Transcript Slide 1

The International Cancer Benchmarking
Partnership (ICBP):
A model for international collaboration
Professor Sir Mike Richards
Copenhagen
April 2012
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The International Cancer Benchmarking Partnership (ICBP)
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Why do we need an international partnership?
Who is involved?
What are we doing?
Successes and challenges
How are we using the findings from ICBP in the UK
Possible lessons for future collaborations
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Why do we need an international collaborative? (1)
• We already have a considerable amount of internationally
comparable data on cancer e.g.
– Incidence (Globocan: IARC)
– Mortality (IARC; OECD)
– Survival (EUROCARE; CONCORD – but only for patients
diagnosed more than 10 years ago)
– Chemotherapy (International variations report 2010)
– CT and MRI scanners (OECD)
– Radiotherapy facilities (OECD)
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Why do we need an international collaboration? (2)
• But ... there’s a lot we do not know, because we do not
collect routine data
• Better information could help individual countries to
formulate policy to improve outcomes
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Gaps in information
• What didn’t we know at start of ICBP?
– Up to date comparisons of survival
– Reasons for variations on survival
• What we still don’t know
– Differences in access to care and use of diagnostics
– Differences in treatment rates
– Differences in quality of life of survivors
– Differences in patients’ experience of care
– Differences in costs of cancer care
– Etc.
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European Country Selection:
National Cancer Registration
National Coverage of Cancer Registration (%)
Germany
Poland
Czech Republic
France
Spain
Italy
Switzerland
Netherlands
Portugal
Belgium
Slovenia
Malta
Austria
UK
Scandanavia
0
6
20
40
60
80
100
ICBP: Who is involved? (1)
• 6 countries; 12 Jurisdictions
– Australia (New South Wales; Victoria)
– Canada (British Columbia, Alberta, Manitoba
and Ontario)
– Denmark
– Norway
– Sweden
– UK (England, Wales and Northern Ireland)
• Jurisdictions selected on basis of comprehensive
cancer registration and willingness to participate
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ICBP: Who is involved? (2)
• A very large number of policy makers, cancer registry staff,
epidemiologists, academic clinicians, behavioural scientists
• A Programme Board with representation from each
jurisdiction (funders)
• Module teams
• Programme management secretariat
– Initially McKinsey’s
– Now Cancer Research UK
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ICBP: What are we doing?
• Two key questions are being addressed
– How has survival changed between 1995 and 2007?
– Can we explain international differences in survival?
• Focusing on 4 cancers
– Breast, colorectal, lung and ovarian cancer
• 5 Modules
– Module 1: Epidemiology (survival, stage + treatment)
– Module 2: Survey of public awareness, beliefs and behaviours (study
specific survey tool)
– Module 3: Survey of primary care physicians
– Module 4: Newly diagnosed patients – Routes to diagnosis, delays,
stage and treatment
– Module 5: To be decided
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ICBP: Successes
• The partnership is now well established. Partners are enthusiastic
about working together
• Module 1
– Survival comparisons published (Lancet 2011)
– New methods for comparing different staging systems
(“esperanto” for stage) submitted for publication
– Stage and survival papers x 4: Submitted
• Module 2
– Survey tool developed and survey conducted in all 6 countries
– Methods and results papers: completed
• Module 3
– In progress
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ICBP Module 1: Lancet paper
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ICBP: 5 year relative survival. Coleman et al, Lancet 2011
70
20
AUS
CAN
SWE
NOR
DEN
65
UK
AUS
CAN
CAN
18
AUS
16
SWE
60
55
SWE
NOR
14
DEN
12
NOR
UK
DEN
10
50
UK
8
45
6
1995-99
2000-02
2005-07
1995-99
2000-02
2005-07
Lung Cancer 5yr RS
Colorectal Cancer 5yr RS
90
45
SWE
AUS
85
CAN
NOR
CAN
NOR
40
AUS
DEN
80
UK
UK
DEN
35
75
70
1995-99
AUS
2000-02
Breast Cancer
5yr
CAN
SWE
NOR
2005-07
RS DEN
UK
30
1995-99
AUS Ovarian
CAN
2000-02
Cancer
RS
NOR 5yrDEN
2005-07
UK
ICBP: 1 year relative survival. Coleman et al, Lancet 2011
90
45
AUS
CAN
SWE
NOR
DEN
SWE
UK
AUS
85
CAN
40
SWE
AUS
CAN
80
NOR
NOR
35
DEN
DEN
75
UK
UK
30
25
70
20
65
1995-99
2000-02
1995-99
2005-07
Colorectal Cancer 1yr RS
2000-02
2005-07
Lung Cancer 1yr RS
100
80
SWE
98
NOR
75
CAN
AUS
CAN
AUS
96
70
DEN
NOR
DEN
94
UK
65
UK
60
92
55
90
1995-99
AUS
2000-02
BreastSWE
CancerNOR
1yr
CAN
2005-07
RSDEN
UK
50
1995-99
AUS
CAN
Ovarian
2000-02
2005-07
NOR
DEN RS UK
Cancer
1yr
ICBP: Challenges
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ICBP: Challenges
• Programme Board meetings: Finding an acceptable time of day for
participants from 3 continents!
• Funding
– Department of Health in England funded Module 1. This enabled
trust and understanding to develop within the partnership
– Shared funding for other modules – difficult to get jurisdictions to
commit
• Timescales
– Time costs money
– Getting the balance right between ‘quick and dirty’ and
‘academically rigorous’
• Ensuring comparability of data/survey tools. Harmonisation between
languages
• Sustainability
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How are we using the findings in England?
• The Government has set a goal of “saving an additional 5000
lives” from cancer by 2014/15. In effect this means halving
the gap between England and the best in Europe (or around
the world)
• We are now converting the “5000 lives” into 1 and 5 year
survival rates for breast, colorectal and lung cancer
• The findings have re-emphasised the need to focus on early
diagnosis of cancer. A National Awareness and Early
Diagnosis Initiative is in progress
Breast cancer: 5 year relative survival, England v.
combined Australia, Sweden and Canada
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Colorectal cancer: 5 year relative survival, England v.
combined Australia, Sweden and Canada
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Lung cancer: 5 year relative survival, England v.
combined Australia, Sweden and Canada
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Be clear on cancer: Bowel cancer
Lung Cancer Campaign
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Possible lessons for future collaborations
• International collaborations are hard work, take time and
cost money ... but can yield very valuable insights
• There is still a great deal of scope for going further on cancer
(e.g. Other outcomes apart from survival) and inclusion of
other countries
• There is potential to look at other disease areas (e.g.
cardiovascular) if adequate datasets exist – and if there is
sufficient interest
• Excellent programme management is essential
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