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

2. 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

3. 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)

4. % 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 & TREATMENT (suggestions for ECHI list)

5. Anti- tobacco regulations Estimated cost for a cancer patient Total Public Expenditure on Health Gross Domestic Product SOCIAL AND MACRO-ECONOMIC DETERMINANTS (indicators in ECHI list are underlined)

6. 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

7. 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 diagnosi 5-year- age- and cancer site- adjusted relative survival (women)

8. Tumore al colon – Totale spesa sanitaria nazionale (m+f 1992) FontiEUROCARE-2 Fonti: EUROCARE-2; Cancer Survival in European Elderly Patients and its Health, Social and Economic Determinants

9. Tumore alla mammella – Totale spesa sanitaria nazionale (f 1992) FontiEUROCARE-2 Fonti: EUROCARE-2; Cancer Survival in European Elderly Patients and its Health, Social and Economic Determinants

10. 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 II) 920 < Public health expend. < 1492 42.0 III) Public health expend.> 1492 44.8 III) Public health expend. > 1492 44.8 Total public expenditure on health and cancer survival - Men 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

11. Total public expenditure on health and cancer survival - Women 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 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 II) 920 < Public health expend. < 1492 53.0 III) Public health expend.> 1492 54.2 III) Public health expend. > 1492 54.2

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

13. EUROCHIP-2: a European team-work for action and a bridge between research and health authorities EUROCHIP-2: a European team-work for action and a bridge between research and health authorities

14. What’s needed? cancer data sources a) To liase with cancer data sources b) To encourage the set-up of data areas where information collection in areas where information is unavailable is unavailable c) To check data quality and promote standardisation d) To develop a European health data bank EUROCHIP-2

15. 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 TO Support actions to reduce inequalities in cancer control

16. - The EUROCHIP-1 Network - The European Imprimatur - A Process Approach who by? under which umbrella? through which phases? - The EUROCHIP-1 Network - The European Imprimatur - A Process Approach EUROCHIP-2

17. Ex. of health indicator: Breast cancer screening population coverage EUROCHIP-2: PROCESS APPROACH

18. Example of health indicator: Computed Tomography Scanners EUROCHIP-2 : PROCESS APPROACH

19. Comparison of the indicators in Finland and Denmark

20. Also takes into account the relation between cancer and other chronic diseases EUROCHIP-2

21. Improvement in CVD and cancer treatment Life expectancy increased Number of cancer cases is increasing Inflation of prevalent cases NEEDS NEEDS: Actions in primary prevention Long term: reduction of cases Short term Short term: assistance, palliative care, and hospices

22. 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

23. Population covered by cancer registry Incidence Incidence rates, trends and projections urvival Survival rates, trends and projections revalence Prevalence prop., trends and projections ortality 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 REGISTRATION & EPIDEMIOLOGY

24. High qualified population based information Permanent organisation Public health-oriented CANCER REGISTRIES: AN IMPORTANT ROLE