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HMP: Health Monitoring Programme
EUROCHIP - EUROpean Cancer Health Indicators Project
A project supported by the European Commission
Andrea Micheli1, Paolo Baili1, Carmen Martinez2, Riccardo Capocaccia3, Jan Willem Coebergh4, Arduino Verdecchia3, Franco Berrino1, Eugegno Mugno1, Camilla Amati1, and Michel Coleman5
of Epidemiology – Istituto Nazionale per la Cura e lo Studio dei Tumori – Milan (I) – 2 Granada Cancer Registry – Escuela Andaluza de Salud Publica – Granada (E), 3 Laboratory of Epidemiology and Biostatistics –
Istituto Superiore di Sanità – Rome (I), 4 Comprehnsive Cancer Centre South Eindhoven Cancer Registry – Eindhoven (NL), 5 Cancer and Public Health Unit – London School of Hygiene & Tropical Medicine – London (UK)
1 Unit
BACKGROUND
AIMS
EUROCHIP was implemented in Europe to set
indicators for all health aspects as part of the European
Commission Health Monitoring Programme (HMP).
Main aim of EUROCHIP was to promote an established
surveillance system on cancer in Europe.
EUROCHIP aimed to produce, through an intellectual
work, a comprehensive list of health indicators
pertaining to cancer, with variables on cancer prevention,
registration and epidemiology, screening, treatment and
clinical aspects and social and macro-economic
information related with health.
Discussion was based on different axes: the main one
being “disease natural history”.
METHODS
MAIN AXIS OF DISCUSSION
130 CANCER SPECIALISTS
RISK FACTORS
/ PREVENTION
OUTCOME
LIST
CARE
PREVALENCE
OF
CANCER
INDICATORS
CANCER
RECURRENCES
PRE-CLINICAL
ACTIVITY
OCCURENCE
CLINICAL
FOLLOW-UP
DIAGNOSTIC AND
THERAPEUTIC
PROCEDURES
23 INTERNATIONAL MEETINGS
PARTICIPATION of ALL EU COUNTRIES
Each indicator was discussed by experts of different
background, who described it by its general presentation,
operational definition, meaning, possible use, caveat,
modalities of classification, possible source, standardisation
and validity.
The final list resulted from various discussions on priorities:
on added value to the indicator, problems and cost relative to
data collection and on the comparability between European
countries.
RESULTS
CLASSIFICATION OF INDICATORS
PRELIMINARY
LIST OF 158
INDICATORS
DISCUSSIONS
52 INDICATORS:
26 AT HIGH PRIORITY
30 NEW INDICATORS
PROPOSED BY
EUROCHIP
www.istitutotumori.mi.it/project/eurochip/homepage.htm
PRIORITY
Prevention
Epidemiology-cancer registration
Screening
Treatment
Social-economic variables
TOTAL
HIGH
7 (2
2)
7 (3
3)
4 (4
4)
5 (5
5)
3 (1
1)
26 (1
15 )
MEDIUM
4 (2
2)
7 (7
7)
3 (3
3)
12 (4
4)
26 (1
15)
In parenthesis number of new indicators proposed by EUROCHIP
LIST OF INDICATORS AT HIGH PRIORITY
PREVENTION
SCREENING
1) Consumption of fruit and vegetables
15) Percentage of women that have undergone a
2) Consumption of alcohol
mammography (breast cancer)
3) Body Mass Index distribution in population
16) Percentage of women that have undergone a cervical
4) Physical activity
citology examination (cervical cancer)
5) Tobacco survey
17) Percentage of persons that have undergone a colo-rectal
6) Exposure to sun radiation
cancer screening test (colorectal cancer)
7) Prevalence of occupational exposure to
18) Organized screening coverage
carcinogens
TREATMENT AND CLINICAL ASPECTS
EPIDEMIOLOGY AND REGISTRATION
19) Delay of cancer treatment (pilot studies)
8) Population covered by Cancer Registries
20) Percentage of radiation systems in the population
9) Cancer incidence rates and trends
21) Percentage of diagnostic CAT (Computed Axial
10) Cancer relative survival rates and trends
Tomography) systems in the population
11) Cancer prevalence proportions and trends
22) Compliance with best oncology practice
12) Cancer mortality rates, trends and person23) Percentage of patients receiving palliative radiotherapy
years of life lost due to cancer
MACRO SOCIAL-ECONOMIC VARIABLES
13) Stage at diagnosis: percentage of cases
24) Gross Domestic Product
with early diagnosis
25) Total Public Expenditure on Health
14) Stage at diagnosis: percentage of cases
26) Estimated cost for a cancer patient
with a metastatic test
KEY: shared with Health Monitoring Programme projects
KEY: proposed by EUROCHIP alone
SOURCES
Sources for the indicators were classified as follows:
a) international databanks already available (26 indicators)
b) health surveys (22 indicators)
c) Cancer Registries (4 indicators)
CONCLUSIONS AND FUTURE
EUROCHIP achieved to gather guidelines for the health
information system in Europe on cancer.
Final goal of EUROCHIP was to find information able to
describe differences and also to promote action that would
reduce inequalities in managing cancer. This is the core of the
ongoing EUROCHIP-2 project.
To reduce inequalities across Europe, some countries have to
prioritise action on prevention, others on care, others on
surveillance. However, it is vital for each countries’ success in
the fight against cancer, that the trans-national European
nature of the study is maintained at all levels of data
collection, data analysis, problem evaluation, and action.
EUROCHIP-2 will add value to each countrie’s actions by
stimulating data comparison and providing a unified European
imprimatur to cancer action. EUROCHIP-2 will try to:
 SET UP DATA COLLECTION
 ANALYSE THE BEHAVIOUR OF VARIOUS
INDICATORS IN RELATION TO THEIR UTILITY
 IDENTIFY DEFICIENCIES IN EUROPEAN HEALTH
SYSTEMS
 ENCOURAGE ACTIONS TO REDUCE
INADEQUANCIES IN CANCER CONTROL