Transcript Diapositiva 1

EUROCHIP
Health Indicators for
Monitoring Cancer in
Europe
Health Monitoring Program (HMP)
EUROPEAN COMMISSION
HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL
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EUROCHIP
GROUP OF SPECIALISTS
on
EPIDEMIOLOGY AND
CANCER REGISTRATION
Murcia, 12th-13th November 2002
Chairperson: Dr Carmen Navarro
INTRODUCTION
TO THE
MEETING
Dr. Carmen Navarro
AIMS OF THE MEETING
• An updated list of indicators for “epidemiology and
cancer registration” domain
• A consensual classification of these indicators by priority
• An updated DESCRIPTIVE FORM for each indicator
• Indications on the methodological problems
• Indications on the availability of these indicators
• The list of tumour sites to include in EUROCHIP
• Suggestions on the future role of Cancer Registries as
sources of the EUROCHIP indicators
SUBJECTS OF THE MEETING
FIRST DAY
• Verification of the completeness of the list of indicators
• Discussion about priorities of the indicators
• Discussion on cancer sites to include in EUROCHIP
• Discussion/modification of the forms of the indicators of
this domain
SECOND DAY
• Focus on the future steps of the European
Commission Public Health Programmes
• Discussion on the role of Cancer registries as source of the
indicators (with some examples)
• Next EUROCHIP steps
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 “epidemiology and
cancer registration” 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
EUROCHIP PROJECT:
PRESENTATION
Dr. Andrea Micheli
EUROCHIP INTRODUCTION
AIM: To produce a list of health indicators which describe
cancer in Europe, to help the development of the future
European Health Information System
STEP 1 (Jan 2002 – Jul 2002) : To discuss a preliminary list at national
level, in all members of the European Union. The result was a
list of more than 100 indicators subdivided by priority level
STEP 2 (Sep 2002 – Dec 2002) : To discuss the indicators (of the list
produced at STEP 1) by different domain (prevention, epidemiology and
cancer registration, screening, treatment and clinical aspects, and macro
social-economic variables). To discuss methodological problems for
the indicators at high priority.
STEP 3 (Jan 2003 – May 2003) : Definition of the final list of indicators
subdivided by domain and by priority level.
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EUROCHIP
Comprehensive range of health indicators for cancer:
EUROCARE/EUROPREVAL
CAMON
OCCURENCE
SURVIVAL
RISK FACTORS
LIST
OF
CANCER CARE/
PREVALENCE
CANCER
RECURRENCE
AND MORTALITY
CANCER
INDICATORS
PRE-CLINICAL
ACTIVITY/
SCREENING
DIAGNOSTIC AND
THERAPEUTIC
PROCEDURES
CLINICAL
FOLLOW-UP
Standardised methods for collecting, checking and validating the data
will be proposed for each indicator
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FRAMEWORK OF THE PROJECT
Steering Committee
GS: Groups of specialists
Discussion of indicators at
national and domain level
Working Team
Operational work
Panel of Experts
GS
Discussion &
organization at
national level
GS
GS
GS
GS
Methodological Group
GS
Methodological aspects
of the indicators
GS
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FIRST AND FUTURE STEPS
130
CANCER SPECIALISTS ARE INVOLVED IN EUROCHIP
13
INTERNATIONAL MEETINGS HELD
ALL COUNTRIES OF THE EUROPEAN UNION ARE
PARTICIPATING IN THE PROJECT
Next steps:
 Groups of Specialists in each of five domains (prevention,
screening, data registration and epidemiology, macro-health
variables, and clinical aspects and treatment) discuss the indicators
at the European level.
