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EUROCHIP
Health Indicators for Monitoring Cancer in Europe
Health Monitoring Program (HMP) EUROPEAN
COMMISSION HEALTH CONSUMER PROTECTION
DIRECTORATE-GENERAL
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EUROCHIP
GROUP OF SPECIALISTS on SCREENING Edinburgh,
20th November 2002
Chairperson Dr Elena Riza
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INTRODUCTION TO THE MEETING
Dr. Elena Riza
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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

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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

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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 diseases 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

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EUROCHIP PROJECT PRESENTATION
Dr. Andrea Micheli
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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.
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EUROCHIP
Comprehensive range of health indicators for
cancer
OCCURENCE
RISK FACTORS
LIST OF CANCER INDICATORS
PRE-CLINICAL ACTIVITY/ SCREENING
SURVIVAL
CAMON EUROCARE/EUROPREVAL
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
CANCER CARE/ PREVALENCE
CANCER RECURRENCE AND MORTALITY
CLINICAL FOLLOW-UP
Standardised methods for collecting, checking and
validating the data will be proposed for each
indicator
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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 Discussion organization at
national level
Methodological Group Methodological aspects of
the indicators
GS
GS
GS
GS
GS
GS
GS
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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

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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
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EUROCHIP FINAL RESULTS(AT THE END OF STEP 3)

• For each indicator at high priority EUROCHIP will
  produce
• A DESCRIPTIVE FORM including
• Desired indicators characteristics (definition,
  use, caveat )
• Operational definition and indications on sources
• Indications on availability in all EU member
  countries
• A METHODOLOGICAL FORM including
• Methodological aspects (standardisation,
  validity, variability)
• Bibliography on the indicator
• Suggestions to the European Commission

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DESCRIPTION
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(No Transcript)
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THOROUGHNESS OF THE INDICATOR LIST
Dr. Franco Berrino
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LIST OF EUROCHIP HIGH PRIORITY INDICATORS
EPIDEMIOLOGY AND CANCER REGISTRATION
PREVENTION
1.Tobacco consumption 2.Exposure to asbestos
3.Coverage of cancer registration 4.Stage at
diagnosis
SCREENING
TREATMENT AND CLINICAL ASPECTS
5.Breast cancer screening coverage 6.Cervical
cancer screening coverage 7.Performance
indicators of organized screening programmes

• 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

MACRO SOCIAL-ECONOMIC VARIABLES
16.Total National Expenditure on Health
for cancer 17.Total Public Expenditure on
Health for cancer
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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
• 14) DCO
• 15) Incidence / mortality
• 16) of istological cases

Connected with other HMP projects
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INDICATORS AT HIGH PRIORITY (2)

• SCREENING
• 17) Breast cancer screening coverage
• 18) Cervical cancer screening coverage
• 19) Performance indicators of organized screening
  programmes
• TREATMENT AND CLINICAL ASPECTS
• 20) Interval between first symptoms and diagnosis
• 21) Interval between diagnosis and first
  treatment
• 22) Radiation equipment
• 23) of centres with at least 2 radiation
  equipments
• 24) Doctors by specialization
• 25) Compliance with guidelines
• 26) Patients treated by surgery
• 27) Pain units and hospices
• 28) Use of morphine

Connected with other HMP projects
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INDICATORS AT HIGH PRIORITY (3)

• MACRO SOCIAL-ECONOMIC VARIABLES
• 29) Education level attained
• 30) Deprivation index
• 31) Income
• 32) Gross Domestic Product
• 33) Total Social Expenditure
• 34) Total National Expenditure on Health
• 35) Total National Expenditure on Health for
  cancer
• 36) Total Public Expenditure on Health
• 37) Total Public Expenditure on Health for cancer
• 38) elderly in 2010-2020-2030
• 39) Age distribution of population

Connected with other HMP projects
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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
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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

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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

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BREAST CANCER SCREENING COVERAGE
Dr. Nieves Ascunce Elizaga
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BREAST CANCER SCREENING COVERAGE
Diffusion of the mammography among females
between 40 and 70 years old
CONTEXT
SOURCE
National organized screening programmes. Survey
for other countries
STANDARDIZATION
No problems
VARIABILITY
No problems
VALIDITY
No problems
DESCRIPTIVE FORM
METHODOLOGICAL FORM
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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?

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CERVICAL CANCER SCREENING COVERAGE
Dr. Elena Riza
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CERVICAL CANCER SCREENING COVERAGE
Diffusion of the pap smear examination among
females between 25 and 64 years old
CONTEXT
SOURCE
National organized screening programmes. Survey
for other countries
STANDARDIZATION
No problems
VARIABILITY
No problems
VALIDITY
No problems
DESCRIPTIVE FORM
METHODOLOGICAL FORM
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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?

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PERFORMANCE INDICATORS OF ORGANIZED SCREENING PROG
RAMMES
Dr. Elena Riza
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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

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SCREENING VOLUME
Coverage of organized screening programmes
CONTEXT
SOURCE
Organized screening programmes.
STANDARDIZATION
No problems
Relevant in countries without national coverage
VARIABILITY
VALIDITY
No problems
DESCRIPTIVE FORM
METHODOLOGICAL FORM
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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).
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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
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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
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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)
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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
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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
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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
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EUROPEAN COMMISSION PUBLIC HEALTH PROGRAMS
Dr. Andrea Micheli
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PUBLIC HEALTH IN EUROPE

• the European past and next strategy
• FOCUS ON CANCER
• past/present in HMP EUROCHIP and CAMON
• next Working Party

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Priority areas of the public health programme
General health policy
Health determinants
Health information
Health threats
By Dr. Tapani Piha
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Bringing programmes together
-2002
Health information
Health monitoring
Injury
Cancer
Pollution
Aids
Rare diseases
2003-
By Dr. Tapani Piha
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Bringing programmes together
-2002
Health information
Health monitoring
Injury
Cancer
Pollution
Aids
Rare diseases
2003-
By Dr. Tapani Piha
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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
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Stages in data processing
By Dr. Tapani Piha