EUROCHIP Health Indicators for Monitoring Cancer in Europe Health Monitoring Program (HMP) EUROPEAN...

EUROCHIPEUROCHIP

Health Indicators for Health Indicators for Monitoring Cancer in EuropeMonitoring Cancer in Europe

Health Monitoring Program (HMP)Health Monitoring Program (HMP)EUROPEAN COMMISSIONEUROPEAN COMMISSION

HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERALHEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL

Www.istitutotumori.mi.it/project/eurochip/homepage.htmWww.istitutotumori.mi.it/project/eurochip/homepage.htm

GROUP OF SPECIALISTS GROUP OF SPECIALISTS ononTREATMENT AND TREATMENT AND

CLINICAL ASPECTSCLINICAL ASPECTS

Edinburgh, 21st-22nd November 2002Edinburgh, 21st-22nd November 2002

EUROCHIPEUROCHIP

Chairperson: Dr Ian Kunkler

INTRODUCTION INTRODUCTION TO THE TO THE

MEETINGMEETING

Dr. Ian Kunkler

AIMS OF THE MEETINGAIMS OF THE MEETING

• An updated list of indicators for “treatment and

clinical aspects” 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 MEETINGSUBJECTS OF THE MEETING

• Verification of the completeness of the list of indicators

• Discussion about priorities of the indicators

• Discussion on cancer sites to include in EUROCHIP

• Discussion/modification of the forms of the indicators of this domain

• Indications on methodological aspects

CONSIDERATIONSCONSIDERATIONSParticipants 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 “treatment and clinical aspects” 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:EUROCHIP PROJECT:PRESENTATIONPRESENTATION

Dr. Andrea Micheli

EUROCHIP INTRODUCTIONEUROCHIP INTRODUCTIONAIM: 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.


Comprehensive range of health indicators for cancer:

LIST LIST

OF OF

CANCERCANCER

INDICATORSINDICATORS

RISK FACTORS

PRE-CLINICAL ACTIVITY/ SCREENING

CLINICAL FOLLOW-UP

DIAGNOSTIC AND THERAPEUTIC PROCEDURES

CANCER RECURRENCE

AND MORTALITY

CANCER CARE/ PREVALENCE

SURVIVAL

OCCURENCE

Standardised methods for collecting, checking and validating the data will be proposed for each indicator

EUROCHIPEUROCHIPC

AM

ON

EU

RO

CA

RE

/EU

RO

PR

EV

AL



Steering CommitteeSteering Committee

Working TeamWorking Team

Operational work

Panel of ExpertsPanel of Experts

Discussion & organization at national level

Methodological GroupMethodological Group

Methodological aspects of the indicators

GS: Groups of specialistsGS: Groups of specialists

Discussion of indicators at national and domain level

GSGS

GSGS

GSGSGSGSGSGS

GSGS

GSGS

FRAMEWORK OF THE PROJECTFRAMEWORK OF THE PROJECT


130130 CANCER SPECIALISTS ARE INVOLVED IN EUROCHIP

1616 INTERNATIONAL MEETINGS HELD

ALLALL COUNTRIES OF THE EUROPEAN UNION ARE PARTICIPATING IN THE PROJECT

FIRST AND FUTURE STEPSFIRST AND FUTURE STEPS

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


RESULTSRESULTS

PRELIMINARY LIST OF 158158 INDICATORS

3939 INDICATORS AT HIGH PRIORITY

For each indicator we compile a FORMFORM subdivided in three sections:

DESIRED INDICATORDESIRED INDICATOR: all indicator characteristics we wish to have METHODOLOGYMETHODOLOGY: operational definition, possible sources and methodological issues AVAILABILITYAVAILABILITY in different countries

EUROCHIP MEETINGSEUROCHIP MEETINGS

LIST OF INDICATORSLIST OF INDICATORS

EUROCHIP FINAL RESULTSEUROCHIP FINAL RESULTS(AT THE END OF STEP 3)(AT THE END OF STEP 3)

For each indicator at high priority EUROCHIP will produce:

1. A DESCRIPTIVE FORM 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 METHODOLOGICAL FORM including:

• Methodological aspects (standardisation, validity, variability)

