Download findings, impacts and next steps Correct as of

THE INTERNATIONAL
CANCER
BENCHMARKING
PARTNERSHIP
Summary of the partnership: findings,
impacts and next steps
Correct as of September 2016
Outline
• What is the ICBP?
• Findings from Phase 1
• Impacts
• Launch of Phase 2
• Next steps
Correct as of September 2016
2
Not just any international partnership
•
The only international cancer survival
comparison study focussed on measuring
differences and understanding factors that
drive these
•
Multidisciplinary partnership of academics,
clinicians, policymakers, cancer registry
teams and data experts
•
Aimed at delivering high quality findings
with rapid translation into practice
•
Funded by cancer charities (including
CRUK), departments of health, cancer
registries, universities in each jurisdiction
Correct as of September 2016
3
Who has been involved so far?
A total of 22 jurisdictions in 8 countries
Correct as of September 2016
4
Phase 1 of the ICBP
13 jurisdictions in
6 countries
4 cancers
Correct as of September 2016
5
Phase 1 modules
 Modules 1-3 are now
complete (although followup studies are still occurring)
 Modules 4-5 are ongoing - up
to 10 publications are due
within the next 12 months
Correct as of September 2016
6
Module 1 – survival differences (1 YEAR)
•
Breast, lung, colorectal and ovarian cancer survival is highest in Australia, Canada
and Sweden, intermediate in Norway and lower in the UK and Denmark
90
AUS
CAN
SWE
NOR
DEN
UK
AUS
SWE
CAN
NOR
85
80
45
40
SWE
CAN
35
AUS
NOR
30
DEN
UK
DEN
75
UK
70
25
65
20
1995-99
2000-02
2005-07
1995-99
Colorectal Cancer 1yr Relative Survival
2000-02
2005-07
Lung Cancer 1yr Relative Survival
80
100
98
96
94
92
SWE
75
CAN
AUS
NOR
DEN
UK
70
NOR
CAN
AUS
DEN
65
UK
60
55
90
50
1995-99
2000-02
Breast Cancer 1yr Relative Survival
2005-07
1995-99
2000-02
2005-07
Ovarian Cancer 1yr Relative Survival
Coleman MP, Forman D, Bryant H et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden and
the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based
cancer registry data. The Lancet 2011, 377: 127-138
Correct as of September 2016
7
Module 1 – survival differences (5 YEAR)
Cancer survival improved overall between 1995-2007 in all jurisdictions
Coleman MP, Forman D, Bryant H et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden and
the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based
cancer registry data. The Lancet 2011, 377: 127-138
Correct as of September 2016
8
Module 2 - awareness and beliefs
• Lower survival rates in Denmark and UK are
explained in part by lower cancer awareness
and more negative beliefs about cancer
Method
• Surveyed the general population across all
jurisdictions - nearly 20,000 were
interviewed
Headline findings
• Surprisingly, positive attitudes and beliefs
about cancer in all jurisdictions
• Interestingly, found a low awareness of
increasing risk with age (even in Sweden)
• In the UK, people more likely to identify
barriers to seeing their GP (though likely to
vary at a national level)
Forbes LJL, Simon AE, Warburton F et al. Differences in cancer awareness and beliefs between Australia,
Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do
they contribute to differences in cancer survival? Brit J Cancer. 2013. 108(2):292-300
Correct as of September 2016
9
Module 3 – Primary care
•
•
Investigated whether differences in primary care systems are associated with
poor outcomes
Surveyed of GPs focussing on clinical scenarios and direct questions about the
health systems they work (length of consultations, direct access to diagnostic
tests, waiting times for tests)
Results
• Association between overall survival and the readiness of GPs to refer or
investigate a patient’s symptoms at first consultation
- lung cancer scenario
- UK has low survival
rates and low
readiness to
refer/investigate
Rose PW, et al. Explaining
variation in cancer survival
between 11 jurisdictions in the
International Cancer
Benchmarking Partnership: a
primary care vignette survey.
BMJ Open 2015;5: e007212
Correct as of September 2016
10
Module 4 - Time intervals and routes to
diagnosis (from symptom to treatment)
•
Differences in time intervals from first symptom until diagnosis and treatment
between jurisdictions could affect the outcomes of patients with suspected
cancer.
•
The team developed validated patient, primary care practitioner (PCP) and
cancer treatment specialists (CTS) questionnaires. Questionnaires gathered
information on key milestones within the patient journey.
•
Information was provided on areas
including:
•
•
•
•
Specific time intervals and details of a
patients route to diagnosis and
treatment.
The number of times a patient saw a
health care professional before diagnosis.
The nature of any referrals and
diagnostic tests carried out
To date, breast and colorectal data have
been analysed.
