment rates • Machine throughput (no of courses of RT per linear accelerator per year)

  31. Evidence based use of radiotherapy • Division of cancer care and epidemiology, Kingston, Ontario (McKillop, IJRBOP,2002) • Swedish Council of Technology in Health Care (Acta Oncol) • Collaboration for Cancer Outcomes Research and Evaluation, NSW Au (Delaney et al)

  32. Optimal use of radiotherapy • Overall external beam RT needed in 53% all cancer patients (Delaney,2003) • Some regions of UK only 22% offered RT (2002) • Breast (83%) but clinical use 24%-71% • Lung (76%) • Prostate (60%) • Rectum (61%) • Gynae (31%)

  33. Radiotherapy: linac provision 2000(Cottier,2004)

  34. No of linacs needed per 106 pop’nto reproduce SBU pattern of RT usage • Hungary 11.2 • Denmark 5 • Ireland 3.6

  35. Limitations of QUARTS study • Heavily reliant on Swedish and Australasian data • Cross validation with other data sources valuable especially from central and southern Europe • Data on stage needed since could differ between Australasian CCORE data and EU

  36. EUROCHIP2-QUARTS collaboration • Advantages: use of existing dataset and expertise on RT provision in 25 EU countries EUROCHIP2 could provide data on stage to crossvalidate QUARTS data based on SBU and CCORE

  37. Measuring delay between diagnosis and first treatment • Many ‘curative’ treatments involve multimodality treatment (surgery,systemic therapy,RT) • Systemic therapy pre RT eg breast cancer may mask delays in access to RT • Delays in access to RT best measured where no adjuvant chemo eg breast conserving therapy, early larynx cancer,early cervix ca

  38. DELAY OF CANCER TREATMENT: CONTEXT • Phases of disease history: • Symptoms: not accurately defined on time • First medical attendance: date on which patient reports his symptoms to the Health System (general practitioner, hospital ...) • Diagnosis: date defined specifically site per site • First treatment: date of the beginning of primary treatment defined specifically site per site. • As the date of first symptoms is not intrinsically defined as an event, the working group suggests to use the date of the first diagnosis as a reference. • The indicator is the average time between date of diagnosis and date of first treatment • The treatment group suggests specific definitions for 5 cancer sites: breast, colon, rectum, lung and prostate. • To provide these indicators, Cancer Registries have to collect the dates of first treatment (either surgery, chemotherapy, radiotherapy or endocrine therapy)

  39. DELAY OF CANCER CARE PROCESS APPROACH • KNOWLEDGE • Definition of disease history phases for 5 cancers: breast, colon, rectum, lung and prostate • Identification of countries where pilot studies need be carried out • Writing of pilot studies protocol • Finding relations with cancer outcomes • CHOICE • Analysing data coming from pilot studies • ACTION • Promotion of the diffusion of the pilot studies • Actions to reduce delay of cancer care

  40. TODAY IN THE UK: CANCER PLAN IN UK : WAITING TIMES • Maximum 1 month wait from urgent GP referral to treatment guaranteed for children’s and testicular cancers and acute leukaemia • Maximum 1 month wait from diagnosis to treatment for breast cancer • Maximum 1 month wait from diagnosis to treatment for all cancers by 2005 • Maximum 2 months wait from urgent GP referral to treatment for breast cancer • Maximum 2 months wait from urgent GP referral to treatment for all cancers by 2005 • Cancer is the first priority for roll out of booked appointments • By 2004 every patient diagnosed with cancer will benefit from pre-planned and pre-booked care

  41. Clinical Standards Board for Scotland – breast cancer examples • Minimum of 80% of patients with diagnosis within 2/52 of first clinic (including image-guided needle biopsy or excision biopsy) • Therapeutic surgery: minimum of 70% within 3/52 of first clinic visit • Minimum of 70% conservation rate of surgically treated small invasive cancers (<15mm path.diameter) excluding DCIS and multifocal disease • Adjuvant RT: minimum of 70% within 4/52 of final operation/chemotherapy • Adjuvant chemotherapy: minimum of 80% with 4/52 of final operation

  42. COMPLIANCE WITH BEST ONCOLOGY PRACTICE PROCESS APPROACH • KNOWLEDGE • Update of the High Resolution Studies Protocol to collect data for these indicators • Identification of cancer registries where organise HR Studies • Collection of the data • CHOICE • Analysing data coming from HR Studies • ACTION • Diffusion of the results

  43. COMPLIANCE WITH BEST ONCOLOGY PRACTICE The indicator aims to reflect the compliance with best practices in oncology. BREAST - Proportion of patients receiving post-operative breast radiotherapy after breast conserving surgery -Proportion of breast conservation surgery in pT1 cases (multiple cancers excluded) COLON - Proportion of patients with Dukes C (or TNM Stage 3) receiving adjuvant chemotherapy -Proportion of patients with Dukes B (or TNM Stage 2) not receiving adjuvant chemotherapy RECTUM -Proportion of patients receiving pre-operative radiotherapy LUNG - Proportion of patients with non small cell undergoing radical surgery - Proportion of patients undergoing staging with thoracic CT scanning CERVIX - Proportion of FIGO-stage III/IVreceiving combined chemo-radiotherapy - Proportion of patients with FIGO-stage “Ia2” and “Ib” undergoing hysterectomy with pelvic lymphadentectomy (WERTHEIM-MEIGS hysterectomy)

  44. Guidelines • For which parameters of best practice as defined by EUROCHIP2 is data routinely collected in each EU country for breast,colon,lung, rectum, lung, cervix at national/regional level? • Is this data accessible to EUROCHIP (ethical considerations, confidentiality)? • Proposals for data not collectable and/or not accessible • Does EUROCHIP2 have necessary resources for data collation and analysis (eg how should per country funding best be used?)

  45. PROPORTION OF PATIENTS TREATED WITH PALLIATIVE RADIOTHERAPY Number of patients who have received palliative radiotherapy WHAT? Quality of life for incurable cancer patients WHY? HOW? Survey on radiotherapy units

  46. Requirements for modern radiotherapy service • ‘Unfortunately there is not a single department in the UK that meets all these requirements’ Royal College of Radiologists,2004

  47. Differences in palliative RT for bone metastases in W.Europe (Lievens et al,2000) • Questionnaire survey of 565 RT centres • 205 centres responded (36%) • Most common RT schedule 30 Gy in 10 fractions • largest centres used shorter fractionation and less complex treatments • Level 1 evidence that single fractions as effective as multiple fractions

  48. Lung cancer waiting times and tumour growth • Prospective audit of 29 lung cancer patients awaiting radical (curative) radiotherapy • Comparison of tumour size on diagnostic and RT planning scans • 2 progressed so unfit for RT, 4 tumours became too large for radical RT • 21% of patients became incurable • Median time Ist hospital visit to starting RT= 94 days (range 35-187) O’Rourke N Clin Oncol 2000;12:141-4

  49. Conclusions • Collaboration needed with ESTRO QUARTS project for RT equipment and palliative RT provision • Engage the oncology community • Use of high resolution studies • Identification of: (i) provision of diagnostic CT scanners (ii) date of diagnosis and date of first treatment (iii) national/european audit data on compliance with evidence based guidelines

More Related