Originally published as JCO Early Release 10.1200/JCO.2005.03.3365 on January 9 2006

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Results of the National Initiative for Cancer Care Quality: How Can We Improve the Quality of Cancer Care in the United States?

From the RAND Corporation, Santa Monica; Department of Medicine, University of California Los Angeles, Los Angeles, CA; Department of Health Policy and Management, Harvard School of Public Health; Section on Health Policy, Division of General Medicine, Brigham and Women's Hospital, Boston, MA; and the Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD.

Address reprint requests to Jennifer L. Malin, MD, Amgen, One Amgen Center Dr, MS 28-3-A, Thousand Oaks, CA 91320; e-mail: jmalin{at}amgen.com

PURPOSE: In 1999, the National Cancer Policy Board called attention to the quality of cancer care in the United States and recommended establishing a quality monitoring system with the capability of regularly reporting on the quality of care for patients with cancer.

METHODS: Using data from a patient survey 4 years after diagnosis and review of medical records, we determined the percentage of stage I to III breast cancer and stage II to III colorectal cancer survivors in five metropolitan statistical areas (MSAs) across the United States who received recommended care specified by a comprehensive set of explicit quality measures.

RESULTS: Two thousand three hundred sixty-six (63%) of 3,775 eligible patients responded to the survey, and 85% consented to have their medical records reviewed. Our final analytic sample (n = 1,765) included 47% of the eligible patients. Patients with breast and colorectal cancer received 86% of recommended care (95% CI, 86% to 87%) and 78% of recommended care (95% CI, 77% to 79%), respectively. Adherence to quality measures was less than 85% for 18 of the 36 breast cancer measures, and significant variation across MSAs was observed for seven quality measures. The percent adherence was less than 85% for 14 of the 25 colorectal cancer measures, and one quality measure demonstrated statistically significant variation across the MSAs.

CONCLUSION: Initial management of patients with breast and colorectal cancer in the United States seemed consistent with evidence-based practice; however, substantial variation in adherence to some quality measures point to significant opportunities for improvement.

Supported by a grant from the American Society of Clinical Oncology. J.L.M. was supported by a CI-10 Damon Runyon-Lilly Clinical Investigator Award from the Damon Runyon Cancer Research Foundation. The authors have received honoraria for presenting research results at conferences sponsored by the American Society of Clinical Oncology and the American College of Surgeons.

Presented in part at the 38th Annual Meeting of the American Society of Clinical Oncology (ASCO), Orlando, FL, May 18-21, 2002; the 39th Annual Meeting of ASCO, Chicago, IL, May 31-June 3, 2003; the 40th Annual Meeting of ASCO, New Orleans, LA, June 5-8, 2004; and the 41st Annual Meeting of ASCO, Orlando, FL, May 13-17, 2005.

The assertions and opinions expressed in this article are solely those of the authors and are not necessarily those of the American Society of Clinical Oncology or its representatives.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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