Download Nessun titolo diapositiva

EUROCHIP
Health Indicators for
Monitoring Cancer in Europe
Health Monitoring Program (HMP)
EUROPEAN COMMISSION
HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
EUROCHIP
GROUP OF SPECIALISTS on
SCREENING
Edinburgh, 20th November 2002
Chairperson: Dr Elena Riza
INTRODUCTION
TO THE
MEETING
Dr. Elena Riza
AIMS OF THE MEETING
• An updated list of indicators for “screening” domain
• A consensual classification of these indicators by priority
• An updated DESCRIPTIVE FORM for each indicator
• Indications on the methodological problems
• Indications on the availability of these indicators
SUBJECTS OF THE MEETING
• Verification of the completeness of the list of indicators
• Discussion about priorities of the indicators
• Discussion/modification of the forms of the indicators of
this domain
• Decision of indicators to include in the group
“performance indicators of organised programs “
CONSIDERATIONS
Participants have to consider that:
• indicators at high priority should be in a limited
number;
• indicators should be able to suggest actions to
reduce inequalities and to promote health;
• indicators should refer to the “epidemiology and
cancer registration” domain
• indicators have been developed considering 3 axes:
1) the natural disease’s history (prevention, screening,
diagnosis, treatment, surveillance, end results)
2) indicator groups as suggested by the ECHI
HMP project (demographic and social-economic factors,
health status, determinant of health, health system)
3) cancer sites
EUROCHIP PROJECT:
PRESENTATION
Dr. Andrea Micheli
EUROCHIP INTRODUCTION
AIM: To produce a list of health indicators which describe
cancer in Europe, to help the development of the future
European Health Information System
STEP 1 (Jan 2002 – Jul 2002) : To discuss a preliminary list at national
level, in all members of the European Union. The result was a
list of more than 100 indicators subdivided by priority level
STEP 2 (Sep 2002 – Dec 2002) : To discuss the indicators (of the list
produced at STEP 1) by different domain (prevention, epidemiology and
cancer registration, screening, treatment and clinical aspects, and macro
social-economic variables). To discuss methodological problems for
the indicators at high priority.
STEP 3 (Jan 2003 – May 2003) : Definition of the final list of indicators
subdivided by domain and by priority level.
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
EUROCHIP
Comprehensive range of health indicators for cancer:
EUROCARE/EUROPREVAL
CAMON
OCCURENCE
SURVIVAL
RISK FACTORS
LIST
OF
CANCER CARE/
PREVALENCE
CANCER
RECURRENCE
AND MORTALITY
CANCER
INDICATORS
PRE-CLINICAL
ACTIVITY/
SCREENING
DIAGNOSTIC AND
THERAPEUTIC
PROCEDURES
CLINICAL
FOLLOW-UP
Standardised methods for collecting, checking and validating the data
will be proposed for each indicator
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
FRAMEWORK OF THE PROJECT
Steering Committee
GS: Groups of specialists
Discussion of indicators at
national and domain level
Working Team
Operational work
Panel of Experts
GS
Discussion &
organization at
national level
GS
GS
GS
GS
Methodological Group
GS
Methodological aspects
of the indicators
GS
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
FIRST AND FUTURE STEPS
130
CANCER SPECIALISTS ARE INVOLVED IN EUROCHIP
13
INTERNATIONAL MEETINGS HELD
ALL COUNTRIES OF THE EUROPEAN UNION ARE
PARTICIPATING IN THE PROJECT
Next steps:
 Groups of Specialists in each of five domains (prevention,
screening, data registration and epidemiology, macro-health
variables, and clinical aspects and treatment) discuss the indicators
at the European level.
