Measuring equity in cancer care quality: Critical review of national frameworks and lessons learnt

Abstract Issue/problem Cancer inequalities persist across Europe, with inequitable access and delivery of care playing a key role. Quality indicators (QIs) are essential to assess inequalities experienced by migrants, ethnic minorities and socioeconomically disadvantaged groups, and to evaluate the impacts of policy. While national QI frameworks for cancer exist in many countries, their adequacy from a health equity perspective is unclear. Description of the problem We conducted a critical review to describe how cancer care quality is defined and measured, and assess how well current methods address migrant, ethnic and socioeconomic inequalities. We searched Pubmed and grey literature for national QI frameworks in G7 countries. We focused on those using the Donabedian model to assess performance in breast and colorectal cancer, as two common cancers for which highly effective treatments are available. We explored gaps in current practice and measures addressing these. Results Fourteen frameworks were found from five countries: the US (n = 5), UK (n = 5), Canada (n = 2), France (n = 1), and Germany (n = 1), in addition to one international framework. No eligible frameworks were found from Japan or Italy. We extracted 437 QIs spanning structural, process and outcome domains. Most were process measures derived from clinical guidelines. 39 thematic domains were identified. Equity-specific indicators were rare or absent. Methods addressing gaps included performance metrics specific to systemic therapy such as dose intensity and treatment toxicity; patient reported outcomes and experience surveys; and composite QIs such as opportunity scoring, textbook outcomes, and measures of pathway concordance. These consistently revealed inequity in treatment quality. Lessons To improve treatment equity, standardised equity-focused indicators should be embedded in national QI frameworks, with administrative data offering a promising approach for national and comparative assessment across Europe. Key messages • Inequalities in cancer care quality are well documented; addressing them will help reduce inequalities in cancer mortality and patient experience. • Equity-focused indicators should be developed to enable European countries to improve cancer outcomes for all.