 Final meeting at which the final selection of indicators will be
drawn up
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RESULTS
For each indicator we compile a FORM subdivided in three sections:
 DESIRED INDICATOR: all indicator characteristics we wish to have
 METHODOLOGY: operational definition, possible sources and
methodological issues
 AVAILABILITY in different countries
LIST OF INDICATORS
PRELIMINARY LIST OF 158 INDICATORS
EUROCHIP MEETINGS
39 INDICATORS AT HIGH PRIORITY
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EUROCHIP FINAL RESULTS
(AT THE END OF STEP 3)
For each indicator at high priority EUROCHIP will produce:
1. A DESCRIPTIVE
•
•
•
FORM
including:
Desired indicators characteristics (definition, use, caveat …)
Operational definition and indications on sources
Indications on availability in all EU member countries
2. A METHODOLOGICAL FORM
•
•
•
including:
Methodological aspects (standardisation, validity, variability)
Bibliography on the indicator
Suggestions to the European Commission
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DESCRIPTION
THOROUGHNESS
OF THE
INDICATOR LIST
Dr. Andrea Micheli
INDICATORS AT HIGH PRIORITY (1)
PREVENTION
1)
Tobacco consumption
2)
Consumption of fruit and vegetable *
3)
Consumption of alcohol *
4)
Body Mass Index *
5)
Exposure to asbestos
6)
AIDS incidence *
7)
Prevalence of hepatitis B/C *
EPIDEMIOLOGY AND CANCER REGISTRATION
8)
Coverage of cancer registration
9)
Incidence rates *
10)
Survival rates *
11)
Prevalence proportion *
12)
Mortality rates *
13)
Stage at diagnosis
* Connected with other HMP projects
14)
DCO *
15)
Incidence / mortality *
16)
% of istological cases *
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INDICATORS AT HIGH PRIORITY (2)
SCREENING
17)
18)
19)
Breast cancer screening coverage
Cervical cancer screening coverage
Performance indicators of organized screening programmes
TREATMENT AND CLINICAL ASPECTS
20)
21)
22)
23)
24)
25)
26)
27)
28)
Interval between first symptoms and diagnosis
Interval between diagnosis and first treatment
Radiation equipment
% of centres with at least 2 radiation equipments
Doctors by specialization
Compliance with guidelines
Patients treated by surgery *
Pain units and hospices
Use of morphine
* Connected with other HMP projects
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INDICATORS AT HIGH PRIORITY (3)
MACRO SOCIAL-ECONOMIC VARIABLES
29)
30)
31)
32)
33)
34)
35)
36)
37)
38)
39)
Education level attained *
Deprivation index *
Income *
Gross Domestic Product *
Total Social Expenditure
Total National Expenditure on Health *
Total National Expenditure on Health for cancer
Total Public Expenditure on Health *
Total Public Expenditure on Health for cancer
% elderly in 2010-2020-2030
Age distribution of population
* Connected with other HMP projects
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LIST OF EUROCHIP HIGH PRIORITY INDICATORS
PREVENTION
1.Tobacco consumption
2.Exposure to asbestos
SCREENING
5.Breast cancer screening coverage
6.Cervical cancer screening coverage
7.Performance indicators of
organized screening programmes
MACRO SOCIALECONOMIC VARIABLES
16.Total National Expenditure
on Health for cancer
17.Total Public Expenditure
on Health for cancer
EPIDEMIOLOGY AND
CANCER REGISTRATION
3.Coverage of cancer registration
4.Stage at diagnosis
TREATMENT AND
CLINICAL ASPECTS
8.Interval between first
symptoms and diagnosis
9.Interval between diagnosis
and first treatment
10.Radiation equipment
11.% of centres with at least
2 radiation equipments
12.Doctors by specialization
13.Compliance with guidelines
14.Pain units and hospices
15.Use of morphine
INDICATOR
PRIORITY
Dr. Willi Oberaigner
PRIORITY LEVELS
A
Direct indicator – Important – With or without any problem
B
Indirect indicator – Important – With or without any problem
C
Potentially useful but with presenting a great deal of problems
D
Very low priority – Irrelevant
DO YOU WANT SOMETHING ELSE
AT HIGH PRIORITY?
