Cancer care quality: current state and future directions

Delivery of high-quality medicine is essential in all fields, but it is particularly crucial in cancer medicine in which therapies can be toxic and life-threatening and appropriate treatment can lead to long-term remissions or cure, and when poor therapy compromises survival. Variability in postoperative mortality has been demonstrated for several complex cancer surgeries, depending on surgical expertise and volumes. Systemic therapy, including both cytotoxic and targeted therapies (which are the backbones of many curative regimens), can have severe toxicities. Small upward errors in dosing or schedule can result in unnecessary morbidity and mortality, and they can result in reduced efficacy and poor outcomes. Similarly, radiation therapy is a critical modality in the treatment of so many cancers, but clinically important morbidity and mortality can be associated with it. Methods to continually assess quality in ways that lead to interventions to improve care are essential in cancer medicine today, and they can be viewed as an obligation of our profession.