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EUROCHIP

EUROCHIP. Health Indicators for Monitoring Cancer in Europe. Health Monitoring Program (HMP) EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL. Www.istitutotumori.mi.it/project/eurochip/homepage.htm. EUROCHIP. GROUP OF SPECIALISTS on PREVENTION

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EUROCHIP

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  1. EUROCHIP Health Indicators for Monitoring Cancer in Europe Health Monitoring Program (HMP) EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Www.istitutotumori.mi.it/project/eurochip/homepage.htm

  2. EUROCHIP GROUP OF SPECIALISTS on PREVENTION Amsterdam, 12th-13th December 2002 Chairperson: Dr Benedetto Terracini

  3. INTRODUCTION TO THE MEETING Dr. Julietta Bloch

  4. AIMS OF THE MEETING • Discussion on the complete list of the indicators • An updated list of indicators for “prevention” domain • Definition of eventual new indicators for environmental and occupational risks • A consensual classification of these indicators by priority • Information on sources for indicators at high priority • Discussion on validity and standardization of indicator at • high priority

  5. CONSIDERATIONS • Participants have to consider that: • indicators at high priority should be in a limited • number; • indicators should be able to suggest actions to • reduce inequalities and to promote health; • indicators should refer to the “prevention” domain • indicators have been developed considering 3 axes: 1) the natural disease’s history (prevention, screening, • diagnosis, treatment, surveillance, end results) • 2) indicator groups as suggested by the ECHI • HMP project (demographic and social-economic factors, health status, determinant of health, health system) • 3) cancer sites

  6. INTRODUCTION Several axis for indicators DPSEEA Exposure Outcome Action OECD Relevance (- PARP/Olav)Analytical soundness Measurability Scale of application (national/subnational)

  7. Availability (cost) Census Health surveys  statistical power Ad hoc Specificity (to cancer) Robustness (validity, sensitivity) Precision (standardization of methods for measurement) Comparability

  8. What is environment? Everything Non genetic Non social behavioural natural Specific chemical, physical, biological agents

  9. EUROCHIP Health Indicators for Monitoring Cancer in Europe A project of the Health Monitoring Program (HMP) EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Www.istitutotumori.mi.it/project/eurochip/homepage.htm

  10. 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, to help the development of the future European Health Information System

  11. WHAT ABOUT THIS PRESENTATION • METHODS • FIRST RESULTS • FUTURE

  12. A METHOD FOR THE DISCUSSION EUROCHIP MAIN AXIS OF ANALYSIS OCCURENCE RISK FACTORS SURVIVAL LIST OF CANCER INDICATORS PRE-CLINICAL ACTIVITY/ SCREENING CAMON EUROCARE/EUROPREVAL CANCERCARE PREVALENCE DIAGNOSTIC&THERAPEUTICPROCEDURES CANCERRECURRENCE ANDMORTALITY CLINICAL FOLLOW-UP

  13. A METHOD FOR 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

  14. A METHOD 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

  15. RESULTS 130CANCER SPECIALISTS ARE INVOLVED IN EUROCHIP 17 INTERNATIONAL MEETINGS HELD IN A YEAR 15 ALL COUNTRIES OF THE EUROPEAN UNION ARE PARTICIPATING IN THE PROJECT

  16. RESULTS PRELIMINARY LIST OF 158 INDICATORS EUROCHIP MEETINGS 38 INDICATORS AT HIGH PRIORITY

  17. RESULT: INDICATORS AT HIGH PRIORITY PREVENTION • Tobacco consumption • Tobacco abstinence • Consumption of fruit and vegetable * • Consumption of alcohol * • Body Mass Index * • Exposure to asbestos • AIDS incidence * • Prevalence of hepatitis B/C * • EPIDEMIOLOGY AND CANCER REGISTRATION • Coverage of cancer registration • Incidence rates * • Survival rates * • Prevalence proportion * • Mortality rates * • Stage at diagnosis • Person-years life lost due to cancer • Completeness of the registration (DCO and Incidence / mortality) • % of microscopically cases * * Connected with other HMP projects

