title: A Decade of Research on the Quality of Systemic Cancer Therapy in Routine Care: What Aspects of Quality Are We Measuring?
abstract: To systematically review population-based studies that evaluated the quality of care related to delivery of systemic cancer therapy (ST) in routine practice, summarize the literature, and define knowledge gaps across five quality domains: access, treatment delivery, toxicity, safety, and outcome.
  
  
  
  We searched MEDLINE using terms pertaining to ST and keywords related to health care quality for articles published in English from January 1, 2000, to December 31, 2010. Articles were included if they were original studies that examined quality of care of ST among adult patients with cancer from a population perspective.
  
  
  
  Our search identified 179 articles. The number of studies published each year increased over time. Most studies (58%) were conducted in the United States in either colorectal (31%) or breast cancers (27%), and focused on adjuvant intent cytotoxic chemotherapy (73%). The majority of the studies (92%) retrospectively identified patients from cancer registries (83%) and used either billing data (36%) or information in the registry itself (27%) for identification of ST. No study examined safety from a population perspective. Access was the most frequently evaluated domain (77%), whereas treatment delivery was the least examined (12%). Among studies that assessed the outcome of ST, most evaluated patient-specific outcomes such as survival (89%), although a few (11%) examined system-level outcomes such as cost.
  
  
  
  The majority of studies evaluating quality of ST have focused on access to cytotoxic chemotherapy in early stage disease. Further studies focusing on other aspects of quality and in different clinical settings are needed.
authors.affiliation: University of Toronto; Institute for Clinical Evaluative Sciences; and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Shixin
authors.initials: S
authors.lastname: Shen
authors.affiliation: University of Toronto; Institute for Clinical Evaluative Sciences; and Princess Margaret Cancer Centre, Toronto, Ontario, Canada monika.krzyzanowska@uhn.ca.
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000628:therapy; D005260:Female; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D011787:Quality of Health Care; D012042:Registries; D012106:Research; D014481:United States