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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
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EUROCHIP
GROUP OF SPECIALISTS on PREVENTION Amsterdam,
12th-13th December 2002
Chairperson Dr Benedetto Terracini
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INTRODUCTION TO THE MEETING
Dr. Julietta Bloch
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AIMS OF THE MEETING

• Discussion on the complete list of the
  indicators
• An updated list of indicators for prevention
  domain
• Definition of eventual new indicators for
  environmental and occupational risks
• A consensual classification of these indicators
  by priority
• Information on sources for indicators at high
  priority
• Discussion on validity and standardization of
  indicator at
• high priority

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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 prevention
  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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INTRODUCTION
Several axis for indicators DPSEEA Exposure Outcom
e Action OECD Relevance (-? PARP/Olav)Analytical
soundness Measurability Scale of application
(national/subnational)
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Availability (cost) Census Health surveys ?
statistical power Ad hoc Specificity (to
cancer) Robustness (validity, sensitivity) Precisi
on (standardization of methods for
measurement) Comparability
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What is environment? Everything Non genetic Non
social behavioural natural Specific chemical,
physical, biological agents
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EUROCHIP
Health Indicators for Monitoring Cancer in Europe
A project of the Health Monitoring Program
(HMP) EUROPEAN COMMISSION HEALTH CONSUMER
PROTECTION DIRECTORATE-GENERAL
Www.istitutotumori.mi.it/project/eurochip/homepage
.htm
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EUROCHIP AIMS
AN INTECTUAL WORK INVOLVING CANCER EXPERTS OF EU
MEMBERS, CANCER NETWORKS, INSTITUTES AND
ORGANISATIONS To produce a list of health
indicators which describe cancer in Europe, to
help the development of the future European
Health Information System
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WHAT ABOUT THIS PRESENTATION

• METHODS
• FIRST RESULTS
• FUTURE

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A METHOD FOR THE DISCUSSION
EUROCHIP MAIN AXIS OF ANALYSIS
OCCURENCE
RISK FACTORS
SURVIVAL
LIST OF CANCER INDICATORS
PRE-CLINICAL ACTIVITY/ SCREENING
CAMON EUROCARE/EUROPREVAL
DIAGNOSTIC THERAPEUTIC PROCEDURES
CANCER CARE PREVALENCE
CANCER RECURRENCE AND MORTALITY
CLINICAL FOLLOW-UP
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A METHOD FOR THE ORGANISATION
Steering Committee
Standardised methods for collecting, checking and
validating the data proposed for each indicator

• 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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A METHOD TO DESCRIBE THE INDICATORS

• For each indicator we compile a FORM
• DESIRED INDICATOR all indicator
  characteristics we wish to have
• METHODOLOGY operational definition, possible
  sources and methodological issues
• AVAILABILITY in different countries

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RESULTS
130 CANCER SPECIALISTS ARE INVOLVED IN
EUROCHIP 17 INTERNATIONAL MEETINGS HELD
IN A YEAR 15 ALL COUNTRIES OF THE EUROPEAN
UNION ARE PARTICIPATING IN THE PROJECT
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RESULTS
PRELIMINARY LIST OF 158 INDICATORS
EUROCHIP MEETINGS
38 INDICATORS AT HIGH PRIORITY
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RESULT INDICATORS AT HIGH PRIORITY

• PREVENTION
• Tobacco consumption
• Tobacco abstinence
• Consumption of fruit and vegetable
• Consumption of alcohol
• Body Mass Index
• Exposure to asbestos
• AIDS incidence
• Prevalence of hepatitis B/C
• EPIDEMIOLOGY AND CANCER REGISTRATION
• Coverage of cancer registration
• Incidence rates
• Survival rates
• Prevalence proportion
• Mortality rates
• Stage at diagnosis
• Person-years life lost due to cancer
• Completeness of the registration (DCO and
  Incidence / mortality)
• of microscopically cases

Connected with other HMP projects
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RESULTS INDICATORS AT HIGH PRIORITY

• SCREENING
• Breast cancer screening coverage
• Cervical cancer screening coverage
• Colorectal cancer screening coverage
• Organized screening process indicators
• TREATMENT AND CLINICAL ASPECTS
• Interval between diagnosis and first treatment
• Radiation equipment
• of centres with at least 2 radiation equipments
• CAT Equipments
• Compliance with guidelines
• Patients treated by surgery / chemotherapy /
  radiotherapy
• Palliative care teams

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RESULTS INDICATORS AT HIGH PRIORITY

