Periodic Reporting for period 1 - EU-TOPIA-EAST (TOwards imProved screening for breast, cervical and colorectal cancer in Eastern-Europe: Equitable, Actionable, Sustainable and Trustworthy)
Berichtszeitraum: 2021-05-01 bis 2022-10-31
Colorectal, breast and cervical cancer cause 155,000 deaths each year in middle income countries (MIC) in Eastern Europe, while there is good evidence that a large proportion could be prevented by organized screening. Although many MIC in Eastern Europe have implemented some form of cancer screening, this screening is often non-organized, leading to lack of data and quality assurance systems. Also, coverage is commonly low and minority groups are not reached.
In a previous HORIZON2020 project ‘EU-TOPIA’, we developed road maps to improve cancer screening programmes in Europe. In the current project, EU-TOPIA-EAST, these roadmaps will be refined and translated into action plans for three MICs: Georgia (breast), Romania (cervix) and Montenegro (colorectal). These action plans will take the local health and social system into account by performing detailed barrier and stakeholder analyses, leading to feasible changes to current screening programs. Next, we will implement these action plans: e.g. in Georgia, we will increase coverage of the programme by establishing a new screening unit; in Romania, we will develop new IT infrastructure to allow invitation-based cervical cancer screening; and finally in Montenegro we will establish a new colonoscopy center to increase programme capacity decrease travel time for participants.
The implemented programs will be monitored and evaluated using key indicators and sophisticated decision models to predict the long-term and country-wide benefits, harms and cost-effectiveness. During workshops and round-table discussions for policymakers and screening program coordinators from all countries in Eastern Europe and the Mediterranean to build capacity and upscale the implementation of these intervention(s) in Equitable, Accessible, and SusTainable (EU-TOPIA-EAST) ways. In this way, the project will improve the prevention and early diagnosis of cancer in real-life settings in Eastern European and Mediterranean countries.
The overall goal of EU-TOPIA-EAST is to implement effective screening programmes for breast, cervical and colorectal cancer in three exemplary MICs in Eastern Europe (Georgia, Romania and Montenegro) and to build capacity for screening implementation in other Eastern European and Mediterranean countries, in order to reduce the cancer burden in these countries and to achieve equity in cancer care.
More specifically, our objectives are to:
1. Extend, update and refine the innovative road maps, which were initiated in the EU-TOPIA project by Georgia, Montenegro and Romania, into concrete action plans with steps and timeliness to successfully implementing these (WP 2, 3)
2. Follow the steps in the road maps and action plans and implement in some regions the identified feasible interventions in the existing screening programmes for breast cancer in Georgia, for cervical cancer in Romania colorectal cancer in Montenegro (WP 5, 6 and 7)
3. Monitor the impact of the implemented interventions on important short-term screening performance indicators, such as participation and detection rates (WP 2, 4)
4. Estimate required resources, health outcomes (benefits and harms, quality of life) and cost-effectiveness of scaling up the interventions to a national level and to other MIC in Eastern-Europe and the Mediterranean using innovative dedicated microsimulation models (WP 2)
5. Disseminate good implementation practices from participating countries to other MIC in Eastern Europe and the Mediterranean by organising interactive workshops and round table discussions with national, regional and local policymakers and other stakeholders (WP 8)
The knowledge and network obtained in the first EU-TOPIA project will provide the perfect base to start EU-TOPIA-EAST and the consortium, with new Eastern European partners added, will have the expertise and experience to perform the project .
In a previous HORIZON2020 project ‘EU-TOPIA’, we developed road maps to improve cancer screening programmes in Europe. In the current project, EU-TOPIA-EAST, these roadmaps will be refined and translated into action plans for three MICs: Georgia (breast), Romania (cervix) and Montenegro (colorectal). These action plans will take the local health and social system into account by performing detailed barrier and stakeholder analyses, leading to feasible changes to current screening programs. Next, we will implement these action plans: e.g. in Georgia, we will increase coverage of the programme by establishing a new screening unit; in Romania, we will develop new IT infrastructure to allow invitation-based cervical cancer screening; and finally in Montenegro we will establish a new colonoscopy center to increase programme capacity decrease travel time for participants.
The implemented programs will be monitored and evaluated using key indicators and sophisticated decision models to predict the long-term and country-wide benefits, harms and cost-effectiveness. During workshops and round-table discussions for policymakers and screening program coordinators from all countries in Eastern Europe and the Mediterranean to build capacity and upscale the implementation of these intervention(s) in Equitable, Accessible, and SusTainable (EU-TOPIA-EAST) ways. In this way, the project will improve the prevention and early diagnosis of cancer in real-life settings in Eastern European and Mediterranean countries.
The overall goal of EU-TOPIA-EAST is to implement effective screening programmes for breast, cervical and colorectal cancer in three exemplary MICs in Eastern Europe (Georgia, Romania and Montenegro) and to build capacity for screening implementation in other Eastern European and Mediterranean countries, in order to reduce the cancer burden in these countries and to achieve equity in cancer care.
