Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
The International Cancer Benchmarking Partnership (ICBP): A model for international collaboration Professor Sir Mike Richards Copenhagen April 2012 1 The International Cancer Benchmarking Partnership (ICBP) • • • • • • Why do we need an international partnership? Who is involved? What are we doing? Successes and challenges How are we using the findings from ICBP in the UK Possible lessons for future collaborations 2 Why do we need an international collaborative? (1) • We already have a considerable amount of internationally comparable data on cancer e.g. – Incidence (Globocan: IARC) – Mortality (IARC; OECD) – Survival (EUROCARE; CONCORD – but only for patients diagnosed more than 10 years ago) – Chemotherapy (International variations report 2010) – CT and MRI scanners (OECD) – Radiotherapy facilities (OECD) 3 Why do we need an international collaboration? (2) • But ... there’s a lot we do not know, because we do not collect routine data • Better information could help individual countries to formulate policy to improve outcomes 4 Gaps in information • What didn’t we know at start of ICBP? – Up to date comparisons of survival – Reasons for variations on survival • What we still don’t know – Differences in access to care and use of diagnostics – Differences in treatment rates – Differences in quality of life of survivors – Differences in patients’ experience of care – Differences in costs of cancer care – Etc. 5 European Country Selection: National Cancer Registration National Coverage of Cancer Registration (%) Germany Poland Czech Republic France Spain Italy Switzerland Netherlands Portugal Belgium Slovenia Malta Austria UK Scandanavia 0 6 20 40 60 80 100 ICBP: Who is involved? (1) • 6 countries; 12 Jurisdictions – Australia (New South Wales; Victoria) – Canada (British Columbia, Alberta, Manitoba and Ontario) – Denmark – Norway – Sweden – UK (England, Wales and Northern Ireland) • Jurisdictions selected on basis of comprehensive cancer registration and willingness to participate 7 ICBP: Who is involved? (2) • A very large number of policy makers, cancer registry staff, epidemiologists, academic clinicians, behavioural scientists • A Programme Board with representation from each jurisdiction (funders) • Module teams • Programme management secretariat – Initially McKinsey’s – Now Cancer Research UK 8 ICBP: What are we doing? • Two key questions are being addressed – How has survival changed between 1995 and 2007? – Can we explain international differences in survival? • Focusing on 4 cancers – Breast, colorectal, lung and ovarian cancer • 5 Modules – Module 1: Epidemiology (survival, stage + treatment) – Module 2: Survey of public awareness, beliefs and behaviours (study specific survey tool) – Module 3: Survey of primary care physicians – Module 4: Newly diagnosed patients – Routes to diagnosis, delays, stage and treatment – Module 5: To be decided 9 ICBP: Successes • The partnership is now well established. Partners are enthusiastic about working together • Module 1 – Survival comparisons published (Lancet 2011) – New methods for comparing different staging systems (“esperanto” for stage) submitted for publication – Stage and survival papers x 4: Submitted • Module 2 – Survey tool developed and survey conducted in all 6 countries – Methods and results papers: completed • Module 3 – In progress 10 ICBP Module 1: Lancet paper 11 ICBP: 5 year relative survival. Coleman et al, Lancet 2011 70 20 AUS CAN SWE NOR DEN 65 UK AUS CAN CAN 18 AUS 16 SWE 60 55 SWE NOR 14 DEN 12 NOR UK DEN 10 50 UK 8 45 6 1995-99 2000-02 2005-07 1995-99 2000-02 2005-07 Lung Cancer 5yr RS Colorectal Cancer 5yr RS 90 45 SWE AUS 85 CAN NOR CAN NOR 40 AUS DEN 80 UK UK DEN 35 75 70 1995-99 AUS 2000-02 Breast Cancer 5yr CAN SWE NOR 2005-07 RS DEN UK 30 1995-99 AUS Ovarian CAN 2000-02 Cancer RS NOR 5yrDEN 2005-07 UK ICBP: 1 year relative survival. Coleman et al, Lancet 2011 90 45 AUS CAN SWE NOR DEN SWE UK AUS 85 CAN 40 SWE AUS CAN 80 NOR NOR 35 DEN DEN 75 UK UK 30 25 70 20 65 1995-99 2000-02 1995-99 2005-07 Colorectal Cancer 1yr RS 2000-02 2005-07 Lung Cancer 1yr RS 100 80 SWE 98 NOR 75 CAN AUS CAN AUS 96 70 DEN NOR DEN 94 UK 65 UK 60 92 55 90 1995-99 AUS 2000-02 BreastSWE CancerNOR 1yr CAN 2005-07 RSDEN UK 50 1995-99 AUS CAN Ovarian 2000-02 2005-07 NOR DEN RS UK Cancer 1yr ICBP: Challenges 14 ICBP: Challenges • Programme Board meetings: Finding an acceptable time of day for participants from 3 continents! • Funding – Department of Health in England funded Module 1. This enabled trust and understanding to develop within the partnership – Shared funding for other modules – difficult to get jurisdictions to commit • Timescales – Time costs money – Getting the balance right between ‘quick and dirty’ and ‘academically rigorous’ • Ensuring comparability of data/survey tools. Harmonisation between languages • Sustainability 15 How are we using the findings in England? • The Government has set a goal of “saving an additional 5000 lives” from cancer by 2014/15. In effect this means halving the gap between England and the best in Europe (or around the world) • We are now converting the “5000 lives” into 1 and 5 year survival rates for breast, colorectal and lung cancer • The findings have re-emphasised the need to focus on early diagnosis of cancer. A National Awareness and Early Diagnosis Initiative is in progress Breast cancer: 5 year relative survival, England v. combined Australia, Sweden and Canada 17 Colorectal cancer: 5 year relative survival, England v. combined Australia, Sweden and Canada 18 Lung cancer: 5 year relative survival, England v. combined Australia, Sweden and Canada 19 Be clear on cancer: Bowel cancer Lung Cancer Campaign 21 Possible lessons for future collaborations • International collaborations are hard work, take time and cost money ... but can yield very valuable insights • There is still a great deal of scope for going further on cancer (e.g. Other outcomes apart from survival) and inclusion of other countries • There is potential to look at other disease areas (e.g. cardiovascular) if adequate datasets exist – and if there is sufficient interest • Excellent programme management is essential 22