  18. RESULTS: INDICATORS AT HIGH PRIORITY SCREENING • Breast cancer screening coverage • Cervical cancer screening coverage • Colorectal cancer screening coverage • Organized screening process indicators • TREATMENT AND CLINICAL ASPECTS • Interval between diagnosis and first treatment • Radiation equipment • % of centres with at least 2 radiation equipments • CAT Equipments • Compliance with guidelines • Patients treated by surgery / chemotherapy / radiotherapy • Palliative care teams

  19. RESULTS: INDICATORS AT HIGH PRIORITY MACRO SOCIAL-ECONOMIC VARIABLES • Education level attained * • Average income * • Gini index * • Gross Domestic Product * • Total Social Expenditure * • Total National Expenditure on Health * • Anti-tobacco regulations • Public Expenditure on Health for cancer • Total Public Expenditure on Health * • Private/Non Profit Expenditure on Health for cancer • Age distribution of population in 2010-2020-2030 * • Lifetables * * Connected with other HMP projects

  20. GDP and life expectancy at birth Life expectancy at birth $PPP Yrs I) GDP< 1561172.4 II) 15611>GDP<1753876.7 III) GDP>1753876.8 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Holland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

  21. GDP and cancer incidence $PPP World-age-stand. incidence rate 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

  22. 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

  23. GDP and cancer prevalence Cancer prevalence $PPPproportion 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

  24. GDP and cancer mortality World-age-stand. mortality $PPPrate per 100,000I) 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

  25. EUROCHIP PROVIDES • METHODS FOR DISCUSSING AND PROVIDING ACCEPTED INDICATORS • A LIST OF INDICATORS FOR CANCER • A FUTURE BASE TO STUDY CANCER IN EUROPE WITH THE AIM TO REDUCE INEQUALITIES AND PROMOTE HEALTH Www.istitutotumori.mi.it/project/eurochip/homepage.htm

  26. THOROUGHNESS OF THE INDICATOR LIST Dr. Andrea Micheli

  27. LIST OF EUROCHIP HIGH PRIORITY INDICATORS EPIDEMIOLOGY AND CANCER REG. PREVENTION Coverage of cancer registration Stage at diagnosis Person-years life lost due to cancer Completeness of the registration Tobacco consumption Tobacco abstinence Exposure to asbestos SCREENING TREATMENT AND CLINICAL ASP. Breast cancer screening coverage Cervical cancer screening coverage Colo-rectal cancer screening coverage Organised screening process indicators Interval between diagnosis and first treatment Patients treated by surgery / chemotherapy / radiotherapy Radiation equipment % of centres with at least 2 radiation equipments CAT equipment Compliance with guidelines Palliative care teams MACRO SOCIAL-ECONOMIC VARIABLES Anti-tobacco regulations Indicators on Public Expendit. on Health for cancer Indicators on Private Expend. on Health for cancer

  28. FIRST DISCUSSION Occupational exposure other than asbestos (Update of CAREX) UV light HPV Pesticides ETS Recommendation/Legislation

  29. INDICATORS AT HIGH PRIORITY (1) PREVENTION • Tobacco consumption • Tobacco abstinence • Consumption of fruit and vegetable * • Consumption of alcohol * • Body Mass Index * • Exposure to asbestos • AIDS incidence * • Prevalence of hepatitis B/C * • EPIDEMIOLOGY AND CANCER REGISTRATION • Coverage of cancer registration • Incidence rates * • Survival rates * • Prevalence proportion * • Mortality rates * • Stage at diagnosis • Person-years life lost due to cancer • Completeness of the registration (DCO and Incidence / mortality) • % of microscopically cases * * Connected with other HMP projects

