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EUROCHIP

EUROCHIP. Health Indicators for Monitoring Cancer in Europe. Health Monitoring Program (HMP). A Micheli a , P Baili a , A Quaglia b , E Paci c , A Ponti d , C Marinacci e , E Mugno a , C Amati a , E Massimiliani a , N Bianchi a , A Cifalà a , H Lenz f , B Terracini g

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EUROCHIP

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  1. EUROCHIP Health Indicators for Monitoring Cancer in Europe Health Monitoring Program (HMP) A Micheli a , P Baili a, A Quaglia b, E Paci c, A Ponti d, C Marinacci e, E Mugno a, C Amati a, E Massimiliani a , N Bianchi a, A Cifalà a, H Lenz f, B Terracini g (a) Unità di Epidemiologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano; (b) Struttura Epidemiologia Descrittiva, Istituto Nazionale Ricerca sul Cancro, Genova; (c) CSPO Istituto Scientifico della Regione Toscana, Firenze (d) Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte (CPO-Piemonte), Torino (e) Servizio di Epidemiologia, ASL 5 Piemonte (f) Istituto Superiore di Sanità, Roma; (g) Università di Torino, Torino Www.istitutotumori.mi.it/project/eurochip/homepage.htm

  2. GDP and cancer incidence World-age-stand. Incidence $ PPPrate per 100,000 I) GDP < 15611 216.4 II) 15611<GDP<17538 243.7 III) GDP > 17538 255.0 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Holland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland GDP, from OECD. Incidence, from “Cancer incidence in 5 continents”, EUROPREVAL

  3. GDP and cancer mortality World-age-stand.mortality $ PPP rate per 100,000 I) GDP < 15611 140.5 II) 15611<GDP<17538 128.3 III) GDP > 17538 133.6 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Holland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland GDP, from OECD. Mortality, from EUROCIM

  4. GDP and cancer survival 5-year cancer relative survival $ PPP % I) GDP < 15611 33.4 II) 15611<GDP<17538 44.1 III) GDP > 17538 45.2 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Holland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland GDP, from OECD. Survival, from EUROCARE-2

  5. GDP and cancer prevalence Cancer prevalence $ PPP proportion per 100,000 I) GDP < 15611 1030.3 II) 15611<GDP<17538 1405.5 III) GDP > 17538 1524.5 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Holland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland GDP, from OECD. Prevalence, from EUROPREVAL

  6. EUROCHIP AIMS AN INTECTUAL WORK INVOLVING CANCER EXPERTS OF EU MEMBERS, CANCER NETWORKS, INSTITUTES AND ORGANISATIONS To produce a list of health indicators which describe cancer in Europe finalized: a) to help the development of the European Health Information System b) to reduce inequalities and c) to promote action in the fight against cancer

  7. RESULTS 130CANCER SPECIALISTS WERE INVOLVED IN EUROCHIP 23 INTERNATIONAL MEETINGS WERE HELD ALL COUNTRIES OF THE EUROPEAN UNION PARTICIPATED IN THE PROJECT

  8. A FORM TO DESCRIBE THE INDICATORS For each indicator we compile a FORM • DESIRED INDICATOR: all indicator characteristics we wish to have • METHODOLOGY: operational definition, possible sources and methodological issues • AVAILABILITY in different countries

  9. AXES OF CLASSIFICATION • The natural history of cancer • Prevention • Screening • Diagnosis • Treatment • End results • ECHI classification • Demographic and social-economic factors • Health status • Determinants of health • Health system • Tumour sites

  10. CANCER SITES (1) • All cancers combined without non melanoma skin cancersfor cancer burden and cancer trends. For total cost of cancer care. For Incidence and mortality • Major cancers(in terms of incidence or prevalence) • Lungfor prevention, tobacco smoking (very limited for asbestos). For mortality (in countries without data). For preventable estimation of deaths • Breastfor monitoring screening programmes (mortality and incidence) and to evaluate the care (tamoxifen) • Colorectalto evaluate the care, evaluation of early diagnosis (and screening programmes ). For delay of diagnosis • Prostatefor future trends and future resources

