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EUROCHIP-1&2

EUROCHIP-1&2. Health Indicators for Monitoring Cancer in Europe. Health Monitoring Program (HMP) EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Presentè par A Micheli, L Cherie Challine, P Baili , J Bloch, P Grosclaude,

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EUROCHIP-1&2

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  1. EUROCHIP-1&2 Health Indicators for Monitoring Cancer in Europe Health Monitoring Program (HMP) EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Presentè par A Micheli, L Cherie Challine, P Baili, J Bloch, P Grosclaude, C Amati, M Velten, F Berrino, C Martinez, M Coleman Www.istitutotumori.mi.it/project/eurochip/homepage.htm

  2. Europe is characterised by unacceptable inequalities - inègalitèes - in cancer control EUROCHIP-1 AIMS AN - travaille - 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 - finalisation- : a) to help the development of the European Health Information System - banque d’information Européenne de la santè c) to promote action in the fight against - contre -cancer

  3. Life expectancy trends 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

  4. GDP and cancer incidence World-age-stand. incidence $PPPrate per 100,000 I) GDP<15611 216 II) 15611<GDP<17538 244 III) GDP>17538 253 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

  5. GDP and cancer survival 5-year cancer relative survival $PPP % I) GDP<15611 31 II) 15611<GDP<17538 43 III) GDP>17538 45 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

  6. GDP and cancer mortality World-age-stand. mortality $PPP rate per 100,000 I) GDP<15611 146 II) 15611<GDP<17538 133 III) GDP>17538 135 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

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

  8. LIST OF INDICATORS PRELIMINARY LIST OF 158 INDICATORS EUROCHIP MEETINGS 52 INDICATORS 26 AT HIGH PRIORITY: 15 NEW INDICATORS (by EUROCHIP)

  9. INDICATORS: AXES OF CLASSIFICATION • The natural history of cancer • Prevention • Screening • Diagnosis • Treatment • End results • 2. Cancer sites

  10. INDICATORS AT HIGH PRIORITY SOCIAL AND MACRO-ECONOMIC DETERMINANTS • Mesures de lutte contre le tabagisme • Coût par patient • Dépenses publiques de santé • Produit intérieur brut

  11. INDICATORS AT HIGH PRIORITY PREVENTION • 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)

  12. INDICATORS AT HIGH PRIORITY SCREENING • 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

  13. INDICATORS AT HIGH PRIORITY CANCER REGISTRATION & EPIDEMIOLOGY • 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

  14. INDICATORS AT HIGH PRIORITY CARE & TREATMENT • 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

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

  16. EUROCHIP-I RESULTS EUROCHIP-2 AIMS • A LIST OF INDICATORS FOR CANCER • TO DEVELOP AN EUROPEAN DATA-BANK • TO ESTABLISH GROUPS AT NATIONAL LEVEL TO DISCUSS INEQUALITIES IN CANCER SURVEILLANCE • TO PROMOTE ACTIONS AGAINST CANCER: AT LEAST ONE IN EACH COUNTRY

  17. EUROCHIP-II: THE AIMS • Extension of the system of EUROCHIP-I cancer networks involving all 25 European countries, new health institutions ... • Liaison with sources 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 information 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.

  18. EUROCHIP-II: EXPECTED RESULTS • 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

  19. EUROCHIP-II: PHASES • Phase 1: Identification of sources of the data pertaining to health indicators. Verify that data are collected as suggested by EUROCHIP-1 • Phase 2: Collection, validation, standardisation of data and unification in a single database • Phase 3: Analysis of data from the database pertaining to a given health indicator in relation to other factors • Phase 4: Identification of problems at the international and national level (e.g. general health inequalities and those pertaining to access and availability) • Phase 5: Assessment of utility of health indicators in promoting effective political action

  20. CANCER SITES (1) • All cancers combined without non melanoma skin cancers for cancer burden and cancer trends. For total cost of cancer care. For Incidence and mortality • 2. Major cancers (in terms of incidence or prevalence) • Lung for 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 • Prostate for future trends and future resources

  21. CANCER SITES (2) • 2. Major cancers • Stomach for monitoring the decreasing trends (ethnic differences) • Head and neck-larynx, oropharynx (specifying ICD-9 code) for prevention and care. Treatment for organ preservation • Melanoma for prevention (early diagnosis-stage migration) • Bladder: for mortality • 3. Other cancers • Kaposi for sentinel • Mesothelioma for sentinel • Testis for rare cancer • Lymphomas (H for health services and NH for trends) and Leukaemia (for treatment) • All childhood (0-14) cancers (for survival) rare cancer • Cervix (for screening) We need information on incidence and mortality (note: corpus uteri vs cervix misclassification)

  22. GDP and cancer prevalence Cancer prevalence $PPP proportion per 100,000 I) GDP<15611 996 II) 15611<GDP<17538 1355 III) GDP>17538 1560 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

  23. EUROCHIP: THE ORGANISATION Steering Committee GS: Groups of specialists Discussion of indicators at national and domain level (prevention, cancer epidemiology, screening, cure & treatment, macro-indicators) Standardised methods for collecting, checking and validating the data proposed for each indicator Working Team Operational work Panel of Experts Discussion & organisation at national level Methodological Group Methodological aspects of the indicators GS GS GS GS GS GS GS

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