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Slide 1 - High resolution study experiences in Ticino and Switzerland, a selectionSEA Malpensa Center, 6 th November 2012Workshop for a European High Resolution Study Different projects are ongoing in Ticino and Switzerland Probably some ongoing studies are today unknown to us A pattern of care study on Prostata cancer is scheduled (data-collection) A End of life pattern of care study on different cancers is ongoing (record-linkage) IN SWITZERLAND
Slide 2 - Incidence and mortality trends of Colorectal Cancer Ticino versus Switzerland INCIDENCE MORTALITY EPIDEMIOLOGY
Slide 3 - Colorectal Cancer in Ticino, 1996-2011 EPIDEMIOLOGY
Slide 4 - IN TICINO
Slide 5 - IN TICINO
Slide 6 - IN TICINO
Slide 7 - Quality indicators study, Ticino, 2011-2013, a population based studyWhy quality indicators? 2011 2012 2013 2014 2015……………..2020 Quality indicators Survival results “Disadvantage” Less worldwide defined PILOT STUDIES are necessary
Slide 8 - Some methods of QC3 Quality Indicator Denominator % OF PATIENTS OBSERVED…… Results should be compared with other national and/or international initiatives
Slide 9 - How to retrieve QI?
Slide 10 - According to the up-to-date literature Through existing guidelines (NCCI, ESMO, other) How are the quality indicators defined? Cancer Registry with a dedicated staff (Bianchi-Galdi V, Spitale A, Ortelli L, Bordoni A)
Slide 11 - How to increase quality, acceptance and translation of results into the daily clinical practice? The QC3 study is based on expertise and active involvement of local health care providers representing all major disciplines (epidemiology, statistic, and clinical experts in pathology, radiology, surgery, radio-oncology, oncology)
Slide 12 - How are the indicators defined? QC3 Working Groups Lung Cancers (n=13): Dr. med. A. Azzola, PD Dr. med. M. Bongiovanni, PD Dr. med. A. Dutly, Dr. med. A. Franzetti-Pellanda, Dr. med. P. Frösch, Dr. med. S. Györik, Prof. Dr. med. S. Martinoli, Dr. med. F. Martucci, Prof. Dr. med. L. Mazzucchelli, Dr. med. G. Pesce, Dr. med. C. Puligheddu, Dr. med. F. Quadri, Dr. med. F. Zappa. Colo-Rectal Cancers (n=16): Dr. med. J. Barizzi, Dr. med. F. Bihl, Dr. med. D. Christoforidis, Dr. med. A. Franzetti-Pellanda, PD Dr. med. L. Giovanella, Dr. med. J. Heinkel, Dr. med. M. Maffei, Prof. Dr. med. L. Mazzucchelli, Dr. med. B. Miazza, Dr. med. A. Pelloni, Dr. med. C. Quattropani, Prof. Dr. med. R. Rosso, Dr. med. P. Saletti, Dr. med. M.C. Valli, Dr. med. M. Varini, PD Dr. med. R. Wyttenbach. Prostate Cancers (n=11): Dr. med. G. Ballerini, Dr. med. G. Casanova, Dr. med. S. Crippa, Dr. med. A. Lladò, Prof. Dr. med. L. Mazzucchelli, Dr. med. G. Pesce, Dr. med. A. Pedrazzini, Dr. med. E. Roggero, Dr. med. F. Stoffel, Dr. med. S. Suriano, PD Dr. med. R. Wyttenbach. Ovarian/Uterine Cancers (n=12): Dr. med. G. Ballerini, Dr. med. L. Bronz, Dr. med. A. Calderoni, Dr. med. L. Ceriani, Dr. med. C. Cannizzaro, Dr. med. T. Gyr, Dr. med. M. Manganiello, Dr. med. C. Marini, Prof. Dr. med. L. Mazzucchelli, Dr. med. A. Richetti, Dr. med. T. Rusca, Prof. Dr. med. C. Sessa
Slide 13 - Process used to select QC3 quality indicators 1 Extract Indicators from Literature 2 In-person Worging Groups Meeting Questionnaires (Delphi Round 1) 3 Questionnaires (Delphi Round 2) 4 Advisory Board
Slide 14 - QC3 Colo-Rectal Cancer Advisory Board Pathology: Prof. Dr. med. Phil Quirke, Director, Leeds Institute of Molecular Medicine (LIMM), Section of Pathology, Wellcome Trust Brenner Building, St James’s University Hospital, Leeds (UK) Oncology: Prof. Dr. med. Roberto Labianca, Director, Oncology and Haematology Dept., Ospedali Riuniti, Bergamo (I) Gastroenterology: Prof. Dr. med. Gian Dorta, Director, Digestive Endoscopy Dept., Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne (CH) Surgery: Prof. Dr. med. Emmanuel Tiret, Director, Pôle Digestif des Hôpitaux Univesitaires Paris Est, Chef Service de Chirurgie Générale et Digestive, Hôpital Saint-Antoine, Paris (F) Radiology: Prof. Dr. med. Dominik Weishaupt, Director, Radiology Dept., Stadtspital Triemli, Zürich (CH) Radiation Therapy: Prof. Dr. med. Vincenzo Valentini, Director, Unità Operativa Complessa Radioterapia 1, Policlinico Universitario Agostino Gemelli, Rome (I) Nuclear Medicine: Prof. Dr. med. Stefano Fanti, Director, PET Center, Policlinico S. Orsola-Malpighi, Bologna (I) Cancer Registry: Prof. Dr. med. Jean Faivre, Director, Registre Bourguignon des Cancers Digestifs, Dijon Cedex (F) Local Experts: Prof. Dr. med. Franco Cavalli, Scientific Director, Oncologic Institute of Italian Switzerland (IOSI), Bellinzona (CH) Prof. Dr. med. Sebastiano Martinoli, Director, General Surgery Dept., Clinica Luganese, Lugano (CH)
