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EUROCHIP - EUROpean Cancer Health Indicators Project A project supported by the European Commission Andrea Micheli 1, Paolo Baili 1, Carmen Martinez 2, Riccardo Capocaccia 3, Jan Willem Coebergh 4, Arduino Verdecchia 3, Franco Berrino 1, Eugegno Mugno 1, Camilla Amati 1, and Michel Coleman 5 1 Unit of Epidemiology – Istituto Nazionale per la Cura e lo Studio dei Tumori – Milan (I) – 2 Granada Cancer Registry – Escuela Andaluza de Salud Publica – Granada (E), 3 Laboratory of Epidemiology and Biostatistics – Istituto Superiore di Sanità – Rome (I), 4 Comprehnsive Cancer Centre South Eindhoven Cancer Registry – Eindhoven (NL), 5 Cancer and Public Health Unit – London School of Hygiene & Tropical Medicine – London (UK) HMP HMP: Health Monitoring ProgrammeAIMS LISTOFCANCER INDICATORS INDICATORS RISK FACTORS / PREVENTION PRE-CLINICAL ACTIVITY OCCURENCE CLINICAL FOLLOW-UP DIAGNOSTIC AND THERAPEUTIC PROCEDURES CANCER RECURRENCES CARE PREVALENCE OUTCOME 130 130 CANCER SPECIALISTS 23 23 INTERNATIONAL MEETINGS ALL PARTICIPATION of ALL EU COUNTRIES BACKGROUND LIST OF INDICATORS AT HIGH PRIORITY PREVENTION 1) Consumption of fruit and vegetables 2) Consumption of alcohol 3) Body Mass Index distribution in population 4) Physical activity 5) Tobacco survey 6) Exposure to sun radiation 7) Prevalence of occupational exposure to carcinogens EPIDEMIOLOGY AND REGISTRATION 8) Population covered by Cancer Registries 9) Cancer incidence rates and trends 10) Cancer relative survival rates and trends 11) Cancer prevalence proportions and trends 12) Cancer mortality rates, trends and person- years of life lost due to cancer 13) Stage at diagnosis: percentage of cases with early diagnosis 14) Stage at diagnosis: percentage of cases with a metastatic testSCREENING 15) Percentage of women that have undergone a mammography (breast cancer) 16) Percentage of women that have undergone a cervical citology examination (cervical cancer) 17) Percentage of persons that have undergone a colo-rectal cancer screening test (colorectal cancer) 18) Organized screening coverage TREATMENT AND CLINICAL ASPECTS 19) Delay of cancer treatment (pilot studies) 20) Percentage of radiation systems in the population 21) Percentage of diagnostic CAT (Computed Axial Tomography) systems in the population 22) Compliance with best oncology practice 23) Percentage of patients receiving palliative radiotherapy MACRO SOCIAL-ECONOMIC VARIABLES 24) Gross Domestic Product 25) Total Public Expenditure on Health 26) Estimated cost for a cancer patient KEY : shared with Health Monitoring Programme projects KEY: KEY: proposed by EUROCHIP alone DISCUSSIONS 158 PRELIMINARY LIST OF 158 INDICATORS 52 52 INDICATORS: 26 26 AT HIGH PRIORITY 30 30 NEW INDICATORS PROPOSED BY EUROCHIP www.istitutotumori.mi.it/project/eurochip/homepage.htm CONCLUSIONS AND FUTURE EUROCHIP achieved to gather guidelines for the health information system in Europe on cancer. Final goal of EUROCHIP was to find information able to describe differences and also to promote action that would reduce inequalities in managing cancer. This is the core of the ongoing EUROCHIP-2 project. To reduce inequalities across Europe, some countries have to prioritise action on prevention, others on care, others on surveillance. However, it is vital for each countries’ success in the fight against cancer, that the trans-national European nature of the study is maintained at all levels of data collection, data analysis, problem evaluation, and action. EUROCHIP-2 will add value to each countrie’s actions by stimulating data comparison and providing a unified European imprimatur to cancer action. EUROCHIP-2 will try to:  SET UP DATA COLLECTION  ANALYSE THE BEHAVIOUR OF VARIOUS INDICATORS IN RELATION TO THEIR UTILITY  IDENTIFY DEFICIENCIES IN EUROPEAN HEALTH SYSTEMS  ENCOURAGE ACTIONS TO REDUCE INADEQUANCIES IN CANCER CONTROL EUROCHIP was implemented in Europe to set indicators for all health aspects as part of the European Commission Health Monitoring Programme (HMP). Main aim of EUROCHIP was to promote an established surveillance system on cancer in Europe. EUROCHIP aimed to produce, through an intellectual work, a comprehensive list of health indicators pertaining to cancer, with variables on cancer prevention, registration and epidemiology, screening, treatment and clinical aspects and social and macro-economic information related with health. Discussion was based on different axes: the main one being “disease natural history”. Each indicator was discussed by experts of different background, who described it by its general presentation, operational definition, meaning, possible use, caveat, modalities of classification, possible source, standardisation and validity. The final list resulted from various discussions on priorities: on added value to the indicator, problems and cost relative to data collection and on the comparability between European countries. CLASSIFICATION OF INDICATORS SOURCES In parenthesis number of new indicators proposed by EUROCHIP Sources for the indicators were classified as follows: a) international databanks already available (26 indicators) b) health surveys (22 indicators) c) Cancer Registries (4 indicators) MAIN AXIS OF DISCUSSION METHODS RESULTS