• Bibliography on the indicator

• Suggestions to the European Commission


THOROUGHNESS THOROUGHNESS OF THE OF THE

INDICATOR LISTINDICATOR LIST

Dr. Franco Berrino

LIST OF EUROCHIP HIGH PRIORITY INDICATORSLIST OF EUROCHIP HIGH PRIORITY INDICATORS

1.Tobacco consumption1.Tobacco consumption2.Exposure to asbestos2.Exposure to asbestos

PREVENTIONPREVENTION

5.Breast cancer screening coverage5.Breast cancer screening coverage6.Cervical cancer screening coverage6.Cervical cancer screening coverage7.Performance indicators of 7.Performance indicators of organized screening programmesorganized screening programmes

SCREENINGSCREENING

8.Interval between first 8.Interval between first symptoms and diagnosissymptoms and diagnosis 9.Interval between diagnosis 9.Interval between diagnosis and first treatmentand first treatment10.Radiation equipment10.Radiation equipment11.% of centres with at least 11.% of centres with at least 2 radiation equipments2 radiation equipments12.Doctors by specialization12.Doctors by specialization13.Compliance with guidelines13.Compliance with guidelines14.Pain units and hospices14.Pain units and hospices15.Use of morphine15.Use of morphine

TREATMENT AND CLINICAL ASP.TREATMENT AND CLINICAL ASP.

3.Coverage of cancer registration3.Coverage of cancer registration4.Stage at diagnosis4.Stage at diagnosisPerson-years life lost due to cancerPerson-years life lost due to cancerCompleteness of the registrationCompleteness of the registration

EPIDEMIOLOGY AND CANCER REG.EPIDEMIOLOGY AND CANCER REG.

16.Total National Expenditure 16.Total National Expenditure on Health for canceron Health for cancer17.Total Public Expenditure 17.Total Public Expenditure on Health for canceron Health for cancer

MACRO SOCIAL-MACRO SOCIAL-ECONOMIC VARIABLESECONOMIC VARIABLES


PREVENTIONPREVENTION1) Tobacco consumptionTobacco consumption2) Consumption of fruit and vegetable *3) Consumption of alcohol *4) Body Mass Index *5) Exposure to asbestosExposure to asbestos6) AIDS incidence *7) Prevalence of hepatitis B/C *EPIDEMIOLOGY AND CANCER REGISTRATIONEPIDEMIOLOGY AND CANCER REGISTRATION8) Coverage of cancer registrationCoverage of cancer registration9) Incidence rates *10) Survival rates *11) Prevalence proportion * Mortality rates *13) 13) Stage at diagnosisStage at diagnosis14) Person-years life lost due to cancer15) Completeness of the registration (DCO and Incidence / mortality)16) % of microscopically cases *

INDICATORS AT HIGH PRIORITY (1)INDICATORS AT HIGH PRIORITY (1)

* Connected with other HMP projects



SCREENINGSCREENING

17) Breast cancer screening coverageBreast cancer screening coverage18) Cervical cancer screening coverageCervical cancer screening coverage19) Performance indicators of organized screening programmesPerformance indicators of organized screening programmes

TREATMENT AND CLINICAL ASPECTSTREATMENT AND CLINICAL ASPECTS

20) Interval between first symptoms and diagnosisInterval between first symptoms and diagnosis21) Interval between diagnosis and first treatmentInterval between diagnosis and first treatment22) Radiation equipmentRadiation equipment23) % of centres with at least 2 radiation equipments% of centres with at least 2 radiation equipments24) Doctors by specializationDoctors by specialization25) Compliance with guidelinesCompliance with guidelines26) Patients treated by surgery *27) Pain units and hospicesPain units and hospices28) Use of morphineUse of morphine




MACRO SOCIAL-ECONOMIC VARIABLESMACRO SOCIAL-ECONOMIC VARIABLES

29) Education level attained *30) Deprivation index *31) Income *32) Gross Domestic Product *33) Total Social Expenditure34) Total National Expenditure on Health *35) Total National Expenditure on Health for cancerTotal National Expenditure on Health for cancer36) Total Public Expenditure on Health *37) Total Public Expenditure on Health for cancerTotal Public Expenditure on Health for cancer38) % elderly in 2010-2020-203039) Age distribution of population