  11. CANCER SITES (2) • Major cancers • Stomach • Head and neck-larynx, oropharynx (specifying ICD-9 code) • Melanoma • Bladder • Other cancers • Kaposi • Mesothelioma • Testis • Lymphomas • Leukaemia • All childhood (0-14) cancers • Cervix

  12. LIST OF THE INDICATORS

  13. INDICATORS AT HIGH PRIORITY • Population covered by Cancer Registry • Organized screening coverage • Anti-tobacco regulations • Prevalence of occupational exposure to carcinogens • Exposure to sun radiation • Percentage of women that have undergone a mammography • Percentage of women that have undergone a cervical citology exam. • Percentage of persons that have undergone a colo-rectal screening test • Percentage of radiation systems on population • Percentage of diagnostic CT (Computed Axial Tomography) on pop. • Proportion of patients treated with palliative radiotherapy • Estimated cost for a cancer patient • Stage at diagnosis: % of cases with early diagnosis and with a • metastatic test • Delay of cancer treatment: pilot studies • Compliance with best oncology practice

  14. INDICATORS AT HIGH PRIORITY SOURCES: CANCER REGISTRIES • Population covered by cancer registries • Cancer incidence rates, trends and projections • Cancer survival rates, trends and projections • Cancer prevalence prop., trends and project. • Cancer mortality rates, trends, projections and • person-years life lost due to cancer • Stage at diagnosis: percentage of cases with early • diagnosis and with a metastatic test • Delay of cancer treatment: pilot studies • Compliance with best oncology practice

  15. POPULATION COVERED BY CANCER REGISTRIES Proportion of the national population that is covered by general population-based Cancer Registries present in the “Cancer Incidence in 5 Continents” DEFINITION By registration span. For a given calendar year, the indicator shows the percentage of cancer registration coverage of 5, 10 and 20 years at least CLASSIFICATION INDICATORS ALREADY AVAILABLE NO NEW COSTS HIGH PRIORITY

  16. 1. STAGE AT DIAGNOSIS: PERCENTAGE OF CASES WITH EARLY DIAGNOSIS Proportion of cases classified as "localised" with the condensed-TNM DEFINITION HIGH PRIORITY The expected value of this percentage is site dependent. For some sites (like lung) the expected value of the indicator is lower than 100%, but comparisons among countries are still informative. CONTEXT HIGH COSTS The sources are the Cancer Registries routine registration statistics SOURCE

  17. 2. STAGE AT DIAGNOSIS: PERCENTAGE OF CASES WITH A METASTATIC TEST The indicator is the percentage of cancer cases with presence or absence of a detection test for metastasis DEFINITION HIGH PRIORITY - Cervix: chest x-ray and pelvic imagine - Colon and rectum: liver ultrasound or CT and chest x-ray - Prostate: bone-scan - Lung: CT thorax DETECTION TESTS HIGH COSTS The sources are the Cancer Registries. Specific studies on major cancer sites are to be promoted SOURCE

  18. DELAY OF CANCER TREATMENT Phases of the disease history: · Symptoms: there is not an event and for this it is not strictly defined on time · First medical attendance: date on which patient reports his/her symptoms to the Health System (general practitioner, hospital ...) · Diagnosis: date defined by CR rules · First treatment: date of the beginning of primary treatment. The date of first symptoms is not intrinsically defined as an event and for this reason it will be used the date of the first diagnosis (or first medical attendance for some sites) as the first date reference. EUROCHIP suggests to organise pilot studies in order to study the meaning of first diagnosis-first treatment interval for breast, colon, rectum, lung and prostate cancers. To define this indicator, Cancer Registries have to collect the dates of first treatment (all treatments are to be considered: surgery, chemotherapy, radiotherapy or endocrine therapies)

  19. COMPLIANCE WITH BEST ONCOLOGY PRACTICE Example As an example, Sant (2001) showed that in Southern Italy a very low proportion of breast cancer patients T1N0M0 were treated with conservative surgery while many received Hastled mastectomy. This a clear deviation to guidelines, although motivated by lack of radiotherapy centres in the area. Source: Sant M, and the EUROCARE Working Group: Differences in stage and therapy for breast cancer across Europe. International Journal of Cancer 93: 894-901 (2001) EUROCHIP group defined specific items for breast, colon, rectum, cervical and lung cancers. The sources should be the Cancer Registries.

