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Health Indicators
for Monitoring Cancer in Europe
EUROCHIP-2
the action
Public Health Program
EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL
www.istitutotumori.mi.it/project/eurochip/homepage.htm
EUROCHIP-2 IS BASED ON
THE RESULTS OF EUROCHIP-1
EUROCHIP-1:
a unique public health project,
meetings of uniquely large international consensus on the
necessary information describing cancer and measures
against cancer
Aims: to produce a list of Cancer Health Indicators
to help develop European Health Data Bank
to reduce inequalities in cancer control
PREVENTION
(indicators in ECHI list are underlined)
• Consumption of fruit and vegetables
• Consumption of alcohol
• Body Mass Index distribution in the population
• Distribution of indicators on physical activity in
the population
• Prevalence of tobacco consumption
• Exposure to sun radiation
• Prevalence of occupational exposure to
carcinogens (CAREX)
CARE & TREATMENT
(suggestions for ECHI list)
• % of radiation equipment on population
• % of diagnostic Computed Axial Tomography
(CTS) in the population
• % of patients receiving palliative radiotherapy
• Delay of cancer treatment: pilot studies
• Compliance with best oncology practice
SOCIAL AND MACRO-ECONOMIC
DETERMINANTS
(indicators in ECHI list are underlined)
• Anti- tobacco regulations
• Estimated cost for a cancer patient
• Total Public Expenditure on Health
• Gross Domestic Product
SCREENING
(indicators in ECHI list are underlined)
• Organised screening coverage
• % of women who underwent a mammography
• % of women who underwent a cervical cytology
examination
• % of people who underwent a colorectal cancer
screening test
PIL (1997) e sopravvivenza per tumore a 5 anni dalla diagnosi
5-year- age- and cancer site- adjusted relative survival (women)
L’area del disco è proporzionale alla spesa sanitaria nazionale ($ PPP) nel paese
$ PPP: Parity Purchasing Power per capita (US $) Sources: OECD 2002 for GDP and TNEH; EUROCARE-3 for survival
Tumore al colon – Totale spesa sanitaria nazionale (m+f 1992)
Fonti: EUROCARE-2; Cancer Survival in European Elderly Patients and its Health, Social and Economic Determinants
Tumore alla mammella – Totale spesa sanitaria nazionale (f 1992)
Fonti: EUROCARE-2; Cancer Survival in European Elderly Patients and its Health, Social and Economic Determinants
Total public expenditure on health
and cancer survival - Men
5-year- age- and cancer site- adjusted relative survival
Men - Median values per tertile - 1997 (from Annals, modified, 2003)
$PPP
%
I) Public health expend. < 920
27.3
II) 920 < Public health expend. < 1492
42.0
III) Public health expend. > 1492
44.8
I, Estonia, Poland, Slovakia, Slovenia, Czech Republic, and Spain
II, Finland, UK, Italy, Netherlands, Austria, and Sweden
III, France, Switzerland, Iceland, Denmark, Norway, and Germany
Total public expenditure on health
and cancer survival - Women
5-year- age- and cancer site- adjusted relative survival
Women - Median values per tertile - 1997 (from Annals, modified, 2003)
$PPP
%
I) Public health expend. < 920
41.7
II) 920 < Public health expend. < 1492
53.0
III) Public health expend. > 1492
54.2
I, Estonia, Poland, Slovakia, Slovenia, Czech Republic, and Spain
II, Finland, UK, Italy, Netherlands, Austria, and Sweden
III, France, Switzerland, Iceland, Denmark, Norway, and Germany
Computed Tomography Scanners and
5-year- age- and cancer site- adjusted relative survival (F)
European
team-work for action
and
a bridge between
research and health
authorities
EUROCHIP-2: a
EUROCHIP-2
What’s needed?
a) To liase with cancer data sources
b) To encourage the set-up of data
collection in areas where information
is unavailable
c) To check data quality and promote
standardisation
d) To develop a European health data
bank
EUROCHIP-2
What must be done?
a) Analysis of indicators’ behaviour
b) Identification of deficiencies and
differences in Europe taking into account
health politics
IN ORDER TO
Support actions to reduce inequalities in cancer control
EUROCHIP-2
who by? under which umbrella? through which
phases?
- The EUROCHIP-1 Network
- The European Imprimatur
- A Process Approach
EUROCHIP-2: PROCESS APPROACH
Ex. of health indicator: Breast cancer screening population coverage
Number of countries
25
Start
End
20
15
10
5
0
Check of
screening
databases
Data collection
Data
comparison
Promotion of
screening
EUROCHIP-2 : PROCESS APPROACH
Example of health indicator: Computed Tomography Scanners
Number of countries
25
Start
End
20
15
10
5
0
Check of
sources
Data collection
Data
comparison
Diffusion of CTS
Comparison of the indicators in Finland and Denmark
EUROCHIP-2
Also takes into account the
relation between
cancer and other chronic diseases
Improvement in CVD
and cancer treatment
Life expectancy
increased
Number of cancer
cases is increasing
Inflation of prevalent cases
NEEDS: Actions in
primary prevention
Short term:
assistance, palliative
care, and hospices
Long term: reduction of cases
Health facilities required to manage a wide range
of chronic and degenerative diseases are similar
so that resources and in particular information
resources can be shared
Prevention
Cancer
Smoking
Cardiovascular &
cerebrovascular dis.
Diabetes
Diet
Alcohol
BMI
Others chronic
degenerative dis.
….
Preclinical
phase
Cure Treatment
Assistance
Hospices
Home
assistance
Palliative
care
Rehabilitation
CANCER REGISTRATION &
EPIDEMIOLOGY
• Population covered by cancer registry
• Incidence rates, trends and projections
• Survival rates, trends and projections
• Prevalence prop., trends and projections
• Mortality rates, trends, projections and
person-years life lost due to cancer
• Stage at diagnosis: % of cases with early
diagnosis and % who underwent a metastatic test
CANCER REGISTRIES:
AN IMPORTANT ROLE
High qualified population based information
Permanent organisation
Public health-oriented