PRIORITYPRIORITYLEVELSLEVELS

Dr. Ian Kunkler

PRIORITY LEVELSPRIORITY LEVELS

AA Direct indicator – Important – With or without any problem

BB Indirect indicator – Important – With or without any problem

C C Potentially useful but with presenting a great deal of problems

D D Very low priority – Irrelevant

TREATMENT AND CLINICAL ASPECTSTREATMENT AND CLINICAL ASPECTS

- Interval between symptoms and diagnosis (DELETED)

- Interval between diagnosis and first treatment (3)

- Radiation equipment (2)

- % of centres with at least 2 radiation equipments

- Number of CT scan per …. (NEW)

- Medical cancer work force (DELETED)

- Compliance with guidelines (3)

- Patients treated by surgery / chemotherapy /… (NEW)

- Palliative care (3)

- Pain units and hospices

DO YOU WANT SOMETHING ELSE DO YOU WANT SOMETHING ELSE AT HIGH PRIORITY?AT HIGH PRIORITY?

ARE THESE PRIORITIES OK?ARE THESE PRIORITIES OK?

AA- Interval between first symptoms and diagnosisInterval between first symptoms and diagnosis- Interval between diagnosis and first treatmentInterval between diagnosis and first treatment- Radiation equipmentRadiation equipment- % of centres with at least 2 LinAcs% of centres with at least 2 LinAcs- Doctors by specializationDoctors by specialization- Compliance with guidelines Compliance with guidelines - Patients treated by surgery, chemotherapy, …- Pain units and hospicesPain units and hospices- Use of morphineUse of morphine- CATCAT

CC- Nr of bad-days attributable to cancer careNr of bad-days attributable to cancer care- Patients treated with conservative surgery / Patients treated with conservative surgery / radiotherapy / chemotherapy / hormonal treatmentradiotherapy / chemotherapy / hormonal treatment- Quality of cancer patients indicatorsQuality of cancer patients indicators

BB- CATCAT

STAGE AT DIAGNOSISSTAGE AT DIAGNOSIS

Dr. Carmen Martinez

• Cancer type: Breast, colorectal cancer, cervix, lung, prostate (NEW SITES)

• Generic definition: proportion of incidence cases classified with the TNM value or, in absence, with condensed-TNM. The non-metastatic cases will be classified by presence or absence of a specific test for the detection of the metastasis

• Rationale: Early/late diagnosis • Utility: Determinant of treatment and prognosis

• Modalities of classification: TNM or cond. TNM (+ non-metastatic cases with/without detection test)

• By sex and by age

STAGE AT DIAGNOSIS Descriptive Form

• Suggestions to the EC: to subsidize CR. In the first years we will have to recommend clinicians and pathologists to indicate the stage in the clinical reports

• Source: Cancer Registries with High resolution studies

STAGE AT DIAGNOSIS Methodological Form

INDICATORS ONINDICATORS ONDELAY OF CAREDELAY OF CARE

Dr. Ian Kunkler

DELAY OF CARE: DELAY OF CARE: PHASES OF THE DISEASE HISTORYPHASES OF THE DISEASE HISTORY

SYMPTHOM: there is not an event and it is not strictly defined on time

FIRST MEDICAL ATTENDANCE: date in which patient reports his sympthoms to the Health System

DIAGNOSIS: date defined using the conventional date index of Cancer Registries

FIRST TREATMENT: Date of the beginning of primary treatment

DEFINITIVE TREATMENT: ?

INDICATORS ON DELAY OF CARE:INDICATORS ON DELAY OF CARE:INTERVAL BETWEEN FIRST SYMPTOMS AND DIAGNOSIS INTERVAL BETWEEN FIRST SYMPTOMS AND DIAGNOSIS

and INTERVAL BETWEEN DIAGNOSIS AND TREATMENTand INTERVAL BETWEEN DIAGNOSIS AND TREATMENT We suggest to use the distance between first medical attendance and diagnosis and between diagnosis and first treatment

CONTEXT

SOURCE

STANDARDIZATION

VARIABILITY

VALIDITY

Cancer Registries The dates have to be in the form DD/MM/YY

We need exact definitions of the phases of the disease history

Relevant

A lot of problems (see methodological form)

FIRST MG RESULTSFIRST MG RESULTS• study colon, cervix and breast cancers• distinguish between screening clinical diagnosis • use the date of pathological confirmation as the date of diagnosis • use the date of first medical attendance as the first stage of the disease• A1.4Tr.2 interval is from date of pathological confirmation and start of first treatment • The two indicators should be condensed in only one• The sources are the Cancer Registries. For frequent cancer sites as breast, cervix and colorectal a sample of cases could be studied.