 Final meeting at which the final selection of indicators will be
drawn up
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
RESULTS
For each indicator we compile a FORM subdivided in three sections:
 DESIRED INDICATOR: all indicator characteristics we wish to have
 METHODOLOGY: operational definition, possible sources and
methodological issues
 AVAILABILITY in different countries
LIST OF INDICATORS
PRELIMINARY LIST OF 158 INDICATORS
EUROCHIP MEETINGS
39 INDICATORS AT HIGH PRIORITY
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
EUROCHIP FINAL RESULTS
(AT THE END OF STEP 3)
For each indicator at high priority EUROCHIP will produce:
1. A DESCRIPTIVE
•
•
•
FORM
including:
Desired indicators characteristics (definition, use, caveat …)
Operational definition and indications on sources
Indications on availability in all EU member countries
2. A METHODOLOGICAL FORM
•
•
•
including:
Methodological aspects (standardisation, validity, variability)
Bibliography on the indicator
Suggestions to the European Commission
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
DESCRIPTION
THOROUGHNESS
OF THE
INDICATOR LIST
Dr. Franco Berrino
LIST OF EUROCHIP HIGH PRIORITY INDICATORS
PREVENTION
1.Tobacco consumption
2.Exposure to asbestos
SCREENING
5.Breast cancer screening coverage
6.Cervical cancer screening coverage
7.Performance indicators of
organized screening programmes
MACRO SOCIALECONOMIC VARIABLES
16.Total National Expenditure
on Health for cancer
17.Total Public Expenditure
on Health for cancer
EPIDEMIOLOGY AND
CANCER REGISTRATION
3.Coverage of cancer registration
4.Stage at diagnosis
TREATMENT AND
CLINICAL ASPECTS
8.Interval between first
symptoms and diagnosis
9.Interval between diagnosis
and first treatment
10.Radiation equipment
11.% of centres with at least
2 radiation equipments
12.Doctors by specialization
13.Compliance with guidelines
14.Pain units and hospices
15.Use of morphine
INDICATORS AT HIGH PRIORITY (1)
PREVENTION
1)
Tobacco consumption
2)
Consumption of fruit and vegetable *
3)
Consumption of alcohol *
4)
Body Mass Index *
5)
Exposure to asbestos
6)
AIDS incidence *
7)
Prevalence of hepatitis B/C *
EPIDEMIOLOGY AND CANCER REGISTRATION
8)
Coverage of cancer registration
9)
Incidence rates *
10)
Survival rates *
11)
Prevalence proportion *
12)
Mortality rates *
13)
Stage at diagnosis
* Connected with other HMP projects
14)
DCO *
15)
Incidence / mortality *
16)
% of istological cases *
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
INDICATORS AT HIGH PRIORITY (2)
SCREENING
17)
18)
19)
Breast cancer screening coverage
Cervical cancer screening coverage
Performance indicators of organized screening programmes
TREATMENT AND CLINICAL ASPECTS
20)
21)
22)
23)
24)
25)
26)
27)
28)
Interval between first symptoms and diagnosis
Interval between diagnosis and first treatment
Radiation equipment
% of centres with at least 2 radiation equipments
Doctors by specialization
Compliance with guidelines
Patients treated by surgery *
Pain units and hospices
Use of morphine
* Connected with other HMP projects
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
INDICATORS AT HIGH PRIORITY (3)
MACRO SOCIAL-ECONOMIC VARIABLES
29)
30)
31)
32)
33)
34)
35)
36)
37)
38)
39)
Education level attained *
Deprivation index *
Income *
Gross Domestic Product *
Total Social Expenditure
Total National Expenditure on Health *
Total National Expenditure on Health for cancer
Total Public Expenditure on Health *
Total Public Expenditure on Health for cancer
% elderly in 2010-2020-2030
Age distribution of population
* Connected with other HMP projects
Www.istitutotumori.mi.it/project/eurochip/homepage.htm
PRIORITY LEVELS
A
Direct indicator – Important – With or without any problem
B
Indirect indicator – Important – With or without any problem
C
Potentially useful but with presenting a great deal of problems
D
Very low priority – Irrelevant
DO YOU WANT SOMETHING ELSE
AT HIGH PRIORITY?
SCREENING
- Breast cancer screening coverage
- Cervical cancer screening coverage
- Performance indicators of organized screening programmes:
- Screening volume
- Screening recall rate
- Screening detection rate
- Screening localized cancers
- Screening positive predictive value
- Screening benign/malignant biopsy ratio
- Screening conservative vs radical treatment
- Screening interval between detection and treatment
- Screening ‘interval cancers’
- Screening sensitivity
- Screening specificity
ARE THESE PRIORITIES OK?
A
- Breast cancer screening coverage
- Cervical cancer screening coverage
- Performance indicators of organized
screening programmes
?
- Incidence of DCIS and LCIS (breast cancer)
- Incidence of insitu carcinoma of cervix
- Incidence of adenocarcinoma in polyp
- Incidence of A stage for prostate
C
- Occult blood
- PSA
- Colonoscopy
BREAST CANCER
SCREENING COVERAGE
Dr. Nieves Ascunce Elizaga
BREAST CANCER SCREENING COVERAGE
CONTEXT
SOURCE
Diffusion of the mammography among
females between 40 and 70 years old
National organized screening programmes.
Survey for other countries
STANDARDIZATION
No problems
VARIABILITY
No problems
VALIDITY
No problems
DESCRIPTIVE FORM
METHODOLOGICAL FORM
Indicator characteristics
• Both organized and opportunistic screening
• Distintion between
- countries with national organized screening: we
need also information on activity of women who
rejects organized screening
- countries with regional programmes: we need a
national survey
• Women ages: 40-70.
- Which is the role to decide these ages?
- Are they correct?
• Periodicity of the mammography exam: 2 years
- Is it correct?
CERVICAL CANCER
SCREENING COVERAGE
Dr. Elena Riza
CERVICAL CANCER SCREENING COVERAGE
CONTEXT
Diffusion of the pap smear examination
among females between 25 and 64 years old
SOURCE
National organized screening programmes.
