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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
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
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
GDP and cancer incidence
World-age-stand. incidence
$PPP
I) GDP<15611
II) 15611<GDP<17538
III) GDP>17538
rate per 100,000
216
244
253
I, Estonia, Poland, Slovenia, Slovakia, and Spain;
II, UK, Finland, Netherland, Sweden, Italy, and Austria;
III, Iceland, Denmark, France, Germany, and Switzerland
GDP and cancer survival
5-year cancer relative survival
$PPP
I) GDP<15611
II) 15611<GDP<17538
III) GDP>17538
I, Estonia, Poland, Slovenia, Slovakia, and Spain;
II, UK, Finland, Netherland, Sweden, Italy, and Austria;
III, Iceland, Denmark, France, Germany, and Switzerland
%
31
43
45
GDP and cancer mortality
World-age-stand. mortality
$PPP
rate per 100,000
I) GDP<15611
II) 15611<GDP<17538
III) GDP>17538
I, Estonia, Poland, Slovenia, Slovakia, and Spain;
II, UK, Finland, Netherland, Sweden, Italy, and Austria;
III, Iceland, Denmark, France, Germany, and Switzerland
146
133
135
Gross Domestic Product and
5-year- age- and cancer site- adjusted relative survival (m)
The area of the disk is proportional to the Total National Health Expenditure ($ PPP) in the country
$ PPP: Parity Purchasing Power per capita (US $) Sources: OECD 2002 for GDP and TNEH; EUROCARE-3 for survival
LIST OF INDICATORS
PRELIMINARY LIST OF 158 INDICATORS
EUROCHIP MEETINGS
52 INDICATORS
26 AT HIGH PRIORITY:
15 NEW INDICATORS (by
EUROCHIP)
INDICATORS: AXES OF CLASSIFICATION
1. The natural history of cancer
• Prevention
• Screening
• Diagnosis
• Treatment
• End results
2. Cancer sites
SOCIAL AND MACRO-ECONOMIC
DETERMINANTS
• Mesures de lutte contre le tabagisme
• Coût par patient
• Dépenses publiques de santé
• Produit intérieur brut
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)
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
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
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
Computed Tomography Scanners and
5-year- age- and cancer site- adjusted relative survival (F)
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
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.
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
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
CANCER SITES (1)
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
Breast for monitoring screening programmes (mortality and
incidence) and to evaluate the care (tamoxifen)
Colorectal to evaluate the care, evaluation of early diagnosis (and
screening programmes ). For delay of diagnosis
Prostate for future trends and future resources
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)
GDP and cancer prevalence
Cancer prevalence
$PPP
I) GDP<15611
II) 15611<GDP<17538
III) GDP>17538
proportion per 100,000
996
1355
1560
I, Estonia, Poland, Slovenia, Slovakia, and Spain;
II, UK, Finland, Netherland, Sweden, Italy, and Austria;
III, Iceland, Denmark, France, Germany, and Switzerland
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)
Working Team
Operational work
Standardised
methods for
collecting,
checking and
validating the
data proposed
for each
indicator
Panel of Experts
GS
Discussion &
organisation at
national level
GS
GS
GS
GS
GS
Methodological Group
GS
Methodological aspects
of the indicators