MG Results: FIRST MEDICAL ATTENDANCEMG Results: FIRST MEDICAL ATTENDANCE

The group defines this event as the first medical attendance reporting symptoms for the cancerous disease.

For cases discovered by screening procedures, either organized or spontaneous (breast, cervix, colorectum), we consider positive mammography, PAP smear, and colonscopy as first medical attendance. People at high risk or presenting suspicious symptoms who are under observation with repeated examinations are assimilated to spontaneous screening with respect to first medical attendance definition

MG Results: PATHOLOGICAL CONFIRMATIONMG Results: PATHOLOGICAL CONFIRMATION

Pathological confirmation (histology) is assumed as the major clinically significant event associate to diagnosis.

Patients following their first medical attendance are addressed to perform a diagnostic procedure including biopsy. Pathological confirmation following biopsy defines diagnosis and is a basic information for treatment. Cases discovered by screening follow the same diagnostic procedure and the pathological confirmation defines the diagnosis. This is valid for breast, colorectal, and cervical cancers either screening or symptomatic patients

MG Results: FIRST TREATMENTMG Results: FIRST TREATMENT

First treatment represents the start of a defined treatment for a patient. This would include any treatment that that is defined as a starting point in a protocol, not always the principal treatment.

As an example, radiotherapy is sometimes the first treatment before surgery for cervical cancers, and treatment with tamoxifen before surgery for breast cancer. We will consider as first treatment radiotherapy and tamoxifen, instead of surgery that is the principal treatment, in these cases

Results from Cancer Registration group Results from Cancer Registration group

- The indicator could be collected by CR- The registration cannot be routinely- It is reasonable that a sample of population for a number of Cancer Registries will be included in periodical activities- This periodical activity will cost a large quantity of money- The treatment group will have to indicate a few sites and will have to provide very clear definitions of the phases of the disease

Indicator characteristicsIndicator characteristics

• The Methodological Group suggests • to define exactly the 3 dates (first medical attendance, diagnosis and first treatment) for 3 cancer sites: colon, breast and cervix• to put together the two indicators. The 2 intervals would become the modalities of classification of the new indicator on delay of cancer care

• The indicator is completely new. For its realization the cancer registration will have to improve: infact the Cancer Registries will have to found also these dates for each case

COMPLIANCE WITHCOMPLIANCE WITHGUIDELINESGUIDELINES

Dr. Carmen Martinez

COMPLIANCE WITH GUIDELINESCOMPLIANCE WITH GUIDELINES

We need to collapse the guidelines in a few items

CONTEXT

SOURCE

STANDARDIZATION

VARIABILITY

VALIDITY

Cancer registries

Studies should be conducted using a common protocol and criteria

Relevant

To use studies as “High resolution studies”

First Methodological Group ResultsFirst Methodological Group Results

The indicator is aimed to reflect the deviance to best deviance to best practicepractice in oncology. It implies the existence of specific professional guidelinesguidelines and express something related to the attitude to comply with guidelines rather best practicecomply with guidelines rather best practice. To give an indication on the patients treated according to the guidelines, we need to collapse the guidelines themselves collapse the guidelines themselves into a few simple itemsinto a few simple items. As guidelines usually refer to cases that can be potentially cured, the indicator should refer to should refer to patients potentially eligible for treatmentpatients potentially eligible for treatment according to guidelines.

An examination of the “deviation”“deviation” from guidelines is usually more robust than a look at their “adherence”. The medical attitude in following guidelines may vary considerably and thus, is very difficult to classify. Defining Defining the non-adherence is easier and more robustthe non-adherence is easier and more robust.

ExampleExample

As an example, Sant (2001) showed that in Southern Italy a very low proportion of breast cancer patients T1N0M0 were treated with conservative surgery while many received Hastled mastectomy. This a clear deviation to guidelines, although motivated by lack of radiotherapy centres in the area.

Source: Sant M, and the EUROCARE Working Group: Differences in stage and therapy for breast cancer across Europe. International Journal of Cancer 93: 894-901 (2001)

SOURCESOURCE

The indicator is a new indicator

The sources should be the Cancer Registries.

