Use of Routine Quality Metrics to Describe Disparities in Cancer Care: a Narrative Review & Thematic Analysis

Cancer inequalities persist globally, with inequitable access and delivery of care playing a key role. Quality indicators (QIs) are widely used to assess cancer care performance and evaluate policy impacts, yet the extent to which national QI frameworks capture health equity is unclear. We conducted a narrative review and thematic analysis of QI frameworks used in G7 countries that apply the Donabedian model to breast and colorectal cancer. Searches of Medline and grey literature identified 15 eligible frameworks from five countries: the United States (n=5), United Kingdom (n=5), Canada (n=2), France (n=1), and Germany (n=1), alongside one international framework. Across frameworks, 512 QIs were extracted, the majority being process measures derived from clinical guidelines. Thirty-eight thematic domains were identified, with many frameworks incorporating measures related to equity or patient-centred care. Equity related metrics comprised those addressing systemic inequity - such as stratified performance reporting, mandating removal of barriers to treatment, and clinical trial enrolment targets - and those supporting individual care, such as assessment of social support needs and communication.Measures for removing barriers and stratified performance reporting were limited to a small number of frameworks, and measures of individual-level social support interventions were rare. Although QI frameworks could strengthen equity monitoring by incorporating stratified reporting and indicators of equity-focused interventions, such reporting requires the support of legal and information governance frameworks for sensitive data collection,contextual interpretation and case-mix adjustment, as well as safeguards against punitive use of performance data. POLICY SUMMARY: These findings provide an overview of how national and regional quality frameworks collect and report information relevant to treatment equity. We identify opportunities to strengthen national cancer quality frameworks through expanded stratified reporting and indicators of equity-focused interventions. Such developments, if underpinned by appropriate data governance, interpretation and safeguarding, could inform equity-focused policies and support monitoring their effects over time.