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HMP: Health Monitoring Programme EUROCHIP - EUROpean Cancer Health Indicators Project A project supported by the European Commission Andrea Micheli1, Paolo Baili1, Carmen Martinez2, Riccardo Capocaccia3, Jan Willem Coebergh4, Arduino Verdecchia3, Franco Berrino1, Eugegno Mugno1, Camilla Amati1, and Michel Coleman5 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) 1 Unit BACKGROUND AIMS 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”. METHODS MAIN AXIS OF DISCUSSION 130 CANCER SPECIALISTS RISK FACTORS / PREVENTION OUTCOME LIST CARE PREVALENCE OF CANCER INDICATORS CANCER RECURRENCES PRE-CLINICAL ACTIVITY OCCURENCE CLINICAL FOLLOW-UP DIAGNOSTIC AND THERAPEUTIC PROCEDURES 23 INTERNATIONAL MEETINGS PARTICIPATION of ALL EU COUNTRIES 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. RESULTS CLASSIFICATION OF INDICATORS PRELIMINARY LIST OF 158 INDICATORS DISCUSSIONS 52 INDICATORS: 26 AT HIGH PRIORITY 30 NEW INDICATORS PROPOSED BY EUROCHIP www.istitutotumori.mi.it/project/eurochip/homepage.htm PRIORITY Prevention Epidemiology-cancer registration Screening Treatment Social-economic variables TOTAL HIGH 7 (2 2) 7 (3 3) 4 (4 4) 5 (5 5) 3 (1 1) 26 (1 15) MEDIUM 4 (2 2) 7 (7 7) 3 (3 3) 12 (4 4) 26 (1 15) In parenthesis number of new indicators proposed by EUROCHIP LIST OF INDICATORS AT HIGH PRIORITY PREVENTION SCREENING 1) Consumption of fruit and vegetables 15) Percentage of women that have undergone a 2) Consumption of alcohol mammography (breast cancer) 3) Body Mass Index distribution in population 16) Percentage of women that have undergone a cervical 4) Physical activity citology examination (cervical cancer) 5) Tobacco survey 17) Percentage of persons that have undergone a colo-rectal 6) Exposure to sun radiation cancer screening test (colorectal cancer) 7) Prevalence of occupational exposure to 18) Organized screening coverage carcinogens TREATMENT AND CLINICAL ASPECTS EPIDEMIOLOGY AND REGISTRATION 19) Delay of cancer treatment (pilot studies) 8) Population covered by Cancer Registries 20) Percentage of radiation systems in the population 9) Cancer incidence rates and trends 21) Percentage of diagnostic CAT (Computed Axial 10) Cancer relative survival rates and trends Tomography) systems in the population 11) Cancer prevalence proportions and trends 22) Compliance with best oncology practice 12) Cancer mortality rates, trends and person23) Percentage of patients receiving palliative radiotherapy years of life lost due to cancer MACRO SOCIAL-ECONOMIC VARIABLES 13) Stage at diagnosis: percentage of cases 24) Gross Domestic Product with early diagnosis 25) Total Public Expenditure on Health 14) Stage at diagnosis: percentage of cases 26) Estimated cost for a cancer patient with a metastatic test KEY: shared with Health Monitoring Programme projects KEY: proposed by EUROCHIP alone SOURCES 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) 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