The Methodological group suggests specific studies on sample of cases in order to collect information on therapy and stage, such as the EUROCARE High Resolution Studies

Results from Cancer Registration group Results from Cancer Registration group

- The indicator could be collected by Cancer Registries

- It is reasonable that a sample of population for a few number of sites and items will be included in periodical activities

- It is important studying the “non-adherence”.

- The treatment group has to define a few items with treatments that have not be done


• The Methodological Group suggests• to study the “deviation” from guidelines. • to define the indicator “Deviation from the best practice” or “Frequency of inappropriate treatment”. • the Treatment Group of Specialists to define 3 or 4 cancer sites to study and 2 or 3 treatments universally considered inappropriate for these cancer sites (also considering different stages)

• The indicator should change in the future following the diffusion of new treatments

INDICATORS ON INDICATORS ON RESOURCESRESOURCES

Dr. Jan Willem Coebergh

RADIO-THERAPY EQUIPMENTRADIO-THERAPY EQUIPMENT

Number of linear accelerators installed max since 10 years

CONTEXT

SOURCE

STANDARDIZATION

VARIABILITY

VALIDITY

Survey on all health structures

The Lin Acs have to be working on 31st Dec of the year before the survey

Relevant

No problems

UNITS WITH AT LEAST 2 LINEAR ACCELERATORSUNITS WITH AT LEAST 2 LINEAR ACCELERATORS

Number of cancer units with at least 2 linear accelerators installed max since 10 yrs

CONTEXT

SOURCE

STANDARDIZATION

VARIABILITY

VALIDITY

Survey on all health structures

The Lin Acs have to be working on 31st Dec of the year before the survey

No problems

No problems


• The Methodological group suggests to deletedelete this indicator as before studying the indicator we should reply to this question:

If a country has 10 Lin Acs is it better to have all If a country has 10 Lin Acs is it better to have all 10 Lin Acs in only a cancer unit or 1 Lin Acs in 10 10 Lin Acs in only a cancer unit or 1 Lin Acs in 10 different units?different units?

Medical cancer work-forceMedical cancer work-forceThe medical specializations are not standardized. We suggest to classify the specialization in 3 classes (e.g. medical oncology, radiology and haematology areas)

CONTEXT

SOURCE

STANDARDIZATION

VARIABILITY

VALIDITY

National Medical Associations

We need the classification of various specializations in the 3 classes

No problems

No problems

DELETEDDELETED


The group has to discuss on

• the possibility to classify the specializations in some broad classes

• definition of the broad classes

• classification of the various specializations in the broad classes

INDICATOR ONINDICATOR ONPALLIATIVE CAREPALLIATIVE CARE

Dr. Kaija Holli

PAIN UNITS AND HOSPICESPAIN UNITS AND HOSPICES

Diffusion of the pain units and hospicesCONTEXT

SOURCE

STANDARDIZATION

VARIABILITY

VALIDITY

International Association of Palliative Care

Definition of “pain units”

No problems

No problems

USE OF MORPHINEUSE OF MORPHINE

Indicator of the attitude to treat pain of the cancer patients

CONTEXT

SOURCE

STANDARDIZATION

VARIABILITY

VALIDITY

WHO

No problems

No problems

Overestimate the use of morphine for cancer

DELETEDDELETED

EUROPEAN COMMISSIONEUROPEAN COMMISSIONPUBLIC HEALTHPUBLIC HEALTH

PROGRAMSPROGRAMS

Dr. Andrea Micheli

PUBLIC HEALTH PUBLIC HEALTH IN EUROPEIN EUROPE

• the European past and next strategy

FOCUS ON CANCER• past/present in HMP: EUROCHIP and CAMON

• next: Working Party

Priority areasPriority areas of of thethe public health programmepublic health programme

General health policy

Health determinants

Health threats

Health information

By Dr. Tapani PihaBy Dr. Tapani Piha

Health

information

Bringing programmes togetherBringing programmes together

Cancer

Injury

Health monitoring

Pollution

Aids

Rare diseases

-2002

2003-By Dr. Tapani PihaBy Dr. Tapani Piha

Public health programme Public health programme Implementation focusImplementation 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


Stages in data processingStages in data processing

Stage 1Data definition

andquality development

Stage 2Support to

data collection at national level

Stage 3Data collection, processing and

storage at EU level

Stage 4Analysis, advice,

reporting, informing and consulting

Stage 5Mechanisms for

exchanging, promoting and disseminating

results


SUMMARY OF THE SUMMARY OF THE FIRST DAYFIRST DAY

• Indicators to be deleted“Interval between first symptoms and first diagnosis” “Use of morphine”

