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HMP: Health Monitoring Programme
EUROCHIP - EUROpean Cancer Health Indicators Project
A fight against disequalities in managing cancer
Andrea Micheli1, Paolo Baili1, Carmen Martinez2, Riccardo Capocaccia3, Jan Willem Coebergh4, Arduino Verdecchia3, Franco Berrino1, Eugenio Mugno1, Camilla Amati1, Michel Coleman5
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)
THE PROJECT
www.istitutotumori.mi.it/project/eurochip/homepage.htm
EUROCHIP AIMS
BACKGROUND
Produce a list of health indicators describing cancer in Europe in order for:
a) helping the development of European Health Information System
b) reducing inequalities in cancer control
TERTILES BY GDP.
$PPP a
c) promoting action in the fight against cancer
METHODS
INTELLECTUAL WORK INVOLVING 130 CANCER SPECIALISTS
I) GDP < 15611
II) 15611 < GDP < 17538
III) GDP > 17538
AVERAGE VALUES. ALL SITES COMBINED (M+F)
WORLD-AGEWORLD-AGE5-YR CANCER
STANDARDIZE
CANCER
STANDARDIZE
RELATIVE
d
CANCER
PREVALENCE
CANCER
c
SURVIVAL
INCIDENCE b
MORTALITY e
Proportion per
Rate per 100,000
%
Rate per 100,000
100,000
216.4
33.4
1030.3
140.5
243.7
44.1
1405.5
128.3
255.0
45.2
1524.5
133.6
a
OF EU MEMBERS, CANCER NETWORKS, INSTITUTES AND
ORGANISATIONS
CANCER SITES TO BE CONSIDERED FOR THE LIST
Consumption of fruit and vegetables
Consumption of alcohol
Body Mass Index distribution in population
Physical activity
Tobacco survey
Exposure to sun radiation
Prevalence of occupational exposure to carcinogens
Population covered by Cancer Registries
Cancer incidence rates and trends
Cancer relative survival rates and trends
Cancer prevalence proportions and trends
Cancer mortality rates, trends and person-years of life lost due to cancer
Stage at diagnosis: % of cases with early diagnosis
Stage at diagnosis: % of cases with a metastatic test
% of women that have undergone a mammography
% of women that have undergone a cervical citology examination
% of persons that have undergone a colo-rectal cancer screening test
Organized screening coverage
Delay of cancer treatment
% of radiation systems in the population
% of CAT (Computed Axial Tomography) systems in the population
Compliance with best oncology practice
% of patients receiving palliative radiotherapy
Gross Domestic Product
Total Public Expenditure on Health
Estimated cost for a cancer patient
TERTILES:
I: Estonia, Poland, Slovenia,
Slovakia, and Spain;
II: UK, Finland, Netherland,
Sweden, Italy, and Austria;
III: Iceland, Denmark, France,
Germany, and Switzerland
EUROCHIP provided a list of cancer malignancies taken as proxy of
different phases of cancer surveillance :
b
1)
All cancers combined without non melanoma skin cancers
2)
Cancers of: lung, breast, colorectal, prostate, stomach,head and
neck, larynx, oropharynx, melanoma, kaposi, mesothelioma, testis,
haematopoietic malignancies, childhood tumors, cervix
$PPP: parity purchasing power per caput (US$) by OECD Health Data 1998. Cancer Incidence in Five Continents Vol VII. IARC Scientific
Publications 143. c Survival of Cancer Patients in Europe: the EUROCARE-2 Study. IARC Scientific Publications 151. d Micheli A, et al. Cancer
prevalence in European registry areas. Annals of Oncology 2002;132(6):840-865. e EUROCIM CD-ROM. ENCR
LIST OF INDICATORS AND THEIR AVAILABILITY: COMPARISON BETWEEN EUROPE AND US
LIST OF INDICATORS
PROPOSED BY EUROCHIP
Each indicator was discussed by groups of experts of different expertise
in prevention, cancer registration, screening, treatment and health
economy, who described it by its general presentation, operational
definition, meaning, possible use, caveat, modalities of classification,
possible source, standardisation and validity.
EUROPE
NO
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
YES
YES
NO
A
AVAILABILITY
US CANCER
REPORT 2001 B
YES
YES
YES
YES
YES
YES
NO
NO
YES
YES
NO
YES
YES
NO
YES
YES
YES
NO
NO
NO
NO
NO
NO
YES *
YES *
YES
SEER STAT
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
-
CONCLUSIONS AND FUTURE
EUROCHIP achieved to produce a list of indicators and to gather guidelines and for the European health
information system on cancer.
C
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 last is the core of the ongoing
EUROCHIP-2 project.
A: Availability for large part of
Europe;
B: US Department of Health
and Human Services, Public
Health Service, NIH, National
Cancer
Institute.
CANCER
PROGRESS REPORT 2001;
C: Surveillance Research Program,
National
Cancer
Institute.
SEER*Stat software
Version 5.0.17
(www.seer.cancer.gov/seerstat)
*: From OECD Health Data 2002
It will be really useful to compare European data with American ones. Today this is possible for some
European countries and for traditional epidemiological measures, but it is important to highlight that
many indicators proposed by EUROCHIP are already available in US.
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 countries actions by stimulating data comparison (also with US
data) and providing a unified International/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