EUROCHIP-2 EUROCHIP-2 the action the action Health Indicators Health Indicators for Monitoring Cancer in Europe for Monitoring Cancer in Europe www.istitutotumori.mi.it/project/eurochip/ www.istitutotumori.mi.it/project/eurochip/ homepage.htm homepage.htm Public Health Program Public Health Program EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL
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EUROCHIP-2EUROCHIP-2the actionthe action
Health Indicators Health Indicators for Monitoring Cancer in Europefor Monitoring Cancer in Europe
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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StartEnd
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