• Add at high priority indicators “% patients treated by …”•For the indicator “Stage at diagnosis” the group suggests to collect TNM data also for cervix, prostate and lung and not only for breast and colo-rectal cancers. The group defines also the metastasis detection tests for the different sites considered• For palliative care the indicator should be “Number of specialised palliative care teams”

DECISIONSDECISIONS

The group recommends that Cancer Registries (for breast, prostate, colon, rectum, lung cancers) have to collect the dates of 1st diagnosis (or 1st medical attendance for colon and rectum cancer), 1st surgery, 1st radiotherapy, 1st chemotherapy and 1st endocrine therapy (for breast and prostate)

PROPOSALPROPOSAL

• These dates are necessary for the indicator “Delay of care” so defined “Difference between 1st diagnosis (or 1st medical attendance for colon and rectum cancers) and 1st treatment (among surgery, chemotherapy, radiotherapy or other therapy)• These dates indicate if a patient has had a particular treatment so we can use them for the indicators “% of patients treated by surgery, chemotherapy, radiotherapy and endocrine therapy”

MEETING MEETING DECISIONSDECISIONS

• What are the detection tests we have to do to decide if there is a metastasis?

- Cervix: chest x-ray and pelvic imagine

- Colon: liver ultrasound or CT and chest x-ray

- Rectum: liver ultrasound or CT and chest x-ray

- Prostate: bone-scan

- Lung: CT thorax

- Breast: T1-T2 chest x-ray

T3-T4 or N+: bone-scan and liver ultrasound

STAGE AT DIAGNOSISSTAGE AT DIAGNOSIS

BREAST CANCERBREAST CANCER

From• First FNA (First fine-needle aspirate) or

histological confirmation To• First surgical resection or neo-adjuvant

treatment (date of start of adjuvant radiotherapy, date of start of adjuvant chemotherapy, Date of start of adjuvant endocrine therapy)

INTERVAL BETWEEN DIAGNOSIS AND 1ST TREATMENTINTERVAL BETWEEN DIAGNOSIS AND 1ST TREATMENT

COLON CANCERCOLON CANCER

From

• First medical referral to a specialist

To

• Surgical resection


RECTUM CANCERRECTUM CANCER

From

• First medical referral to a specialist

To

• Date of first adjuvant radiotherapy treatment

• Date of surgical resection


LUNG CANCERLUNG CANCER

From date of first histological/cytological confirmation

To surgical resection / date of first curative radiotherapy treatment / date of first chemotherapy treatment


PROSTATE CANCERPROSTATE CANCER

From date of first histological confirmation

To date of radical prostatectomy or Date of other surgery

date of radical radiotherapy (external beam and/or brachytherapy)

date of first endocrine therapy


BREAST CANCERBREAST CANCER

1) Proportion of patients receiving post-operative breast radiotherapy after breast conserving surgery

By age

2) Proportion of patients with pathological or clinical tumour site 3cm or less receiving conserving surgeryBy age


COLON CANCERCOLON CANCER

1) Proportion of patients with Dukes C receiving adjuvant chemotherapy

By age


RECTUM CANCERRECTUM CANCER

1) Proportion of patients receiving pre-operative radiotherapy

By age


PROSTATE CANCERPROSTATE CANCER

1) Proportion of patients receiving radical prostatectomy

By age

2) Proportion of patients receiving radical radiotherapy by external beam or brachytherapy

By age


LUNG CANCERLUNG CANCER

1) Proportion of patients with non small cell undergoing radical surgery

By age

2) Proportion of patients undergoing staging with thoracic CT scanning

By age


CERVIX CANCERCERVIX CANCER

1) Proportion of patients with FIGO-stage III/IV in cervix cancer receiving chemoradiotherapy

By age

2) Proportion of patients undergoing WERTHEIM-MEIGS hystorectomy by FIGO-stage (including insitu)

By age


EUROCHIP Health Indicators for Monitoring Cancer in Europe Health Monitoring Program (HMP) EUROPEAN...

Documents

Transcript of EUROCHIP Health Indicators for Monitoring Cancer in Europe Health Monitoring Program (HMP) EUROPEAN...