EUROCHIP-1&2 Health Indicators for Monitoring Cancer in Europe Health Monitoring Program (HMP) EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL

EUROCHIP-1&2EUROCHIP-1&2

Health Indicators Health Indicators for Monitoring Cancer for Monitoring Cancer

in Europein EuropeHealth Monitoring Program (HMP)Health Monitoring Program (HMP)

EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERALEUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL

Presentè Presentè par A Micheli, L Cherie Challine, P Baili par A Micheli, L Cherie Challine, P Baili,, J Bloch, P Grosclaude, J Bloch, P Grosclaude, C Amati, M Velten, F Berrino, C Martinez, M ColemanC Amati, M Velten, F Berrino, C Martinez, M Coleman

Www.istitutotumori.mi.it/project/eurochip/homepage.htmWww.istitutotumori.mi.it/project/eurochip/homepage.htm

Europe is characterised by unacceptable Europe is characterised by unacceptable inequalities - inequalities - inègalitèesinègalitèes - in cancer control - in cancer control

AN - AN - travaille -travaille - INTECTUAL WORK INVOLVING CANCER EXPERTS OF EU INTECTUAL WORK INVOLVING CANCER EXPERTS OF EU MEMBERS, CANCER NETWORKS, INSTITUTES AND ORGANISATIONSMEMBERS, CANCER NETWORKS, INSTITUTES AND ORGANISATIONS

To produce a list of health indicators which To produce a list of health indicators which describe cancer in Europe finalized - describe cancer in Europe finalized - finalisationfinalisation- :- :a) to help the development of the European a) to help the development of the European Health Information System - Health Information System - banque d’information banque d’information Européenne de la santèEuropéenne de la santè

c) to promote action in the fight against - c) to promote action in the fight against - contrecontre - -cancercancer

EUROCHIP-1 EUROCHIP-1 AIMSAIMS

Life expectancy Life expectancy trends in Europetrends in Europe

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat (2003). World Population Prospects: The 2002 Revision

World-age-stand. incidence

$PPP rate per 100,000

I) GDP<15611I) GDP<15611 216216 II) 15611<GDP<17538II) 15611<GDP<17538 244244III) GDP>17538III) GDP>17538 253253

GDP and cancer incidenceGDP and cancer incidence

I, Estonia, Poland, Slovenia, Slovakia, and Spain; I, Estonia, Poland, Slovenia, Slovakia, and Spain;

II, UK, Finland, Netherland, Sweden, Italy, and Austria; II, UK, Finland, Netherland, Sweden, Italy, and Austria;

III, Iceland, Denmark, France, Germany, and SwitzerlandIII, Iceland, Denmark, France, Germany, and Switzerland

5-year cancer relative survival

$PPP %

I) GDP<15611I) GDP<15611 31 31 II) 15611<GDP<17538II) 15611<GDP<17538 43 43III) GDP>17538III) GDP>17538 45 45

GDP and cancer survivalGDP and cancer survival




World-age-stand. mortality

$PPP rate per 100,000

I) GDP<15611I) GDP<15611 146 146 II) 15611<GDP<17538II) 15611<GDP<17538 133 133III) GDP>17538III) GDP>17538 135 135

GDP and cancer mortalityGDP and cancer mortality




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

Gross Domestic Product and 5-year- age- and cancer site- adjusted relative survival (m)

PRELIMINARY LIST OF 158158 INDICATORS

5252 INDICATORS

26 AT HIGH PRIORITY:

15 NEW INDICATORS (by EUROCHIP)

EUROCHIP MEETINGSEUROCHIP MEETINGS

LIST OF INDICATORSLIST OF INDICATORS

1.1. The natural history of cancerThe natural history of cancer • PreventionPrevention• ScreeningScreening• DiagnosisDiagnosis• TreatmentTreatment• End resultsEnd results