More specifically, our objectives are to:
1. Extend, update and refine the innovative road maps, which were initiated in the EU-TOPIA project by Georgia, Montenegro and Romania, into concrete action plans with steps and timeliness to successfully implementing these (WP 2, 3)
2. Follow the steps in the road maps and action plans and implement in some regions the identified feasible interventions in the existing screening programmes for breast cancer in Georgia, for cervical cancer in Romania colorectal cancer in Montenegro (WP 5, 6 and 7)
3. Monitor the impact of the implemented interventions on important short-term screening performance indicators, such as participation and detection rates (WP 2, 4)
4. Estimate required resources, health outcomes (benefits and harms, quality of life) and cost-effectiveness of scaling up the interventions to a national level and to other MIC in Eastern-Europe and the Mediterranean using innovative dedicated microsimulation models (WP 2)
5. Disseminate good implementation practices from participating countries to other MIC in Eastern Europe and the Mediterranean by organising interactive workshops and round table discussions with national, regional and local policymakers and other stakeholders (WP 8)
The knowledge and network obtained in the first EU-TOPIA project will provide the perfect base to start EU-TOPIA-EAST and the consortium, with new Eastern European partners added, will have the expertise and experience to perform the project .
We started the project by collecting data from the exemplary countries. These data were needed by the workpackages on evaluation, road maps and monitoring. Data that were collected for the evaluation model were: general epidemiological data as population size by age, life tables, cancer-specific incidence and mortality by year and age and cancer survival by stage. Also we collected data of the current screening programme (participation and referral rate, detection, stage distribution etc) and costs of screening, diagnosis and treatment. These data were used to develop country-specific models to evaluate the short and long term harms, benefits and cost-effectiveness of the current screening programme and to determine the optimal screening programme, taking the local circumstances, capacity and cost-effectiveness into account.
The exemplary countries also delivered a comprehensive description of the screening activities. Next, they performed a barrier analysis to identify the most important barriers considering effectiveness and equity, and a stakeholder analysis, to determine the stakeholders that can help in overcoming the barrier or that should be convinced to overcome the barrier. These analyses were used to outlining appropriate and feasible actions in detailed action plans to improve the current screening programmes.
In addition, we evaluated the monitoring system of the exemplary countries. The current data flow was analysed and technical issues, related to data collection management and quality assurance of the necessary data, including IT and data base management competence, were identified. We checked whether the necessary information to calculate key quality indicators of cancer screening are available and whether the data collection is in compliance with the EU and national privacy legislation requirements.
The exemplary countries started with the preparation of implementing improved screening programmes by revising guidelines and intensive communication with stakeholders to improve access to population databases.
The exemplary countries also delivered a comprehensive description of the screening activities. Next, they performed a barrier analysis to identify the most important barriers considering effectiveness and equity, and a stakeholder analysis, to determine the stakeholders that can help in overcoming the barrier or that should be convinced to overcome the barrier. These analyses were used to outlining appropriate and feasible actions in detailed action plans to improve the current screening programmes.
In addition, we evaluated the monitoring system of the exemplary countries. The current data flow was analysed and technical issues, related to data collection management and quality assurance of the necessary data, including IT and data base management competence, were identified. We checked whether the necessary information to calculate key quality indicators of cancer screening are available and whether the data collection is in compliance with the EU and national privacy legislation requirements.
The exemplary countries started with the preparation of implementing improved screening programmes by revising guidelines and intensive communication with stakeholders to improve access to population databases.
This project has the potential to impact the health and quality of life of millions of women and men. Together, breast, cervical and colorectal cancer are responsible for approximately 200,000 deaths each year in the Eastern European and Mediterranean countries. In these countries cancer screening is mainly opportunistic, there is a lack of resources and in some instances suboptimal/inefficient target ages or screening intervals are used.
The ultimate aim of EU-TOPIA-EAST is to optimize screening for breast, cervical, and colorectal cancer in these countries. EU-TOPIA-EAST will decrease the disparity of cancer burden across countries by using the knowledge gained in the implementation studies in the exemplary countries to build capacity among the other countries. By inviting policymakers, programme coordinators, and researchers from all Eastern Europe and Mediterranean countries, we will enable them to identify the barriers for implementing optimal screening programmes in their countries and use tools for developing a country-specific roadmap. Therefore, they will be able to improve their cancer screening programmes on a structural base.
Improved screening programmes will contribute to the United Nations’ sustainable development goal 3.4: “by 2030, reduce by one-third mortality from non-communicable diseases by prevention and treatment.”
The ultimate aim of EU-TOPIA-EAST is to optimize screening for breast, cervical, and colorectal cancer in these countries. EU-TOPIA-EAST will decrease the disparity of cancer burden across countries by using the knowledge gained in the implementation studies in the exemplary countries to build capacity among the other countries. By inviting policymakers, programme coordinators, and researchers from all Eastern Europe and Mediterranean countries, we will enable them to identify the barriers for implementing optimal screening programmes in their countries and use tools for developing a country-specific roadmap. Therefore, they will be able to improve their cancer screening programmes on a structural base.
Improved screening programmes will contribute to the United Nations’ sustainable development goal 3.4: “by 2030, reduce by one-third mortality from non-communicable diseases by prevention and treatment.”