• MACRO SOCIAL-ECONOMIC VARIABLES
• Education level attained
• Average income
• Gini index
• Gross Domestic Product
• Total Social Expenditure
• Total National Expenditure on Health
• Anti-tobacco regulations
• Public Expenditure on Health for cancer
• Total Public Expenditure on Health
• Private/Non Profit Expenditure on Health for
  cancer
• Age distribution of population in 2010-2020-2030
  
• Lifetables

Connected with other HMP projects
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GDP and life expectancy at birth

• Life expectancy at birth
• PPP Yrs
• I) GDPlt 15611 72.4
• II) 15611gtGDPlt17538 76.7
• III) GDPgt17538 76.8

I, Estonia, Poland, Slovenia, Slovakia, and
Spain II, UK, Finland, Holland, Sweden, Italy,
and Austria III, Iceland, Denmark, France,
Germany, and Switzerland
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GDP and cancer incidence

• PPP World-age-stand. incidence
• rate per 100,000
  
• I) GDPlt 15611 216.4
• II) 15611gtGDPlt17538 243.7
• III) GDPgt17538 255.0

I, Estonia, Poland, Slovenia, Slovakia, and
Spain II, UK, Finland, Holland, Sweden, Italy,
and Austria III, Iceland, Denmark, France,
Germany, and Switzerland
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GDP and cancer survival
5-year cancer relative survival PPP
I) GDPlt 15611 33.4 II) 15611gtGDPlt17538 44.1 II
I) GDPgt17538 45.2
I, Estonia, Poland, Slovenia, Slovakia, and
Spain II, UK, Finland, Holland, Sweden, Italy,
and Austria III, Iceland, Denmark, France,
Germany, and Switzerland
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GDP and cancer prevalence

• Cancer prevalence
• PPP proportion per 100,000
• I) GDPlt 15611 1030.3
• II) 15611gtGDPlt17538 1405.5
• III) GDPgt17538 1524.5

I, Estonia, Poland, Slovenia, Slovakia, and
Spain II, UK, Finland, Holland, Sweden, Italy,
and Austria III, Iceland, Denmark, France,
Germany, and Switzerland
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GDP and cancer mortality

• World-age-stand. mortality
• PPP rate per 100,000 I) GDPlt
  15611 140.5
• II) 15611gtGDPlt17538 128.3
• III) GDPgt17538 133.6

I, Estonia, Poland, Slovenia, Slovakia, and
Spain II, UK, Finland, Holland, Sweden, Italy,
and Austria III, Iceland, Denmark, France,
Germany, and Switzerland
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EUROCHIP PROVIDES

• METHODS FOR DISCUSSING AND PROVIDING ACCEPTED
  INDICATORS
• A LIST OF INDICATORS FOR CANCER
• A FUTURE BASE TO STUDY CANCER IN EUROPE WITH
  THE AIM TO REDUCE INEQUALITIES AND PROMOTE HEALTH

Www.istitutotumori.mi.it/project/eurochip/homepage
.htm
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THOROUGHNESS OF THE INDICATOR LIST
Dr. Andrea Micheli
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LIST OF EUROCHIP HIGH PRIORITY INDICATORS
EPIDEMIOLOGY AND CANCER REG.
PREVENTION
Coverage of cancer registration Stage at
diagnosis Person-years life lost due to
cancer Completeness of the registration
Tobacco consumption Tobacco abstinence Exposure
to asbestos
SCREENING
TREATMENT AND CLINICAL ASP.
Breast cancer screening coverage Cervical cancer
screening coverage Colo-rectal cancer screening
coverage Organised screening process indicators

• Interval between diagnosis
• and first treatment
• Patients treated by surgery /
• chemotherapy / radiotherapy
• Radiation equipment
• of centres with at least
• 2 radiation equipments
• CAT equipment
• Compliance with guidelines
• Palliative care teams

MACRO SOCIAL-ECONOMIC VARIABLES

• Anti-tobacco regulations
• Indicators on Public Expendit.
• on Health for cancer
• Indicators on Private Expend.
• on Health for cancer

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FIRST DISCUSSION
Occupational exposure other than asbestos (Update
of CAREX) UV light HPV Pesticides ETS Recommendati
on/Legislation
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INDICATORS AT HIGH PRIORITY (1)