2. Cancer sites2. Cancer sites

INDICATORS: AXES OF CLASSIFICATIONINDICATORS: AXES OF CLASSIFICATION

• Mesures de lutte contre le tabagisme

• Coût par patient

• Dépenses publiques de santé

• Produit intérieur brut

SOCIAL AND MACRO-ECONOMIC SOCIAL AND MACRO-ECONOMIC DETERMINANTSDETERMINANTS

PREVENTIONPREVENTION

• Consommation de fruits et légumes• Consommation d'alcool• Distribution de l’indice de masse corporelle dans la population• Activité physique• Etude sur le tabagisme• Exposition au soleil• Prévalence de l'exposition professionnelle aux carcinocènes (CAREX)

SCREENINGSCREENING

• Taux de couverture par des programmes de dépistage• % de femmes bénéficiant d'une mammographie• % de femmes bénéficiant d'un frottis• % de personnes bénéficiant dépistage du cancer colo-rectal

• Population couverte par un registre de cancer• Taux d'incidence du cancer, évolution et projections• Taux de survie des patients cancéreux, évolution et projections• Prévalence du cancer, évolution et projections• Taux de mortalité par cancer, évolution, projections, années potentielles de vie perdues à cause du cancer• Stade au diagnostic : % des cas avec un diagnostic précoce et % des cas avec bilan d’extension

•

CANCER REGISTRATION & CANCER REGISTRATION & EPIDEMIOLOGYEPIDEMIOLOGY

• Taux d’équipement en radiologie et radiothérapie• % de scanners (CTS) dans la population

• % de patients traités par radiothérapie paliative

• Délai avant traitement, études pilotes

• Respect des règles de bonnes pratiques en oncologie

CARE & TREATMENTCARE & TREATMENT

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

EUROCHIP-I RESULTSEUROCHIP-I RESULTSEUROCHIP-2 AIMSEUROCHIP-2 AIMS

• A LIST OF INDICATORS FOR CANCERA LIST OF INDICATORS FOR CANCER

• TO DEVELOP AN EUROPEAN DATA-BANKTO DEVELOP AN EUROPEAN DATA-BANK

• TO ESTABLISH GROUPS AT NATIONAL TO ESTABLISH GROUPS AT NATIONAL LEVEL TO DISCUSS INEQUALITIES IN LEVEL TO DISCUSS INEQUALITIES IN CANCER SURVEILLANCECANCER SURVEILLANCE

• TO PROMOTE ACTIONS AGAINST CANCER: TO PROMOTE ACTIONS AGAINST CANCER: AT LEAST ONE IN EACH COUNTRYAT LEAST ONE IN EACH COUNTRY

Extension of the system of EUROCHIP-I cancer networks involving all 25 European countries, new health institutions ... Liaison with sources of cancer datasources of cancer data (e.g. CRs, EUROSTAT, HIS/HES system, other networks involved with smoking, vegetable and fruit consumption etc) To encourage the setting-up of data collection in areas where areas where information is unavailableinformation is unavailable Improvement of the European data-banks with cancer data Checking of the quality and standardisation of available cancer data and that becoming available during the project Analysis of the behaviour of various indicators in relation to their utility as determinants of clinical outcomes Identification of deficiencies in European health systems; To encourage actions based on EUROCHIP-2 findings to reduce inequalities in cancer surveillance and control.

EUROCHIP-IIEUROCHIP-II: THE AIMS: THE AIMS

Produce results at two levels: for European Union as a whole and for individual countries

Focus on the problems and inadequacies of individual countries in order to suggest policy changes at the country level. Meanwhile, action to improve data quality and standardisation, will be taken

Organise activity as a continuous process, i.e. taking a global view of the information system, involving on one hand the promotion of data collection, on the other analysis of already available data, on the other evaluation promoting political action on established inequalities; all as a continuously re-evaluated process

EUROCHIP-IIEUROCHIP-II: EXPECTED RESULTS: EXPECTED RESULTS

Phase 1Phase 1: Identification of sources of the data pertaining to health indicators. Verify that data are collected as suggested by EUROCHIP-1

