In its April 1999 report, the board noted the absence of a core set of quality measures for cancer care and recommended that such a set be developed through a coordinated public–private effort. While there is no accepted set of measures, several “process” quality measures have been used to assess cancer care (Table 5.1). Process quality refers to what providers do for patients and how well they do it, both technically and interpersonally. Effective process measures are identified through evidence from appropriately designed studies (e.g., clinical trials) that show a link between a particular process of care and better outcomes. Once this link has been established, systems can be put into place to monitor adher-

TABLE 5.1 Examples of Process Measures Used to Assess Quality of Cancer Care

Cancer Site

Process Measure


Quality of staging information (tumor size, estrogen receptors, lymph node dissection)

Initial biopsy prior to total mastectomy

Use of breast conserving surgery for local disease

Local breast radiation following lumpectomy

Adjuvant chemotherapy for premenopausal women with node-positive cancer

Use of perioperative bone scan (not indicated)

Use of perioperative abdominal CT scan (not indicated)

Referral to medical oncologist to discuss adjuvant therapy

If mastectomy, visit to plastic surgeon to discuss reconstructive surgery

Follow-up mammography within first 18 months post-operatively

Follow-up bone or CT scans for suspicious symptoms per year (not indicated)


Adjuvant chemotherapy for Stage III disease


Adjuvant chemotherapy and radiation therapy for Stage II/III disease


Presentation of treatment alternatives to patient

Rates of surgical treatment among men aged 70 and older (should be low)

Small-cell lung cancer (SCLC)

Chemotherapy for limited SCLC

Nonseminoma testicular cancer


Hodgkin's disease

Chemotherapy for Stage IIB or IV disease

Non-Hodgkin's lymphoma

Chemotherapy for diffuse intermediate or high-grade disease

SOURCE: IOM, 1999a.

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