Turning Mapping into Action Thinking together about solutions Ana-Maria Forsea
Cancer burden in Europe 3 417 348 new cases/ year 1 755 093 deaths/year Fatality rate 0.47 Cancer 2 nd cause of death Source: EUCAN 2012 (IARC)
Cancer Incidence and mortality in Europe (EUCAN 2012)
Between countries cancer survival differences (2000-2007) (EUROCARE)
Melanoma survival 5 years relative survival 2000-2007 (EUROCARE)
Cancer disparities Cancer outcomes (incidence, mortality, survival, overall burden)
Cancer disparities cancer outcomes Disparities in cancer care spectrum: Prevention/screening, diagnosis, drugs/treatments available, multidisciplinary care available, survivorship care, cancer registration and reporting Disparities in Resources and Management
Where do we stand? Mapping of the current situation Prevention Screening Diagnosis Drugs and treatment available Integrative care Survivorship care Cancer registration and reporting National cancer control plans Data availability
EUROPEAN CODE AGAINST CANCER 12 ways to reduce your cancer risk 1 Do not smoke. Do not use any form of tobacco. 2 Make your home smoke free. Support smoke-free policies at workplace. 3 Take action to be a healthy body weight. 4 Be physically active in everyday life. Limit the time you spend sitting. 5 Have a healthy diet: (Eat plenty of whole grains, pulses, vegetables and fruits, Limit high-calorie foods (foods high in sugar or fat) and avoid sugary drinks, Avoid processed meat; limit red meat and foods high in salt.) 6 limit your alcohol intake. Not drinking alcohol is better for cancer prevention. 7 Avoid too much sun, especially for children. Use sun protection. Do not use sunbeds. 8 In the workplace, protect yourself against cancer-causing substances by following health and safety instructions. 9 Take action to reduce high radon levels in your home. 10 For women: If you can, breastfeed your baby; Limit use of HRT. 11 Ensure your children take part in vaccination programmes for: Hepatitis B (for newborns);human papillomavirus (HPV) (for girls). 12 Take part in organized cancer screening programmes
Degree of implementation of action to reduce exposure of the population to UVR 2006 European Environment and Health Information System (ENHIS), ENHIS II Study WHO European Region The composite index of national efforts to improve the protection of children from exposure to UVR 1. Daily solar UVR index reported through the meteorological office or on TV during the summer 2. Specific national web site dedicated to exposure to UVR and prevention of skin cancer 3. National or regional campaigns during the previous two years on public TV or radio channels to improve the protection of children from UVR 4. Laws to regulate the use of sunbeds by children and teenagers 5. Sun protection programmes in schools at national or regional level 6. State campaigns in tourist agencies during the previous two years to raise tourists awareness of dangers from the sun 7. National or regional campaigns during the previous two years to promote shade structures in public places 8. Laws to promote shade structures in public places Score: Yes: 1; No: 0 Total: Maximum 8, minimum 0
Patient awareness- Duration of melanoma prevention campaigns in Europe V del Marmol et al, Euromelanoma Survey 2011
Screening: Obstacles for implementation of cancer screening programs in new EU countries Shortcomings in awareness and reaching of target population. Lack of specialized health care, disparities in geographical distribution of necessary health workforce: specialists, oncologists, pathologists. Low quality of diagnostic tests Inadequate involvement of all key medical groups and specialties Insufficient knowledge/compliance with cancer management guidelines Shortcomings in the management of population-based programs, Insufficient epidemiological quality control; insufficient understanding by decision makers of the necessary resources for epidemiological surveillance;. Shortcomings in the availability of financial resources. Nicula FA, et al. Challenges in starting organised screening programmes for cervical cancer in the new member states of the European Union. Eur J Cancer 2009;45(15):2679-84. European Network for Information on Cancer (EUNICE).