EPIDEMIOLOGY AND CANCER REGISTRATION
- Coverage of cancer registration
Epidemiological measures
- Incidence rates * * Connected with other HMP projects
- Survival rates *
- Prevalence proportion *
- Mortality rates *
- Stage at diagnosis
Cancer registration quality:
- DCO *
- Incidence / mortality *
- % of istological cases *
ARE THESE PRIORITIES OK?
A
- Coverage of cancer registration
- Incidence rates *
- Survival rates *
- Prevalence proportion *
- Mortality rates *
- Stage at diagnosis
- Person-years life lost due to cancer
- Completeness
* Connected with other HMP projects
- DCO *
- Incidence / mortality *
- % of istological cases * C
B
- Diagnostic certainty (C factor)
- Mortality within 30 days
- % ER available (breast cancer)
- Disease free survival
- % PR available (breast cancer)
- Survival after recurrences
TUMOUR
SITES
Dr. Eugenio Paci
• The other axis is the Type of cancer for which indicators are
required, e.g.:
• All cancers combined without non melanoma skin cancer
• Major cancers (in terms of incidence or prevalence):
• Lung
• Breast
• Colorectal
• Prostate
• Stomach
• Head and neck (especially relevant for Southern Europe)
• Melanoma
• Sentinel cancers[1]:
• (Kaposi)
• Mesothelioma (for etiology)
• Testis
• Hodgkin
• ALL childhood cancers (for treatment)
• Cervix (for etiology and early diagnosis)
•
[1] Chosen for their avoidability, curability, detectability (…).
Measures of occurrence
•
•
•
•
•
•
•
•
Absolute number (EU, per country)
Crude rate (EU, per country)
Cumulative rate (by 0 to , or 50 to xx)
Age-adjusted rate
Survival rate (1, 5, 10)
Survivors (childhood and ..)
Prevalence (Total, 1, 3 ,5 years)
Trends (annual and period variation)
All sites
• Total burden of cancers in Europe and for
each country, for childhood and adults
separately. Prevalence rate is important.
• Trends estimation (age adjusted) as
indicator of success or natural changes
• Long survivors relevant in sickness
perception
• Crude vs adjusted rate: success vs burden
All sites
• All sites or site specific changes in
occurrence rates are usually of difficult
interpretation
• Specific age-group at risk or especially
exposed to prevention or risk factors
• Ex: trends in lung cancer in new cohorts
The impact of preventive action
• All sites minus ….. To assess the
contribution of a preventable cancer
(minus lung cancer or the % attributable to
smoking …. Or impact of all screening
programmes … or ) , by sex or specific
age
All sites
• All cancer mortality as indicator of the
burden of end of life care . The palliative
care need, the technological impact of end
of life care , the cost ( human and
economic ) of the last year of life.
Major cancers : by incidence,
mortality or survival?
• Breast Cancer : incidence is increasing
(screening) and survival improving
• Lung cancer : age adjusted incidence is
decreasing and survival is continuing to be very
poor
• Prostate cancer : incidence and survival are
increasing, but still a relevant cause of mortality.
What happens?
• Colorectal cancer: increasing occurrence and
early diagnosis . Are there true variations in
mortality trends ?
Specific sites
• Trends in mortality or incidence can not be
easily attributed to one preventive action
or risk factor
• The major part of screening programmes
(breast , colorectal cancer) needs long
time in order to show an impact
• The impact is expected on specific age
groups and evaluation of age adjusted
trends might be not sensitive enough
Rare cancers
• What is rare?
• The relevance of risk factors for specific
rare conditions
• Mesothelioma and asbestos exposure
• Leukemia and NHL and occupational and
rnvironmental exposures
• S. Kaposi and HIV
Rare Cancers
• If the exposure is well known risk factor , the
exposure indicator is the most important
• Treatment and care access, support are crucial
in rare diseases and usually related to
socioeconomic condition.