Phase 2Phase 2: Collection, validation, standardisation of data and unification in a single database

Phase 3Phase 3: Analysis of data from the database pertaining to a given health indicator in relation to other factors

Phase 4Phase 4: Identification of problems at the international and national level (e.g. general health inequalities and those pertaining to access and availability)

Phase 5Phase 5: Assessment of utility of health indicators in promoting effective political action

EUROCHIP-IIEUROCHIP-II: PHASES: PHASES

1.1. All cancers combined without non melanoma skin All cancers combined without non melanoma skin cancers cancers for cancer burden and cancer trends. For total cost of cancer for cancer burden and cancer trends. For total cost of cancer care. For Incidence and mortalitycare. For Incidence and mortality

2. Major cancers 2. Major cancers (in terms of incidence or prevalence)(in terms of incidence or prevalence)- Lung Lung for prevention, tobacco smoking (very limited for asbestos). for prevention, tobacco smoking (very limited for asbestos).

For mortality (in countries without data). For preventable estimation For mortality (in countries without data). For preventable estimation of deathsof deaths

- BreastBreast for monitoring screening programmes (mortality and for monitoring screening programmes (mortality and incidence) and to evaluate the care (tamoxifen)incidence) and to evaluate the care (tamoxifen)

- ColorectalColorectal to evaluate the care, evaluation of early diagnosis (and to evaluate the care, evaluation of early diagnosis (and screening programmes ). For delay of diagnosisscreening programmes ). For delay of diagnosis

- Prostate Prostate for future trends and future resourcesfor future trends and future resources

CANCER SITESCANCER SITES (1) (1)

2. Major cancers2. Major cancers- Stomach Stomach for monitoring the decreasing trends (ethnic for monitoring the decreasing trends (ethnic

differences) differences) - Head and neck-larynx, oropharynx (specifying ICD-9 code) Head and neck-larynx, oropharynx (specifying ICD-9 code)

for prevention and care. Treatment for organ preservationfor prevention and care. Treatment for organ preservation- Melanoma Melanoma for prevention (early diagnosis-stage migration)for prevention (early diagnosis-stage migration)- BladderBladder: for mortality: for mortality

3. Other cancers 3. Other cancers - Kaposi Kaposi for sentinel- Mesothelioma Mesothelioma for sentinel- Testis Testis for rare cancer- Lymphomas Lymphomas (H for health services and NH for trends) and and

Leukaemia Leukaemia (for treatment)- All childhood (0-14) cancers All childhood (0-14) cancers (for survival) rare cancer- Cervix Cervix (for screening) We need information on incidence and

mortality (note: corpus uteri vs cervix misclassification)

CANCER SITESCANCER SITES (2) (2)

Cancer prevalence

$PPP proportion per 100,000

I) GDP<15611I) GDP<15611 996 996 II) 15611<GDP<17538II) 15611<GDP<17538 13551355III) GDP>17538III) GDP>17538 15601560

GDP and cancer prevalenceGDP and cancer prevalence




Steering CommitteeSteering Committee

Working TeamWorking Team

Operational work

Panel of ExpertsPanel of Experts

Discussion & organisation at national level

Methodological GroupMethodological Group

Methodological aspects Methodological aspects of the indicatorsof the indicators

GS: Groups of specialistsGS: Groups of specialists

Discussion of indicators at Discussion of indicators at national and domain level national and domain level

(prevention, cancer (prevention, cancer epidemiology,epidemiology,

screening, screening,

cure & treatment, cure & treatment,

macro-indicators)macro-indicators)

GSGS

GSGS

GSGSGSGSGSGS

GSGS

GSGS

EUROCHIPEUROCHIP: THE ORGANISATION: THE ORGANISATION

Standardised methods for collecting, checking and validating the data proposed for each indicator

Documents

EUROCHIP-1&2 Health Indicators for Monitoring Cancer in Europe Health Monitoring Program (HMP) EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL