Quality Indicators for Renal Cancer Care: A Systematic Review

Quality indicators (QIs) are crucial for evaluating health care delivery, including effectiveness, safety, and patient-centered outcomes. In contrast to other fields, the definition and implementation of QIs for renal cell carcinoma (RCC) present distinct challenges and remain unmet needs. We summarized the available data on QIs for RCC, focusing on their characterization throughout the care pathway and the potential areas for further development.

A systematic review of the English-language literature was conducted using the MEDLINE, Embase, and Cochrane databases from January 2000 to March 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (PROSPERO ID: CRD42024511924). Quality assessment was evaluated according to the Appraisal of Indicators through Research and Evaluation (AIRE) instrument.

Out of 58948 potentially relevant papers, 12 sets of QIs (including an overall number of 86 distinct QIs) were identified from 12 studies. QI sets had a large variation in development strategy and quality. Only five studies scored a total of ≥50% on the AIRE tool across four domains. The process employed to develop the set of QIs was heterogeneous across the included papers. The number of proposed QIs varied significantly across studies (range: 1-25). Only a few studies specified the target population explicitly. The QIs addressed different stages of RCC care pathways: diagnosis (33%), staging (25%), data collection (25%), treatment (67%), pathology (42%), outcomes (83%), hospital facilities (25%), and follow-up (17%). Although 83% (10/12) sets have been piloted in practice, none of these has been validated externally. Regardless of the domain, most studies did not specifically report any cutoff value to evaluate whether the proposed QIs were fulfilled or not.

Our review found a relative lack of evidence on QIs for RCC, as well as heterogeneity in their development strategy, definition, reporting, and the included domains of the RCC care pathway. Further efforts are needed to reach consensus on the appropriately developed QIs that could define the quality of care for RCC and to assess their association with clinical outcomes.