• PREVENTION
• Tobacco consumption
• Tobacco abstinence
• Consumption of fruit and vegetable
• Consumption of alcohol
• Body Mass Index
• Exposure to asbestos
• AIDS incidence
• Prevalence of hepatitis B/C
• EPIDEMIOLOGY AND CANCER REGISTRATION
• Coverage of cancer registration
• Incidence rates
• Survival rates
• Prevalence proportion
• Mortality rates
• Stage at diagnosis
• Person-years life lost due to cancer
• Completeness of the registration (DCO and
  Incidence / mortality)
• of microscopically 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) Colorectal cancer screening coverage
• 20) Organized screening process indicators
• TREATMENT AND CLINICAL ASPECTS
• 21) Interval between diagnosis and first
  treatment
• 22) Radiation equipment
• 23) of centres with at least 2 radiation
  equipments
• 24) CAT Equipments
• 25) Compliance with guidelines
• 26) Patients treated by surgery / chemotherapy /
  radiotherapy
• 27) Palliative care teams

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INDICATORS AT HIGH PRIORITY (3)

• MACRO SOCIAL-ECONOMIC VARIABLES
• 28) Education level attained
• 29) Average income
• 30) Gini index
• 31) Gross Domestic Product
• 32) Total Social Expenditure
• Total National Expenditure on Health
• Anti-tobacco regulations
• Public Expenditure on Health for cancer
• Total Public Expenditure on Health
• Private/Non Profit Expenditure on Health for
  cancer
• Age distribution of population in 2010-2020-2030
  
• Lifetables

Connected with other HMP projects
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PRIORITY LEVELS
Dr. Benedetto Terracini
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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?
Lifestyle Tobacco consumption Tobacco abstinence
Consumption of fruit and vegetables
Consumption of alcohol BMI Environment Expos
ure to asbestos PM10 (?) Infection Preval of
Hepatitis B/C AIDS Incidence Macro economical
indicator 5Mv.09a Public expenditure on cancer
prevention against tobacco 5Mv.10a Private/Non
profit exp. on cancer prevention
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Other groups
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INDICATORS ON TOBACCO
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TOBACCO CONSUMPTION
Simple indicator (only cigarettes)
Complex indicator (all type of smoking)
CONTEXT
National survey Health For All DB
SOURCE
European survey
WHO suggests caution in comparison
No problems with the European survey
STANDARDIZATION
VARIABILITY
No indications
Relevant
VALIDITY
Under reporting
No indications
Advanced conclusion We suggest an European
survey indipendently from the indicator choice
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From HEALTH FOR ALL Database
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TOBACCO ABSTINENCE
past smokers who quitted tobacco smoking by
time since quitting
CONTEXT
SOURCE
European survey
STANDARDIZATION
No problems with the European survey
VARIABILITY
Relevant
VALIDITY
No problems
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DISCUSSION ON

• Types of smoking to consider in the survey
• Periodicity of the survey
• Problem of children
• Under-reporting could we assume the uniformity
  of the under-reporting?

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EXPOSURE TO ASBESTOS
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EXPOSURE TO ASBESTOS
Employers in naval dockyards
Mortality trends for mesothelioma
CONTEXT
WHO Mortality Database
SOURCE
Difficult to find
Problem of the exposure time
STANDARDIZATION
No problems
Exposure to asbestos is concentrated in small
areas
VARIABILITY
No indications
Validation is really difficult
Misclassification of cases
VALIDITY
Advanced conclusion We suggest to use the
mesothelioma mortality indicator
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DISCUSSION ON

• Other eventual proxy for the indicator
• Misclassification of mesothelioma cases

First suggestion Update CAREX Database
considering as indicator Number of exposed
workers to carcinogenic
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NEW INDICATORS
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DISCUSSION ON

• Indicators for environmental risk (PM10)
• Indicators for occupational risk (Radon, PAH)
• Indicators on infection
• Other indicators on lifestyle (diet, physical
  activity)
• Indicators on drugs

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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
• Leads to sustainable results and outputs
• Relevant and contributes 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
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FINAL LIST OF INDICATORS
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• Lifestyle
• Prev. of current tobacco smokers among adults
• Prev. of tobacco smokers among 10-14
• Prev. of ex-smokers
• Consumption of fruit and vegetables
• Fast-food
• Consumption of alcohol
• BMI
• Physical activity
• Environment
• Prev. pop. exposed to ETS
• PM10
• Indoor exposure to radon
• Awareness of risk associated to exposure to UV
  radiations
• Occupational risk
• Prev. of occupational exposure to carcinogens
• Exposure to asbestos Incidence and mortality
  trends
• Medicaments
• Hormonal Replacement Treatment Drug