Survey for other countries
STANDARDIZATION
No problems
VARIABILITY
No problems
VALIDITY
No problems
DESCRIPTIVE FORM
METHODOLOGICAL FORM
Indicator characteristics
• Both organized and opportunistic screening
• Distintion between
- countries with national organized screening: we
need also information on activity of women who
rejects organized screening
- countries with regional programmes: we need a
national survey
• Women ages: 25-64.
- Which is the role to decide these ages?
- Are they correct?
• Periodicity of the pap-smear exam: 3 years
- Is it correct?
PERFORMANCE
INDICATORS OF
ORGANIZED
SCREENING
PROGRAMMES
Dr. Elena Riza
INDICATORS
Performance indicators of organized screening programmes:
- Screening volume
- Screening recall rate
- Screening detection rate
- Screening localized cancers
- Screening positive predictive value
- Screening benign/malignant biopsy ratio
- Screening conservative vs radical treatment
- Screening interval between detection and treatment
- Screening ‘interval cancers’
- Screening sensitivity
- Screening specificity
SCREENING VOLUME
CONTEXT
Coverage of organized screening
programmes
SOURCE
Organized screening programmes.
STANDARDIZATION
VARIABILITY
VALIDITY
DESCRIPTIVE FORM
No problems
Relevant in countries without national
coverage
No problems
METHODOLOGICAL FORM
SCREENING RECALL RATE
Context: The number of persons recalled for
further assessment as a proportion of all persons
who had a specific screening test.
Data collection: Recall refers to the physical
recall of the patient to the screening unit either
because of a technical inadequacy (technical
recall) or for the clarification of a perceived
abnormality detected at the screening
examination (recall for further assessment).
SCREENING DETECTION RATE
Context: The number of cancers detected in
the screening programme as a proportion of
all the screening tests performed
Data collection: To calculate the overall
detection rate, one should include cancers
detected by screening round. Cancers
detected in intermediate exploration should
be assigned to a specific screening round
SCREENING LOCALISED CACNERS
Context: Proportion of localised cancers of
the total screen-detected cancers
POSITIVE PREDICTIVE VALUE
Context: The proportion of persons who
have the cancer in question and who are
screened positive
Data collection: In practice, the
denominator refers to the patients recalled
for further assessment following a positive
screening examination
BENIGN/MALIGNANT BIOPSY RATIO
Context: The ratio of pathologically-proven
benign cases to the malignant ones surgically
removed within the screening programme
CONSERVATIVE VS RADICAL TREATM.
Context: The number of persons to whom
cancer was detected as a result of a screening
test and to whom conservative treatment was
offered (e.g. chemotherapy, radiotherapy,
conserving surgery) as opposed to those to
whom radical treatment was performed (e.g.
mastectomy, hysterectomy)
INTERV. BETWEEN DETECTION AND TREATM.
Context: The time between the date of the
result of the screening test to the date the
patient receives treatment
SCREENING INTERVAL CANCER
Context: A primary cancer which has been
diagnosed in the time interval between the
most recent screening test which was negative
for malignancy and next screening test, or
within the specified time interval for the next
screening test in the case the woman has
reached the screening age upper limit
SCREENING SENSITIVITY
Context: The probability that the screening
test correctly identifies people with the
preclinical disease as positive
Data collection: It is calculated as the ratio
of true positive screening tests to the total
of positive cases, whether or not identified
by means of a screening test
SCREENING SPECIFICITY
Context: It is the probability that a
screening test correctly identifies people
without the preclinical disease as negative
Data collection: It is calculated as the ratio
of true negative screening tests to the total
of true negatives and false positives
EUROPEAN COMMISSION
PUBLIC HEALTH
PROGRAMS
Dr. Andrea Micheli
PUBLIC HEALTH
IN EUROPE
• the European past and next strategy
FOCUS ON CANCER
• past/present in HMP: EUROCHIP and CAMON
• next: Working Party
Priority areas of
the public health programme
General health policy
Health
information
Health determinants
Health threats
By Dr. Tapani Piha
Bringing programmes together
-2002
Health monitoring
Injury
Health
Cancer
Pollution
Aids
information
Rare diseases
2003By Dr. Tapani Piha
Bringing programmes together
-2002
Health monitoring
Injury
Health
Cancer
Pollution
Aids
information
Rare diseases
2003By Dr. Tapani Piha
Public health programme
Implementation focus
• European added value
• Large scale (in content and geographical
coverage) multi-annual and multidisciplinary
• Lead to sustainable results and outputs
• Relevant and contribute to policy development
• Attention to the evaluation of the process and
results
By Dr. Tapani Piha
Stages in data processing
Stage 3
Data collection,
processing and storage
at EU level
Stage 4
Analysis, advice,
reporting, informing
and consulting
Stage 5
Mechanisms for
exchanging, promoting
and disseminating
results
Stage 2
Support to
data collection
at national level
Stage 1
Data definition
and
quality development
By Dr. Tapani Piha