  20. PERSON-YEARS OF LIFE LOST DUE TO CANCER Years lost due to cancer using general life expectancy as reference DEFINITION FORMULA where a=age, l=age limit, dat=number of deaths at age a, pat=number of persons aged a in country i at time t, Pa=number of persons aged a in the reference population, Pn=total number of persons aged 0 to l-1 in the reference population

  21. Potential years of life lost standardized rate due to cancer (Age<75) (per 100,000 standard population). 1997

  22. EUROCHIP RESULTS • AN EUROPEAN COHOMPRENSIVE LIST OF INDICATORS FOR CANCER • FUTURE: • 1. TO STUDY CANCER IN EUROPE WITH THE AIM TO DESCRIBE DIFFERENCES • 2. TO ESTABLISH GROUPS AT NATIONAL LEVEL (NETWORK & INSTITUTIONS & PERSONS) TO PROMOTE HEALTH AND ACTIONS Www.istitutotumori.mi.it/project/eurochip/homepage.htm

  23. INDICATORS AT HIGH PRIORITY INDICATORS “AVAILABLE”LOW COSTS • Population covered by cancer registry • Cancer incidence rates, trends and projections • Cancer survival rates, trends and projections • Cancer prevalence prop., trends and project. • Cancer mortality rates, trends, projections and • person-years life lost due to cancer • Gross Domestic Product (OECD) • Total Public Expenditure on Health (OECD)

  24. INDICATORS AT HIGH PRIORITY SOURCES “AVAILABLE”LOW COSTS • Anti-tobacco regulations • Organized screening coverage SOURCE: UPDATE OF DATABASESMEDIUM COSTS • Prevalence of occupational exposure to • carcinogens (CAREX)

  25. INDICATORS AT HIGH PRIORITY SOURCE: SURVEYSMEDIUM COSTS • % of radiation equipments on population • % of diagnostic CT (Computed Axial • Tomography) on population • % of patients treated with palliative radiotherapy • Estimated cost for a cancer patient

  26. INDICATORS AT HIGH PRIORITY SOURCE: HEALTH SURVEYSMEDIUM COSTS • Consumption of fruit and vegetables (EFCOSUM) • Consumption of alcohol (ECAS) • Body Mass Index distribution (EHRM) • Physical activity (EUPASS) • Tobacco survey (EHRM) • Exposure to sun radiation • % of women that have undergone a mammography • % of women that have undergone a cervical citology • examination • % of persons that have undergone a colo-rectal cancer • screening test

  27. INDICATORS AT HIGH PRIORITY SOURCE: CANCER REGISTRIESHIGH COSTS • Stage at diagnosis: percentage of early diagnosis • and of cases with a metastatic test • Delay of cancer treatment: pilot studies • Compliance with best oncology practice

  28. THE ORGANISATION Steering Committee Standardised methods for collecting, checking and validating the data proposed for each indicator GS: Groups of specialists Discussion of indicators at national and domain level Working Team Operational work Panel of Experts Discussion & organization at national level Methodological Group Methodological aspects of the indicators GS GS GS GS GS GS GS

  29. LIST OF INDICATORS PRELIMINARY LIST OF 158 INDICATORS EUROCHIP MEETINGS 52 INDICATORS 26 AT HIGH PRIORITY: 15 PROPOSED BY EUROCHIP Www.istitutotumori.mi.it/project/eurochip/homepage.htm

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