• It is important to assess the communication
system in each country in order to evaluate
access
AXES OF CLASSIFICATION
1. The natural history of cancer
• Prevention
• Screening
• Diagnosis
• Treatment
• End results
2. ECHI classification
• Demographic and social-economic factors
• Health status
• Determinants of health
• Health system
3. Tumour sites
DISCUSSION ON 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
- 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
Other 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. For quality of life
- Melanoma for prevention (early diagnosis-stage migration)
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 (or just Leukaemia?) childhood (0-14) cancers (for
survival) rare cancer we have to choose the sites particularly
related with treatment and burden
- Cervix (for screening) We need information on incidence and
mortality (note: corpus uteri vs cervix misclassification)
COVERAGE OF
CANCER REGISTRATION
Dr. Andrea Micheli
COVERAGE OF CANCER REGISTRATION
CONTEXT
SOURCE
Population-based Cancer registry coverage
by duration of registration. Example
IARC, ENCR and National Cancer
Registry Associations
STANDARDIZATION
No problems
VARIABILITY
No problems
VALIDITY
No problems
DESCRIPTIVE FORM
METHODOLOGICAL FORM
Example of
COVERAGE OF CANCER REGISTRATION
The values of the coverage of cancer registration are indicative:
% national coverage of cancer registration
COUNTRY
2000
1995
1990
1980
1970
D
100
100
100
100
100
M
100
100
70
0
0
E
100
100
50
30
15
Sl
100
100
100
70
70
S
100
100
70
50
30
Indicator characteristics
• Only population-based Cancer Registries
• By site for Cancer Registries
– Which are these sites?
•
•
•
•
•
•
•
All
Colorectal cancers
Digestive cancers
Breast and gynaecological cancers
Childhood cancers
Haematological malignancies
Others?
DESCRIPTIVE FORM
STAGE AT DIAGNOSIS
Dr. Carmen Martinez
Staging cancer
To assess the size of a tumour and its
extent of involvement throughout the
body
Staging Systems
For “all” cancers
• SEER
(USA)
Summary
Staging:
• TNM System: UICC /AJCC
NCI
SEER Summary
Staging
• In situ
• Localized
• Regional
– direct extension to adjacent organs or tissues
– lymph node involvement
– direct extension and lymph node involvement
• Distant Metastasis
TNM System. General
rules
T -- Extent of the primary tumour
N -- Absence or presence and extent of
regional lymph node metastasis
M -- Absence or presence of distant
metastasis
Condensed TNM. ENCR
It should be based in all (the best)
available
information
clinical and pathological
Condensed TNM
Tabulation of results
• Tumour localized:
TL, N0, M0
• Local Spread:
TA, N0, M0
• Regional Spread:
any T, N +, M0
• Advanced cancer:
Metastatic any:
M+
T,
Non-resectable tumours:
MX
• Unknown Extent
any
N,
Condensed TNM
Certainty - Factor
C-factor: certainty of the information on
wich the TNM staging was based
C1.
Standard
radiography)
methods
(palpation,
C2. Special diagnostic means:
imaging: CT scan, ultrasound,
lymphograqphy...
endoscopic biopsy or cytology
Cp- Postsurgical or autopsy histopathology
Staging Systems
For some cancers TNM is not
used
• Lymphomas
• Leukaemia
• Brain
• Chilhood cancers
Stage at diagnosis
Descriptive Form
Stage at diagnosis
• Cancer type: Solid tumours
• Relevance: Diagnosis
• Category: Health status
Stage at diagnosis
• Generic definition:
% of incident cases classified with
Condensed TNM Classification by
site
• Rationale:
Early/late diagnosis
• Utility:
Determinant of treatment and prognosis
Stage at diagnosis
• Caveat:
“T localized”: differences by site
For most tumours: T1 + T2
For breast or skin: T1 + T2 +T3
For ovary: T1
Stage at diagnosis
• Gender:
Male and female separately
• Age:
By age class
Stage at diagnosis
Modalities of classification:
Condensed TNM
Stage at diagnosis
Methodological Form
Stage at diagnosis
Indicator context
• Percentage of cancer cases classified
with condensed TNM by site, sex and age.