Correct as of September 2016
11
Module 5 – factors affecting short-term survival
outcomes (registries and co-morbidities)
The cancer survival benchmarking study highlighted that observed survival variation might
be partly explained by differences in short-term survival. Two theories could explain this:
Registry practices
•
•
High quality cancer registration is essential for the calculation of cancer survival rates
which underpin the core benchmark study. Differences in the collection and recording
of data by cancer registries could be responsible for variations in 1-year survival
calculations.
Semi-structured interviews were conducted with key informants (face-to-face and by
telephone). Variation practices, data sources and definitions used to register cancer
patients were documented for each jurisdiction.
Comorbidities
•
•
Patients who die shortly after diagnosis could be more likely to be living with one or
more health condition(s) (comorbidities) which affects treatment they receive and their
chances of surviving.
Data from cancer registries (Canada, Australia, UK and Norway) was linked with routine
hospital admission datasets and analysed for lung cancer patients diagnosed between
2009-2012. The analysis explored international differences in co-morbidity, as well as
the relation between co-morbidity and early deaths.
Correct as of September 2016
12
Ovarian
Module 1: data stage data:
over 20,000
from 2.4 million
patients
adults
Colorectal
stage data:
over
310,000
patients
Over 150
collaborators
in 13
jurisdictions
Correct as of September 2016
Breast
stage data:
over
250,000
patients
Lung stage
data:
over 57,000
patients
Presented at
over 15
Over 35
organisations conferences
/
globally
funders
Impact in numbers
Module 2:
over 19,000
people over
the age of 50
Module 3:
over 2,700
PCPs
surveyed
Module 4:
over 22,000
surveys
returned (so
far)
Over 1,600
citations for
papers
referencing
ICBP
Over 250
citations for
centrally funded
papers
Impact - academic reach
•
Pioneered a range of methods and research tools to enable robust and
unique international comparisons
•
Published 13 quality peer reviewed papers
•
Figures from the survival benchmark quoted in conference presentations
globally; used as part of the rationale for many investigative research
studies
•
Completed the first international comparisons of:
 Cancer survival and stage at diagnosis using routine data
 Cancer survival and public awareness, attitudes and beliefs (at
this scale)
 Cancer survival and primary care referral behaviour and health
system
Correct as of September 2016
14
Impact - additional analyses
Correct as of September 2016
Impact – policy reach
The partnership has provided evidence for:
• Cancer plans in Norway, Australia (Victoria) and the UK (Scotland and
England).
• Identifying priorities for new cancer control initiatives in Canada, such as
establishing a Rapid Access Clinic for lung cancer in Alberta.
• Public awareness campaigns in Denmark, targeting specific sections of the
population, addressing barriers to seeing a health professional in England and
Scotland.
• Initiatives in England, Scotland and Wales aiming to improve access to
diagnostics and exploring innovative diagnostic referral pathways.
• The relevance of Danish reforms to cancer diagnostic pathways aimed at
diagnosing cancers earlier.
• Engagement exercises with GPs in Manitoba about barriers to accessing
diagnostics, including urban/rural issues.
• Projects to improve cancer data completeness and availability in NSW,
Ontario, England and Wales.
Correct as of September 2016
Phase 2 – who/what is involved
19 jurisdictions in 6 countries
8 cancers
Correct as of September 2016
Phase 2 – Research questions
1.
To establish the most up to date
international cancer survival benchmark
(plus insights into the impact of stage at
diagnosis and stage-specific survival) for
cancers of the colon, rectum, lung, ovary,
liver, stomach, oesophagus, pancreas
Plus two supplementary analyses:
• Overview of international coding
frameworks, including staging
classifications – to confirm feasibility of
collecting & comparing data
• Quantifying the impact of local
registration practices on short term
cancer survival – to identify whether an
adjustment factor should be applied to
cancer survival comparisons
Correct as of September 2016
18
Phase 2 – Research questions
Further in-depth analyses:
2. Access to diagnostics and investigations e.g.
capacity, workforce, use, location, guidelines, safety
procedures, quality measures, costs.
3.
Access to treatment and related factors e.g.
specialisation/centralisation, quality of treatment,
appropriateness, patient safety and innovation.
4.
Cancer patient care pathways e.g. standardised
clinical pathways, typical costs, who pays.
5.
Structure of health systems e.g. care coordination
and continuity, interface between primary and
secondary care, comprehensiveness of healthcare
systems.
Correct as of September 2016
 ICBP
management
team
 To be
commissioned
19
Next steps
•
Open research calls for teams to carry out ‘health systems’
and ‘cancer patient pathways’
•
Findings communicated to wide-range of audiences at
upcoming international conferences
•
Production of an annual report reflecting progress and
policy/practice impacts
•
Within the next 12 months up to 10 new publications from
Module 4 and 5
Correct as of September 2016
20
Thank you!
www.ICBP.org.uk
[email protected]
These slides were produced by the ICBP Programme Management team, based at Cancer
Research UK: Brad Groves, Deborah Robinson, Samantha Harrison, Irene Reguilon
Correct as of September 2016
21