Slide 15 - QC3 Prostate Cancer Advisory Board Pathology: Prof. Dr. J.R. Srigley, McMaster University, Credit Valley Hospital, Mississauga (CDN) Oncology: Prof. Dr. Ian Tannok, Director, Medical Oncology and Medical Biophisics Dept., Princess Margaret Hospital, Toronto (CDN) Urology: Prof. Dr. Peter T. Scardino, Director, General Surgery Dept., Memorial Sloan-Kettering Cancer Center, New York (USA) Radiology: Prof. Dr. Harriet Thöny, Diagnostic Radiology Dept., Inselspital, Bern (CH) Radiation Therapy: Prof. Dr. Raymond Miralbell, Director, Radiation Oncology Dept., Hôpiteaux Universitaires Genève, Genève (CH) Cancer Registry: Dr. Renée Otter, Director, Comprehensive Cancer Center North Netherlands, Groningen (The Netherlands) Local Experts: Prof. Dr. Michele Ghielmini, Medical Director, Medical Oncology Dept., Oncologic Institute of Italian Switzerland (IOSI), Bellinzona (CH)
Slide 16 - QC3 Gynaecologic Cancer AdvisoryBoard Pathology: Prof. Dr. Eshter Oliva, Pathology Dept., Massachussets General Hospital, Boston (USA) Gynaecology - Oncology: Prof. Dr. René H.M. Verheijen, Director, Surgical and Oncological Gynaecology Inst., Reproductive Medicine and Gynaecology Dept., University Medical Center, Uthecht (The Netherlands) Radiation Therapy: Prof. Dr. Akila N. Viswanathan, Director, Gynaecologic Radiation Oncology Dept., Dana-Farber Cancer Institute, Boston (USA) Cancer Registry: Prof. Dr. Hélène Sancho-Garnier, Scientific Director, Epidaure - Pôle prévention du CRLC Val d'Aurelle, Montpellier (France)
Slide 17 - Open questions on quality indicator cancer care study….. Are all the proposed indicators through the Delphy process detectable in the real world? We are now in a “pilot-phase”…. Are the proposed indicators useful/compatible for other reality in Switzerland or Europe? Will this type of studies be compatible with the scheduled new law on cancer registration in Switzerland and Europe?
Slide 18 - Proportion of patients with Colorectal Cancer evaluated by preoperative colonoscopy All patients with Colorectal Cancer undergoing surgery 91.7% Subgroup of patients undergoing preoperative colonoscopy Denominator 294 patients 255 patients Numerator DIAGNOSIS Literature Labianca R, Nordlinger B, Beretta GD et al. Primary colon cancer: ESMO Clinical Practice Guidelines for diagnosis, adjuvant treatment and follow-up. Ann Oncol 2010; 21: v70-v77. Isler JT, Brown PC, Lewis FG, Billingham RP. The role of preoperative colonoscopy in colorectal cancer. Dis Colon Rectum. 1987 Jun;30(6):435-9 Takeuchi H, Toda T, Nagasaki S, Kawano T, Minamisono Y, Maehara Y, Sugimachi K. Synchronous multiple colorectal adenocarcinomas. J Surg Oncol. 1997 Apr;64(4):304-7.
Slide 19 - Is 91.7% enough to warrant a good quality of colorectal cancer care? 89% in France (2003-2004) Mathoulin-Pelissier S et al. BMC Cancer 2012;12:297 97% in Canada (1997-2006) Pinco P. et al., 2001 !! Patients in emergency surgery not included!! Proportion of patients with Colorectal Cancer evaluated by preoperative colonoscopy DIAGNOSIS
Slide 20 - Open questions on quality indicator cancer care study….. Are all the proposed indicators through the Delphy process detectable in the real world? We are now in a “pilot-phase”…. Are the proposed indicators useful/compatible for other reality in Switzerland or Europe?
Slide 21 - We are really grateful for the support of the study sponsors: Zonta Club Locarno Accademia Svizzera delle Scienze Mediche Ricerca Svizzera Contro il Cancro Ente ospedaliero cantonale Repubblica e cantone Ticino