Periodic Reporting for period 2 - EU-TOPIA-EAST (TOwards imProved screening for breast, cervical and colorectal cancer in Eastern-Europe: Equitable, Actionable, Sustainable and Trustworthy)
Período documentado: 2022-11-01 hasta 2024-04-30
Colorectal, breast and cervical cancer cause 155,000 deaths per year in middle income countries (MIC) in Eastern Europe, while there is good evidence that a large proportion could be prevented by organised screening. Although many Eastern European MIC have implemented cancer screening, this is often non-organised, leading to lack of data and quality assurance. Also, coverage is commonly low and minority groups are not reached.
In a previous H2020 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 local health and social system into account by performing detailed barrier and stakeholder analyses, leading to feasible changes to current screening programmes. Next, we will implement these action plans: in Georgia, we will increase coverage by establishing a new screening unit; in Romania, we will develop new IT infrastructure to allow invitation-based cervical cancer screening; in Montenegro we will establish a new colonoscopy centre to increase programme capacity and decrease travel time for participants.
The implemented programmes will be monitored and evaluated using key indicators and decision models to predict long-term and country-wide benefits, harms and cost-effectiveness. During workshops and round-table discussions for policymakers and screening programme coordinators we 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.
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 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.
Objectives:
1. Extend, update and refine innovative road maps, initiated in the EU-TOPIA project by Georgia, Montenegro and Romania, into concrete action plans with steps and timeliness to successfully implementing these
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 in Georgia, Romania and Montenegro
3. Monitor the impact of implemented interventions on important short-term screening performance indicators, such as participation and detection rates
4. Estimate required resources, health outcomes and cost-effectiveness of scaling up the interventions to a national level and to other MIC in Eastern-Europe/Mediterranean using innovative dedicated microsimulation models
5. Disseminate good practices from participating to other countries by organising workshops and round table discussions with national/regional/local policymakers and other stakeholders
In a previous H2020 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 local health and social system into account by performing detailed barrier and stakeholder analyses, leading to feasible changes to current screening programmes. Next, we will implement these action plans: in Georgia, we will increase coverage by establishing a new screening unit; in Romania, we will develop new IT infrastructure to allow invitation-based cervical cancer screening; in Montenegro we will establish a new colonoscopy centre to increase programme capacity and decrease travel time for participants.
The implemented programmes will be monitored and evaluated using key indicators and decision models to predict long-term and country-wide benefits, harms and cost-effectiveness. During workshops and round-table discussions for policymakers and screening programme coordinators we 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.
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 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.
Objectives:
1. Extend, update and refine innovative road maps, initiated in the EU-TOPIA project by Georgia, Montenegro and Romania, into concrete action plans with steps and timeliness to successfully implementing these
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 in Georgia, Romania and Montenegro
3. Monitor the impact of implemented interventions on important short-term screening performance indicators, such as participation and detection rates
4. Estimate required resources, health outcomes and cost-effectiveness of scaling up the interventions to a national level and to other MIC in Eastern-Europe/Mediterranean using innovative dedicated microsimulation models
5. Disseminate good practices from participating to other countries by organising workshops and round table discussions with national/regional/local policymakers and other stakeholders
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 collected for the evaluation model were: general epidemiological data as population size by age, life tables, cancer-specific incidence and mortality by year/age and cancer survival by stage. Also we collected data of the current screening programme and costs of screening, diagnosis and treatment. These data were used to develop country-specific simulation models to evaluate short and long term harms, benefits and cost-effectiveness of the current screening programme and to determine the optimal screening programme, taking local circumstances, capacity and cost-effectiveness into account. For all three exemplary countries, various strategies have been evaluated on costs, effects and capacity to determine the best protocol to implement in future.
The 3 countries also delivered a comprehensive description of 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 outline appropriate and feasible actions in detailed action plans to improve the current screening programmes. A system to monitor the follow-up of the actions has been implemented.
In addition, we evaluated the monitoring system of the 3 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 database 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. IT systems were evaluated and improved to enable easier and complete monitoring of the screening and follow-up process.
The 3 countries started with implementing improved screening programmes. Besides the mentioned improvement of the IT systems, in Georgia the guidelines were revised, and a new screening centre was opened. In Romania and Montenegro efforts have been taken to get access to the population registry by intensive communication with stakeholders. In Montenegro a new colonoscopy centre was opened and the colorectal cancer screening programme restarted after 2 years.
Also, the first workshop was held in Slovenia. This workshop aimed at key elements of screening (monitoring, evaluation and barrier assessment). Delegates (researchers, programme coordinators and policymakers) of all European and Mediterranean countries were invited. For two participants per Eastern European/Mediterranean country participation was free of charge and travel/accommodation was covered. Participants from high-income Eastern Europe countries participated for free, with travel/accommodation at own expenses. In total, 95 people participated.
The 3 countries also delivered a comprehensive description of 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 outline appropriate and feasible actions in detailed action plans to improve the current screening programmes. A system to monitor the follow-up of the actions has been implemented.
In addition, we evaluated the monitoring system of the 3 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 database 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. IT systems were evaluated and improved to enable easier and complete monitoring of the screening and follow-up process.
The 3 countries started with implementing improved screening programmes. Besides the mentioned improvement of the IT systems, in Georgia the guidelines were revised, and a new screening centre was opened. In Romania and Montenegro efforts have been taken to get access to the population registry by intensive communication with stakeholders. In Montenegro a new colonoscopy centre was opened and the colorectal cancer screening programme restarted after 2 years.
Also, the first workshop was held in Slovenia. This workshop aimed at key elements of screening (monitoring, evaluation and barrier assessment). Delegates (researchers, programme coordinators and policymakers) of all European and Mediterranean countries were invited. For two participants per Eastern European/Mediterranean country participation was free of charge and travel/accommodation was covered. Participants from high-income Eastern Europe countries participated for free, with travel/accommodation at own expenses. In total, 95 people participated.
This project has the potential to impact the health and quality of life of millions of women and men in Eastern European and Mediterranean countries, where cancer screening is mainly opportunistic, with lack of resources and sometimes suboptimal target ages or screening intervals. The ultimate aim of EU-TOPIA-EAST is to optimise screening for breast, cervical, and colorectal cancer. 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 other countries. By inviting policymakers, programme coordinators, and researchers from Eastern Europe/Mediterranean, we will enable them to identify the barriers for implementing optimal screening programmes 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.”