1. EUROCHIP-1&2 Health Indicators for Monitoring Cancer in Europe Health Monitoring Program (HMP) EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Presentè par A Micheli, L Cherie Challine, P Baili, J Bloch, P Grosclaude, C Amati, M Velten, F Berrino, C Martinez, M Coleman Www.istitutotumori.mi.it/project/eurochip/homepage.htm

2. Europe is characterised by unacceptable inequalities - inègalitèes - in cancer control AN - travaille - INTECTUAL WORK INVOLVING CANCER EXPERTS OF EU MEMBERS, CANCER NETWORKS, INSTITUTES AND ORGANISATIONS To produce a list of health indicators which describe cancer in Europe finalized - finalisation - : a) to help the development of the European Health Information System - banque dinformation Européenne de la santè c) to promote action in the fight against - contre - cancer EUROCHIP-1 AIMS

3. Life expectancy trends in Europe Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat (2003). World Population Prospects: The 2002 Revision

4. World-age-stand. incidence $PPP rate per 100,000 I) GDP<15611216 I) GDP<15611216 II) 15611<GDP<17538244 II) 15611<GDP<17538244 III) GDP>17538253 GDP and cancer incidence I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

5. 5-year cancer relative survival $PPP % I) GDP<15611 31 II) 15611<GDP<17538 43 II) 15611<GDP<17538 43 III) GDP>17538 45 GDP and cancer survival I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

6. World-age-stand. mortality $PPP rate per 100,000 I) GDP<15611 146 I) GDP<15611 146 II) 15611<GDP<17538 133 II) 15611<GDP<17538 133 III) GDP>17538 135 GDP and cancer mortality I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

7. The area of the disk is proportional to the Total National Health Expenditure ($ PPP) in the country $ PPP: Parity Purchasing Power per capita (US $) Sources: OECD 2002 for GDP and TNEH; EUROCARE-3 for survival Gross Domestic Product and 5-year- age- and cancer site- adjusted relative survival (m)

8. 158 PRELIMINARY LIST OF 158 INDICATORS 52 52 INDICATORS 26 AT HIGH PRIORITY: 15 NEW INDICATORS (by EUROCHIP) EUROCHIP MEETINGS LIST OF INDICATORS

9. 1.The natural history of cancer PreventionPrevention ScreeningScreening DiagnosisDiagnosis TreatmentTreatment End resultsEnd results 2. Cancer sites INDICATORS: AXES OF CLASSIFICATION

10. Mesures de lutte contre le tabagisme Coût par patient Dépenses publiques de santé Produit intérieur brut SOCIAL AND MACRO-ECONOMIC DETERMINANTS

11. PREVENTION Consommation de fruits et légumes Consommation d'alcool Distribution de lindice de masse corporelle dans la population Activité physique Etude sur le tabagisme Exposition au soleil Prévalence de l'exposition professionnelle aux carcinocènes (CAREX)

12. SCREENING Taux de couverture par des programmes de dépistage % de femmes bénéficiant d'une mammographie % de femmes bénéficiant d'un frottis % de personnes bénéficiant dépistage du cancer colo-rectal

13. Population couverte par un registre de cancer Taux d'incidence du cancer, évolution et projections Taux de survie des patients cancéreux, évolution et projections Prévalence du cancer, évolution et projections Taux de mortalité par cancer, évolution, projections, années potentielles de vie perdues à cause du cancer Stade au diagnostic : % des cas avec un diagnostic précoce et % des cas avec bilan dextension CANCER REGISTRATION & EPIDEMIOLOGY

14. Taux déquipement en radiologie et radiothérapie % de scanners (CTS) dans la population % de patients traités par radiothérapie paliative Délai avant traitement, études pilotes Respect des règles de bonnes pratiques en oncologie CARE & TREATMENT

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

16. EUROCHIP-I RESULTS EUROCHIP-2 AIMS A LIST OF INDICATORS FOR CANCER A LIST OF INDICATORS FOR CANCER TO DEVELOP AN EUROPEAN DATA-BANK TO DEVELOP AN EUROPEAN DATA-BANK TO ESTABLISH GROUPS AT NATIONAL LEVEL TO DISCUSS INEQUALITIES IN CANCER SURVEILLANCE TO ESTABLISH GROUPS AT NATIONAL LEVEL TO DISCUSS INEQUALITIES IN CANCER SURVEILLANCE TO PROMOTE ACTIONS AGAINST CANCER: AT LEAST ONE IN EACH COUNTRY TO PROMOTE ACTIONS AGAINST CANCER: AT LEAST ONE IN EACH COUNTRY

17. Extension of the system of EUROCHIP-I cancer networks involving all 25 European countries, new health institutions... sources of cancer data Liaison with sources of cancer data (e.g. CRs, EUROSTAT, HIS/HES system, other networks involved with smoking, vegetable and fruit consumption etc) areas where information is unavailable To encourage the setting-up of data collection in areas where information is unavailable Improvement of the European data-banks with cancer data Checking of the quality and standardisation of available cancer data and that becoming available during the project Analysis of the behaviour of various indicators in relation to their utility as determinants of clinical outcomes Identification of deficiencies in European health systems; To encourage actions based on EUROCHIP-2 findings to reduce inequalities in cancer surveillance and control. EUROCHIP-II : THE AIMS

18. Produce results at two levels: for European Union as a whole and for individual countries Focus on the problems and inadequacies of individual countries in order to suggest policy changes at the country level. Meanwhile, action to improve data quality and standardisation, will be taken Organise activity as a continuous process, i.e. taking a global view of the information system, involving on one hand the promotion of data collection, on the other analysis of already available data, on the other evaluation promoting political action on established inequalities; all as a continuously re-evaluated process EUROCHIP-II : EXPECTED RESULTS

19. Phase 1 Phase 1: Identification of sources of the data pertaining to health indicators. Verify that data are collected as suggested by EUROCHIP-1 Phase 2 Phase 2: Collection, validation, standardisation of data and unification in a single database Phase 3 Phase 3: Analysis of data from the database pertaining to a given health indicator in relation to other factors Phase 4 Phase 4: Identification of problems at the international and national level (e.g. general health inequalities and those pertaining to access and availability) Phase 5 Phase 5: Assessment of utility of health indicators in promoting effective political action EUROCHIP-II : PHASES

20. 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 CANCER SITES (1)

21. 2. 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 -Melanoma for prevention (early diagnosis-stage migration) -Bladder: for mortality 3. Other cancers -Kaposi -Kaposi for sentinel -Mesothelioma -Mesothelioma for sentinel -Testis -Testis for rare cancer -Lymphomas and Leukaemia -Lymphomas (H for health services and NH for trends) and Leukaemia (for treatment) -All childhood (0-14) cancers -All childhood (0-14) cancers (for survival) rare cancer -Cervix -Cervix (for screening) We need information on incidence and mortality (note: corpus uteri vs cervix misclassification) CANCER SITES (2)

22. Cancer prevalence $PPP proportion per 100,000 I) GDP<15611 996 II) 15611<GDP<175381355 II) 15611<GDP<175381355 III) GDP>175381560 GDP and cancer prevalence I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

23. Steering Committee Working Team Operational work Panel of Experts Discussion & organisation at national level Methodological Group Methodological aspects of the indicators GS: Groups of specialists Discussion of indicators at national and domain level (prevention, cancer epidemiology, screening, cure & treatment, macro-indicators) GS GS GS GSGS GS GS EUROCHIP : THE ORGANISATION Standardised methods for collecting, checking and validating the data proposed for each indicator