Measuring Performance

Cancer Endorsement Maintenance 2011 

Project Status: Completed

Cancer Endorsement Maintenance 2011

Access the Endorsement Summary (PDF) | Access the Full Report  

The Opportunity

Cancer refers to a group of more than 100 diseases characterized by uncontrolled cellular growth, proliferation, and spread.1 This group of diseases has an enormous impact on health in the US. As the second leading cause of death, cancer was responsible for an estimated 569,490 deaths among adults and children in 2010.2 The American Cancer Institute estimates that half of all men and one-third of all women in the US will develop cancer during their lifetimes. Diagnosis and treatment of cancer also has great economic impact as well. In 2010, the estimated total annual costs of cancer reached $263.8 billion: $102.8 billion in direct medical costs; $20.9 billion in loss of productivity from illness; and $140.1 billion in lost productivity from premature death.3 Despite enormous focus on prevention and treatment of disease, inconsistencies in cancer care exist, with many patients not receiving care that follows clinical practice guidelines.4 Studies demonstrate persistent socioeconomic disparities in treatment and survival for many different types of cancer, including gastric, breast, prostate, and lung cancers. 5, 6, 7, 8 

Cancer care is complicated for many reasons: treatment regimens are complex, often involving multiple providers, settings of care, and levels of treatment; patients with cancer often require individualized therapies; an evolving evidence base for treatment exists; and care can be hampered by a sometimes limited supply of highly specialized personnel or technologies. Efforts to measure cancer quality can be further complicated by several factors, some of which include:

  • Treatment related factors, including: the inability to identify a standard of care because resources to treat cancer vary regionally; the evidence base for cancer care continues to evolve; disagreements over what optimal care is; patient preference for care;
  • Measure implementation factors, including: which institution or provider is responsible for quality measurement; and
  • Measure design factors, including: given the complexity of care, valid measures might be applicable to only small numbers of patients; measures functioning across different settings (care coordination measures) are lacking.

NQF reviewed areas for measurement in 2002, and in 2008 commissioned a white paper discussing the current state of cancer quality measurement and provided opportunities for next steps in measurement.9 NQF later endorsed 19 performance measures for gauging the quality of cancer care in the areas of breast cancer, colorectal cancer and symptom management, and end-of-life care.10  

About the Project


This project builds on prior NQF work under the Cancer Quality Measures Project, and seeks to identify and endorse additional measures for accountability and quality improvement related to cancer care.

As part of this endorsement maintenance project, NQF will solicit composite, outcome, and process measures proximal to desired outcomes, that are applicable to any healthcare setting. The project will prioritize measures that address specific aspects of the National Quality Strategy (NQS)—particularly those focused on person and family engagement, communication, coordination and safety. Measures that are specified for use with electronic health records (eMeasures) and measures that are harmonized across settings (e.g., outpatient and hospital) are preferred. Additionally, NQF-endorsed® standards relating to cancer care that were endorsed prior to 2009 will be evaluated under the maintenance process. Endorsement maintenance ensures the currency of NQF's portfolio of voluntary consensus standards, provides the opportunity to harmonize specifications, and ensures that endorsed measures represent the best in class.

The project will also inform the work of the NQF-convened National Priorities Partnership (NPP) and Measure Applications Partnership (MAP) relative to the NQS. The NPP provides input to HHS regarding refinements to the NQS, including recommendations for measurement concepts and illustrative measures to track national progress. The MAP will be providing input to HHS on June 1, 2012 regarding the selection of performance measures for public reporting and performance-based payment programs, including guidance on performance measures related to PPS-exempt cancer hospitals.

NQF Process 

Measures will be considered for NQF endorsement as national voluntary consensus standards based on the recommendations developed through NQF's formal Consensus Development Process (CDP) (version 1.9). This project involves the active participation of representatives from across a broad spectrum of healthcare stakeholders and will be guided by a Steering Committee.


This project is funded under a contract provided by the Department of Health and Human Services.

For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit:


Related NQF Work 

Prior to 2011, NQF endorsed 37 cancer-related quality measures including the areas of breast, lung, prostate and colon cancer, melanoma and leukemia. These measures were designed to improve the quality of care delivered to patients as part of a health care system, or in inpatient or ambulatory settings.

List of previously-endorsed cancer measures: 

Table of Previously-Endorsed Cancer Measures (PDF)

Contact Information 

For further information, contact Angela Franklin, JD or Lindsey Tighe, MS at 202-783-1300 or via email at


  1. U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Cancer Institute (NCI), Defining Cancer. Updated 07/12/2010. Bethesda, MD:NCI, 2010. Available at Last accessed February 2011.
  2. American Cancer Society. Cancer Facts & Figures 2010. Atlanta, GA. 2009. Last Medical Review: 05/20/2009. Last Revised: 05/20/2009. Available at Last accessed February 2011.
  3. Ibid. Available at Last accessed February 2011.
  4. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. [see comment]. New England Journal of Medicine. 2003;348(26):2635-2645, and Harlan LC, Greene AL, Clegg LX, Mooney M, Stevens JL, Brown ML. Insurance status and the use of guideline therapy in the treatment of selected cancers. [see comment]. Journal of Clinical Oncology. 2005;23(36):9079-9088, as cited in National Quality Forum (NQF). The Current State of Cancer Quality Measurement 2008: A White Paper. Washington, DC: NQF; 2008.
  5. Du XL, Lin CC, Johnson NJ et al., Effects of individual-level socioeconomic factors on racial disparities in cancer treatment and survival: findings from the National Longitudinal Mortality Study, 1979-2003, Cancer, 2011.
  6. Byers T, Two decades of declining cancer mortality: progress with disparity, Annu Rev Public Health, 2010;31:121.132.
  7. Sherr DL, Stessin AM, Demographic disparities in patterns of care and survival outcomes for patients with resected gastric adenocarcinoma. Cancer Epidemiol Biomarkers Prev. 2011 Mar;20(2):223-33.
  8. Slatore CG, Au DH, Gould MK; American Thoracic Society Disparities in Healthcare Group, An official American Thoracic Society systematic review: insurance status and disparities in lung cancer practices and outcomes. Am J Respir Crit Care Med. 2010 Nov 1;182(9):1195-205.
  9. National Quality Forum (NQF). The Current State of Cancer Quality Measurement 2008: A White Paper. Washington, DC: NQF; 2008.
  10. National Quality Forum (NQF). National Voluntary Consensus Standards for Quality of Cancer Care: A Consensus Report. Washington, DC: NQF; 2009.

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