• The expected value of this percentage is
site dependent. For some sites (like lung)
the expected value of the indicator is lower
than 100%, but comparisons among
countries are still informative.
Stage at diagnosis
Indications on data
collection
sources are the Cancer Registries
•The
performing specific studies for major cancer
sites.
•At the moment, the TNM data collection is
not usual in the cancer registration.
•Sometimes, we have information on TNM
classification for areas covered by organized
screening programs and only for the
screening sites.
Stage at diagnosis
Standardization
• Recommend to use the Condensed TNM
classification proposed by the ENCR
(European Network of Cancer Registries).
•Moreover we need the C Factor for
examining metastatic cases
Stage at diagnosis
Variability within countries
The variability within countries might
be relevant.
Stage at diagnosis
Validity
• Cancer Registry data can be validated
using specific studies such as the
“EUROCARE High Resolution Studies”.
Stage at diagnosis
Suggestions to the European Commission
To subsidize Cancer Registries in
order to collect systematically
data on condensed TNM . In the
first
years
we
will
have
to
recommend clinician to indicate
the stage in the clinical reports
TNM System. C - Factor
Certainty
factor:
validity
classification
according to the diagnostic methods employed
C1Standard
radiography)
methods
(palpation,
C2- Special diagnostic means (CT, biopsy...)
C3- Surgical explorations, including biopsy
C4- Definitive surgery with pathological exam
C5- Autopsy
Condensed TNM Scheme
ENCR Recommendations
T:
L (Localised)
N:
0
+
X
M:
0
+
X
A (Advanced)
X
INDICATORS OF QUALITY
OF CANCER REGISTRATION
Dr. Carmen Navarro
DCN (Death Certificate Notification) &
DCO (Death Certificate Only)
Completeness
(Parkin et al Method)
1
(1-DCN) + (DCN/M:I)
EUROPEAN COMMISSION
PUBLIC HEALTH
PROGRAMS
Dr. Andrea Micheli
PUBLIC HEALTH
IN EUROPE
• the European past and next strategy
FOCUS ON CANCER
• past/present in HMP: EUROCHIP and
CAMON
• next: Working Party
Priority areas of
the public health programme
General health policy
Health
information
Health determinants
Health threats
By Dr. Tapani Piha
Bringing programmes
together
-2002
Health monitoring
Injury
Health
Cancer
Pollution
Aids
information
Rare diseases
2003By Dr. Tapani Piha
Bringing programmes
together
-2002
Health monitoring
Injury
Health
Cancer
Pollution
Aids
information
Rare diseases
2003By Dr. Tapani Piha
Public health programme
Implementation focus
• European added value
• Large scale (in content and geographical
coverage) multi-annual and multidisciplinary
• Lead to sustainable results and outputs
• Relevant and contribute to policy development
• Attention to the evaluation of the process and
results
By Dr. Tapani Piha
Stages in data processing
Stage 3
Data collection,
processing and storage
at EU level
Stage 4
Analysis, advice,
reporting, informing
and consulting
Stage 5
Mechanisms for
exchanging, promoting
and disseminating
results
Stage 2
Support to
data collection
at national level
Stage 1
Data definition
and
quality development
By Dr. Tapani Piha
INDICATOR OF
DELAY OF CARE
Dr. Gemma Gatta
DELAY OF CARE:
PHASES OF THE DISEASE HISTORY
SYMPTHOM: there is not an event and it is not strictly definid
on time
FIRST MEDICAL ATTENDANCE: date in which patient
reports his sympthoms to the Health System
DIAGNOSIS: date defined using the conventional date index
of Cancer Registries
FIRST TREATMENT: Date of the beginning of primary
treatment
DEFINITIVE TREATMENT: ?