Cancer registration in Europe EUROCOURSE (2009-2014) No cancer registry; estimation from neighboring countries Regional cancer registries National cancer registry; incidence data up to 2007 (source IARC- EUCAN 2012) Adapted, Forsea et al Brit J Derm, 2012
Eurocare 31 countries (117 registries, 20 national) Increased coverage in countries with regional registries 50% European population Overall >20 million cancer cases Adult patients (age 15+) 45 major cancer sites Diagnosis 1999-2007 Follow-up 2008 or later Uniform data collection protocol and statistical analyses
Causes of cancer registries pitfalls in South-East Europe Lack of experienced staff Low salaries, frequent personal cuts, frequent administrative changes Inconstant and insufficient financing Lack of understanding and knowledge from the health authorities and decisionmakers Bureaucracy, lack of political support, lack of coordination and cooperation between managing entities Incomplete coverage of data Passive collection, reporting not compulsive and not reinforced, physicians and hospitals insufficient motivated to report Challenging transition to electronic data South East European Cancer Registries, Report Eurocourse workshop WP 8, Deliverable 8.3, EUROCOURSE 2011
Drug Availability Mapping :ESMO Study Erlotinib Gefitinib Crizotinib Afatinib
Annual average net earnings in Europe (Eurostat 2012) 40000 Average annual net earnings (Eur) 30000 20000 10000 7500 EUR/Month Vemurafenib 0 Bulgaria Lithuania Latvia Slovakia Czech Republic Portugal Greece Ireland Iceland United Kingdom Netherlands Denmark Belgium Sweden Norway
Total health expenditure/country Eurostat 7000 Total health expenditure/capita (ppp$) 5250 3500 1750 0 Republic of Moldova Albania Belarus Romania Russian Federajon Latvia Poland Estonia Croaja Slovakia Cyprus Portugal Italy Finland Iceland Belgium France Denmark Netherlands Norway
Sources of differences in cancer survival among countries National Cancer Control Plan stewardship, monitoring, guidelines, case management, quality assurance Screening, waiting times, optimal therapy etc. GOVERNANCE ACCESS TO CARE RESOURCES Total health expenditure, drugs available, diagnostic equipment, treatment centers OECD Cancer Care Systems Questionnaire 2009
EUROCHIP List of proposed indicators Micheli A, et al. Cancer control in Europe: A proposed set of European Cancer Health Indicators EUROCHIP. Eur J Publ Health 2003; 13(Suppl3): 116-118.
EUROCHIP indicators- priority
Mapping: EUROCHIP Indicators sources and avialability (EPAAC)
EPAAC WP9, Annex 02.2 2014
EU Recommendations, guidelines EU guidleines of integrative care (CANCON, in progress ) ECHI: European core Health Indicators "European Guide for Quality National Cancer Control Programmes (EPAAC) European Cancer Information System (ECIS) (planned)
Mapping? ACTION for implementatio n of guidelines Selfreported survey Recomme ndations/ Guideline s Identify best practice Measuring progress Measurable parameters Objectives fulfillment
Mapping Many actions already done Plethora of information Redundancy Information disseminated, fragmented Gaps in topics, geographic coverage, timelines Methodology??- self reporting not independent mapping, not mandatory for countries, not funded Patients networks research input? Overview resources already present, Pinpoint meaningful gaps Promote focus of efforts and resources on meaningful gaps Define and promote better methodology
NOT Ice chipping!! Long-term Planning Long-term investing Have the right tools to measure progress towards measurable objectives
Environment and Health Information System (ENHIS) evidence-based information system aiming to support public health and environmental policies in the WHO European Region. The system is an interactive database, composed of country-level indicators and regional assessments (fact sheets). The fact sheets also include information on how data is obtained and how the indicators are calculated. ENHIS indicators provide information on exposures, health outcomes and policy actions related to the environment and health priority areas for the European Region known as Regional Priority Goals (RPGs): RPG 1: Ensuring public health by improving access to safe water and sanitation; RPG 2: Addressing obesity and injuries through safe environments, physical activity and healthy diet; RPG 3: Preventing disease through improved outdoor and indoor air quality; RPG 4: Preventing disease arising from chemical, biological and physical environments.
Action to reduce the excessive exposure of children to UVR 2006 European Environment and Health Information System (ENHIS), ENHIS II Study WHO European Region