  30. INDICATORS AT HIGH PRIORITY (2) SCREENING 17) Breast cancer screening coverage 18) Cervical cancer screening coverage 19)Colorectal cancer screening coverage 20)Organized screening process indicators TREATMENT AND CLINICAL ASPECTS 21) Interval between diagnosis and first treatment 22) Radiation equipment 23) % of centres with at least 2 radiation equipments 24) CAT Equipments 25) Compliance with guidelines 26)Patients treated by surgery / chemotherapy / radiotherapy 27) Palliative care teams

  31. INDICATORS AT HIGH PRIORITY (3) MACRO SOCIAL-ECONOMIC VARIABLES 28) Education level attained * 29) Average income * 30) Gini index * 31) Gross Domestic Product * 32) Total Social Expenditure * Total National Expenditure on Health * Anti-tobacco regulations Public Expenditure on Health for cancer Total Public Expenditure on Health * Private/Non Profit Expenditure on Health for cancer Age distribution of population in 2010-2020-2030 * Lifetables * * Connected with other HMP projects

  32. PRIORITY LEVELS Dr. Benedetto Terracini

  33. PRIORITY LEVELS ADirect indicator – Important – With or without any problem BIndirect indicator – Important – With or without any problem C Potentially useful but with presenting a great deal of problems D Very low priority – Irrelevant

  34. DO YOU WANT SOMETHING ELSE AT HIGH PRIORITY? Lifestyle Tobacco consumption Tobacco abstinence Consumption of fruit and vegetables * Consumption of alcohol * BMI * Environment Exposure to asbestos PM10 (?) Infection Preval of Hepatitis B/C * AIDS Incidence * Macro economical indicator 5Mv.09a Public expenditure on cancer prevention against tobacco 5Mv.10a Private/Non profit exp. on cancer prevention

  35. Other groups

  36. INDICATORS ON TOBACCO

  37. TOBACCO CONSUMPTION Simple indicator (only cigarettes) Complex indicator (all type of smoking) CONTEXT National survey & Health For All DB SOURCE European survey No problems with the European survey WHO suggests caution in comparison STANDARDIZATION VARIABILITY No indications Relevant VALIDITY Under reporting No indications Advanced conclusion: We suggest an European survey indipendently from the indicator choice

  38. From HEALTH FOR ALL Database

  39. TOBACCO ABSTINENCE % past smokers who quitted tobacco smoking by time since quitting CONTEXT SOURCE European survey STANDARDIZATION No problems with the European survey VARIABILITY Relevant VALIDITY No problems

  40. DISCUSSION ON • Types of smoking to consider in the survey • Periodicity of the survey • Problem of children • Under-reporting: could we assume the uniformity of the under-reporting?

  41. EXPOSURE TO ASBESTOS

  42. EXPOSURE TO ASBESTOS % Employers in naval dockyards Mortality trends for mesothelioma CONTEXT WHO Mortality Database SOURCE Difficult to find Problem of the exposure time STANDARDIZATION No problems Exposure to asbestos is concentrated in small areas VARIABILITY No indications Validation is really difficult Misclassification of cases VALIDITY Advanced conclusion: We suggest to use the mesothelioma mortality indicator

  43. DISCUSSION ON • Other eventual proxy for the indicator • Misclassification of mesothelioma cases First suggestion: Update CAREX Database considering as indicator “Number of exposed workers to carcinogenic”

  44. NEW INDICATORS

  45. DISCUSSION ON • Indicators for environmental risk (PM10…) • Indicators for occupational risk (Radon, PAH…) • Indicators on infection • Other indicators on lifestyle (diet, physical activity…) • Indicators on drugs

  46. EUROPEAN COMMISSION PUBLIC HEALTH PROGRAMS Dr. Andrea Micheli

  47. PUBLIC HEALTH IN EUROPE the European past and next strategy FOCUS ON CANCER past/present in HMP: EUROCHIP and CAMON next: Working Party

  48. Priority areas of thepublic health programme General health policy Health determinants Health information Health threats By Dr. Tapani Piha

  49. Bringing programmes together -2002 Health monitoring Health information Injury Cancer Pollution Aids Rare diseases 2003- By Dr. Tapani Piha

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