INDICATORS ON DELAY OF CARE:
INTERVAL BETWEEN FIRST SYMPTOMS AND DIAGNOSIS
and INTERVAL BETWEEN DIAGNOSIS AND TREATMENT
CONTEXT
SOURCE
STANDARDIZATION
VARIABILITY
VALIDITY
DESCRIPTIVE FORM
We suggest to use the distance between
first medical attendance and diagnosis and
between diagnosis and first treatment
Cancer Registries The dates have to be in the
form DD/MM/YY
We need exact definitions of the phases of
the disease history for some cancer sites
Relevant
A lot of problems
METHODOLOGICAL FORM
FIRST MG RESULTS
• study colon, cervix and breast cancers
• distinguish between screening clinical diagnosis
• use the date of pathological confirmation as the date of
diagnosis
• use the date of first medical attendance as the first stage
of the disease
• A1.4Tr.2 interval is from date of pathological
confirmation and start of first treatment
The sources are the Cancer Registries. For frequent cancer
sites as breast, cervix and colorectal a sample of cases
could be studied.
To define these intervals, Cancer Registries have to collect
data in the form DD/MM/YY with the consequent attention
at the privacy problem. However, the indicator is an
average interval without any problem of privacy.
MG Results: FIRST MEDICAL ATTENDANCE
The group defines this event as the first medical
attendance reporting symptoms for the cancerous
disease.
For cases discovered by screening procedures, either
organized or spontaneous (breast, cervix, colorectum),
we consider positive mammography, PAP smear, and
colonscopy as first medical attendance. People at high
risk or presenting suspicious symptoms who are under
observation with repeated examinations are assimilated
to spontaneous screening with respect to first medical
attendance definition
MG Results: PATHOLOGICAL CONFIRMATION
Pathological confirmation (histology) is assumed as the
major clinically significant event associate to diagnosis.
Patients following their first medical attendance are
addressed to perform a diagnostic procedure including
biopsy. Pathological confirmation following biopsy
defines diagnosis and is a basic information for
treatment. Cases discovered by screening follow the
same diagnostic procedure and the pathological
confirmation defines the diagnosis. This is valid for
breast, colorectal, and cervical cancers either screening
or symptomatic patients
MG Results: FIRST TREATMENT
First treatment represents the start of a defined
treatment for a patient. This would include any
treatment that that is defined as a starting point in a
protocol, not always the principal treatment.
As an example, radiotherapy is sometimes the first
treatment before surgery for cervical cancers, and
treatment with tamoxifen before surgery for breast
cancer. We will consider as first treatment radiotherapy
and tamoxifen, instead of surgery that is the principal
treatment, in these cases
COMPLIANCE
WITH
GUIDELINES
Dr. Carmen Martinez
COMPLIANCE WITH GUIDELINES
CONTEXT
SOURCE
STANDARDIZATION
VARIABILITY
VALIDITY
DESCRIPTIVE FORM
We need to collapse the guidelines in a few
items
Cancer registries
Studies should be conducted using a
common protocol and criteria
Relevant
To use studies as “High resolution studies”
METHODOLOGICAL FORM
First MG Results
The indicator is aimed to reflect the deviance to best practice
in oncology. It implies the existence of specific professional
guidelines and express something related to the attitude to
comply with guidelines rather best practice. To give an
indication on the patients treated according to the guidelines,
we need to collapse the guidelines themselves into a few
simple items. As guidelines usually refer to cases that can be
potentially cured, the indicator should refer to patients
potentially eligible for treatment according to guidelines.
An examination of the “deviation” from guidelines is usually
more robust than a look at their “adherence”. The medical
attitude in following guidelines may vary considerably and
thus, is very difficult to classify. Defining the non-adherence
is easier and more robust.
