The Role of Quality Metrics in Improving Oncologic Survival

  • Matthew A. FacktorEmail author


Clinical quality metrics have become ubiquitous in modern health care. The primary goal is to improve patient care delivery and overall outcomes, but they have also been tied to reimbursement and general quality improvement efforts. Numerous organizations have developed and/or promoted the use of quality metrics, including many for oncology. Ultimately, the hope is that increased use of well-conceived quality metrics will lead to improved survival. This chapter outlines the approach taken by the American College of Surgeons Commission on Cancer (CoC), and highlights recent data on the relationship between quality measures and improvements in survival.


Quality measures Process measures Quality outcomes Oncologic survival Commission on cancer 


  1. 1.
    American College of Surgeons: Commission on Cancer. Accessed 6 Feb 2018.
  2. 2.
    American College of Surgeons: Commission on Cancer, National Cancer Database, CoC Quality of Care Measures. Accessed 6 Feb 2018.
  3. 3.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomized trials. Lancet. 2011;378(9804):1707–16.CrossRefGoogle Scholar
  4. 4.
    Hassett MJ, Hughes ME, Niland JC, et al. Selecting high priority quality measures for breast cancer quality improvement. Med Care. 2008;46:762–70.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus Tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004;351:971–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Peto R, Davies C, Godwin J, et al. Comparisons between different polychemotherapy regimens for early breast cancer: meta-analysis of long-term outcome among 100,000 women in 123 randomized trials. Lancet. 2012;379(9814):432–44.CrossRefGoogle Scholar
  7. 7.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Clarke M, Coates AS, Darby SC, et al. Adjuvant chemotherapy in estrogen-receptor-poor breast cancer: patient level meta-analysis of randomized trials. Lancet. 2008;371(9606):29–40.CrossRefGoogle Scholar
  8. 8.
    Early Breast Cancer Trialists Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet. 2005;365(9472):1687–717.CrossRefGoogle Scholar
  9. 9.
    National Quality Forum: 0559 Combination chemotherapy is recommended or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0, or Stage IB-III hormone receptor negative breast cancer. Accessed 6 Feb 2018.
  10. 10.
    National Quality Forum: 0220 Adjuvant hormonal therapy. Accessed 6 Feb 2018.
  11. 11.
    National Quality Forum: 0223 Adjuvant chemotherapy is recommended within 4 months (120 days) of diagnosis to patients under the age of 80 with AJCC III (lymph node positive) colon cancer. Accessed 6 Feb 2018.
  12. 12.
    National Quality Forum: 0225 At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. Accessed 6 Feb 2018.
  13. 13.
    Ludwig MS, Goodman M, Miller DL, Johnstone PA. Postoperative survival and the number of lymph nodes sampled during resection of node-negative non-small cell lung cancer. Chest. 2005;128(3):1545–50. Scholar
  14. 14.
    Limited thoracic lymphadenectomy worsens survival in 55,122 patients with resected Stage I non-small cell lung cancer P217 society of surgical oncology 66th Annual Symposium, March 6–9, 2013.Google Scholar
  15. 15.
    Samayoa AX, Pezzi TA, Pezzi CM, et al. Rationale for a minimum number of lymph nodes removed with non-small cell lung cancer resection: correlating the number of nodes removed with survival in 98,970 patients. Ann Surg Oncol. 2016;23(Suppl 5):1005–11.CrossRefPubMedGoogle Scholar
  16. 16.
    Handy JR Jr, Costas K, Nisco S, et al. Regarding American College of Surgeons Commission on cancer non-small cell lung cancer quality measure 10RLN. Ann Thorac Surg. 2016;102:1040–1.CrossRefPubMedGoogle Scholar
  17. 17.
    Krantz SB, Lutfi W, Kuchta K, et al. Improved lymph node staging in early-stage lung cancer in the National Cancer Database. Ann Thorac Surg. 2017;104:1805–14.CrossRefPubMedGoogle Scholar
  18. 18.
    Smeltzer MP, Faris NR, Ray MA, et al. Association of pathologic nodal staging quality with survival among patients with non-small cell lung cancer after resection with curative intent. JAMA Oncol. 2018;4(1):80–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Non-small cell lung cancer Version 2.2018. In: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Accessed 8 Feb 2018.
  20. 20.
    Shulman LN, Palis BE, McCabe R, et al. Survival as a quality metric of cancer care: use of the National Cancer Data Base to assess hospital performance. J Oncol Pract. 2018;14(1):e59–72.CrossRefPubMedGoogle Scholar
  21. 21.
    Cancer program standards: ensuring patient-centered care manual. 2016 ed. Accessed 8 Feb 2018.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryGeisinger Health SystemDanvilleUSA

Personalised recommendations