EUROCHIP-2EUROCHIP-2the actionthe action

Health Indicators Health Indicators for Monitoring Cancer in Europefor Monitoring Cancer in Europe

www.istitutotumori.mi.it/project/eurochip/homepage.htmwww.istitutotumori.mi.it/project/eurochip/homepage.htm

Public Health ProgramPublic Health ProgramEUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERALEUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL

EUROCHIP-2 EUROCHIP-2 IS BASED ONIS BASED ON THE RESULTS OF EUROCHIP-1 THE RESULTS OF EUROCHIP-1

EUROCHIP-1: EUROCHIP-1: a unique public health project, a unique public health project, meetings of uniquely large international consensus on the meetings of uniquely large international consensus on the necessary information describing cancer and measures necessary information describing cancer and measures against canceragainst cancer

Aims: Aims: to produce a list of Cancer Health Indicators to produce a list of Cancer Health Indicators to help develop European Health Data Bankto help develop European Health Data Bankto reduce inequalities in cancer controlto reduce inequalities in cancer control

PREVENTIONPREVENTION(indicators in ECHI list are underlined)(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)

• % 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

CARE & TREATMENTCARE & TREATMENT (suggestions for ECHI list)(suggestions for ECHI list)

• Anti- tobacco regulations

• Estimated cost for a cancer patient

• Total Public Expenditure on Health

• Gross Domestic Product

SOCIAL AND MACRO-ECONOMIC SOCIAL AND MACRO-ECONOMIC DETERMINANTSDETERMINANTS

(indicators in ECHI list are underlined)(indicators in ECHI list are underlined)

SCREENINGSCREENING (indicators in ECHI list are underlined)(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

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

PIL (1997) e sopravvivenza per tumore a 5 anni dalla diagnosi5-year- age- and cancer site- adjusted relative survival (women)

Tumore al colon – Totale spesa sanitaria nazionale (m+f 1992)Tumore al colon – Totale spesa sanitaria nazionale (m+f 1992)

FontiFonti: EUROCARE-2EUROCARE-2; Cancer Survival in European Elderly Patients and its Health, Social and Economic Determinants

Tumore alla mammella – Totale spesa sanitaria nazionale Tumore alla mammella – Totale spesa sanitaria nazionale (f 1992)(f 1992)

FontiFonti: EUROCARE-2EUROCARE-2; Cancer Survival in European Elderly Patients and its Health, Social and Economic Determinants

5-year- age- and cancer site- adjusted relative survivalMen - Median values per tertile - 1997 (from Annals, modified, 2003)

$PPP %

I) Public health expend. < 920I) Public health expend. < 920 27.327.3

II) 920 < II) 920 < Public health expend.Public health expend. < 1492< 1492 42.042.0

III) III) Public health expend.Public health expend. > 1492 > 1492 44.844.8

Total public expenditure on health Total public expenditure on health and cancer survival - Menand cancer survival - Men

I, Estonia, Poland, Slovakia, Slovenia, Czech Republic, and SpainI, Estonia, Poland, Slovakia, Slovenia, Czech Republic, and Spain

II, Finland, UK, Italy, Netherlands, Austria, and Sweden II, Finland, UK, Italy, Netherlands, Austria, and Sweden

III, France, Switzerland, Iceland, Denmark, Norway, and GermanyIII, France, Switzerland, Iceland, Denmark, Norway, and Germany

Total public expenditure on health Total public expenditure on health and cancer survival - Womenand cancer survival - Women

I, Estonia, Poland, Slovakia, Slovenia, Czech Republic, and SpainI, Estonia, Poland, Slovakia, Slovenia, Czech Republic, and Spain

II, Finland, UK, Italy, Netherlands, Austria, and Sweden II, Finland, UK, Italy, Netherlands, Austria, and Sweden

III, France, Switzerland, Iceland, Denmark, Norway, and GermanyIII, France, Switzerland, Iceland, Denmark, Norway, and Germany

5-year- age- and cancer site- adjusted relative survivalWomen - Median values per tertile - 1997 (from Annals, modified, 2003)

$PPP %

I) Public health expend. < 920I) Public health expend. < 920 41.741.7

II) 920 < II) 920 < Public health expend.Public health expend. < 1492< 1492 53.053.0

III) III) Public health expend.Public health expend. > 1492 > 1492 54.254.2

Computed Tomography Scanners and 5-year- age- and cancer site- adjusted relative survival (F)

EUROCHIP-2: aEUROCHIP-2: a European European team-work for action team-work for action

and and a bridge between a bridge between

research and health research and health authoritiesauthorities

What’s needed?

a) To liase with cancer data sourcescancer data sources

b) To encourage the set-up of data collection in areas where information areas where information is unavailableis 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

EUROCHIP-2

IN ORDER TOIN ORDER TOSupport actions to reduce inequalities in cancer control

who by? under which umbrella? through which phases?

- The EUROCHIP-1 Network- The EUROCHIP-1 Network- The European Imprimatur - The European Imprimatur - A Process Approach- A Process Approach

EUROCHIP-2

Ex. of health indicator: Breast cancer screening population coverage

EUROCHIP-2: PROCESS APPROACHEUROCHIP-2: PROCESS APPROACH

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Check ofscreeningdatabases

Data collection Datacomparison

Promotion ofscreening

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Example of health indicator: Computed Tomography Scanners

EUROCHIP-2 : PROCESS APPROACHEUROCHIP-2 : PROCESS APPROACH

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Check ofsources

Data collection Datacomparison

Diffusion of CTS

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Comparison of the indicators in Finland and DenmarkComparison of the indicators in Finland and Denmark

Also takes into account the Also takes into account the

relation between

cancer and other chronic diseasescancer and other chronic diseases

EUROCHIP-2

Improvement in CVD and cancer treatment

Life expectancy increased

Number of cancer cases is increasing

Inflation of prevalent cases

NEEDSNEEDS: Actions in primary prevention

Long termLong term: : reduction of casesreduction of cases

Short termShort term: assistance, palliative care, and hospices

PreventionPreclinical

phaseCure -

TreatmentAssistance

Cancer

Cardiovascular &cerebrovascular dis.

Diabetes

Others chronicdegenerative dis.

BMI

Smoking

Alcohol

Diet

….

Hospices

Home assistance

Palliative care

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

Rehabilitation

• Population covered by cancer registry

• IncidenceIncidence rates, trends and projections

• Survivalurvival rates, trends and projections

• Prevalencerevalence prop., trends and projections

• Mortalityortality 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 REGISTRATION & CANCER REGISTRATION & EPIDEMIOLOGYEPIDEMIOLOGY

High qualified population based informationHigh qualified population based information

Permanent organisationPermanent organisation

Public health-orientedPublic health-oriented

CANCER REGISTRIES:CANCER REGISTRIES:AN IMPORTANT ROLEAN IMPORTANT ROLE