Example
As an example, Sant (2001) showed that in Southern Italy
a very low proportion of breast cancer patients T1N0M0
were treated with conservative surgery while the majority
receiving Hastled mastectomy. This a clear deviation to
guidelines, although motivated by lack of radiotherapy
centres in the area.
Source: Sant M, and the EUROCARE Working Group: Differences in stage and
therapy for breast cancer across Europe. International Journal of Cancer 93: 894-901
(2001)
SOURCE
The indicator is a new indicator
The sources should be the Cancer Registries.
The Methodological group suggests specific studies on
sample of cases in order to collect information on therapy
and stage, such as the EUROCARE High Resolution
Studies
FINAL DISCUSSION
1. All cancers combined without non melanoma skin
cancers
2. Major cancers (in terms of incidence or prevalence)
- Lung
- Breast
- Colorectal
LIST
- Prostate
OF
- Stomach
CANCER - Head and neck-larynx, oropharynx (specifying ICD-9
SITES
code)
- Melanoma
3. Other cancers
- Kaposi
- Mesothelioma
- Testis
- Lymphomas (H and NH) and Leukaemia
- All (or just Leukaemia?) childhood (0-14) cancers
- Cervix (note: corpus uteri vs cervix misclassification)
P
R
I
O
R
I
T
I
E
S
A
- Coverage of cancer registration
- Incidence rates *
- Survival rates *
- Prevalence proportion *
- Mortality rates *
- Stage at diagnosis
- Person-years life lost (NEW)
- Completeness of the registration (NEW)
(DCN/DCO *, Incidence / mortality *)
- % of microscopical cases *
B
C
- Diagnostic certainty (C factor)
- % ER available (breast cancer)
- % PR available (breast cancer)
- Mortality within 30 days
- Disease free survival
- Survival after recurrences
STAGE AT DIAGNOSIS Descr. Form
• Cancer type: Breast, colorectal cancer
• Relevance: Diagn., treatm., surv. and end results
• Generic definition: proportion of incidence cases
classified with the TNM value or, in absence, with
condensed-TNM. (The non-metastatic cases will be
classified by presence or absence of a specific test
for the detection of the metastasis)
• Rationale: Early/late diagnosis
• Utility: Determinant of treatment and prognosis
• Caveat: problems
• Modalities of classification: TNM or cond. TNM
(+ non-metastatic cases with/without detection test)
• By sex and by age
STAGE AT DIAGNOSIS Method Form
• Suggestions to the EC: to subsidize CR. In the
first years we will have to recommend clinicians to
indicate the stage in the clinical reports
• Source: CR with High resolution studies
• Does the introduction of TNM values (and not
only of cond. TNM) produce standardization
problems? YES
• Do we consider all incidence cases or sample?
If sample, periodically or routinary?
• What about insitu? We need data => suggestion
to CR to collect data
• Which are the detection tests of metastasis?
=> For treatment domain
PERSON-YEARS LIFE LOST DUE TO CANCER
• Cancer type: All sites combined
• Relevance: end results
• Generic definition: years lost due to cancer using
general life expectancy as reference
• Rationale: synthesize in a single measure the
effects of cancer in a given population compared
with competitive diseases
• Utility: Particularly useful for countries which do
not have cancer registration. Single measure able to
express the impact of cancer in premature mortality
• Caveat: no problems
• Modalities of classification: no
• By sex: yes By age: no
• Methodological problems -> MG
COMPLETENESS OF THE REGISTRATION
• Cancer type: same of the “cr coverage” indicator
• Relevance: same of the “cr coverage” indicator
• Generic definition: Completeness measure
proposed by the ENCR Working Group
• Rationale: indication of the quality of registration
• Utility: to assess the precision of the national rate
estimates
•Caveat: confidentiality, different ways of processing
Death certificates in cancer registries
• Modalities of classif.: no By sex: no By age: no
• EC Suggestions: recommend the EC to verify or
update existing recommendations on confidentiality
in order to allow an access to Death Certificates