Projects

Quality Indicator Project

The Basic Act for Cancer Control established the national responsibility to ensure equal access to high-quality cancer care across Japan. While monitoring and assessment of progress are essential to achieving this goal, no established method currently exists. To address this, we are developing evaluation indicators and a measurement system focused on the cancer care process.

Development of Quality Indicators

Since 2007, our research group supported by the Ministry of Health, Labour and Welfare—and since 2013, funded through the National Cancer Center’s research and development grants—has been working to develop Quality Indicators (QIs) for evaluating cancer care. QIs are typically classified into three categories: structure indicators, which assess aspects like facilities and staffing; process indicators, such as adherence to standard treatment protocols; and outcome indicators, including survival rates and hospital stays. Among these, process indicators are especially important for the ongoing monitoring and improvement of equitable cancer care, as they enable timely and evidence-based evaluation. To this end, our research group has employed the internationally recognized RAND/UCLA Appropriateness Method (a modified Delphi method) to identify standard care practices based on clinical guidelines and develop corresponding QIs. So far, we have developed QIs for major cancer types in Japan, including stomach, lung, liver, breast, and colorectal cancers.

Reference: Higashi T, Nakamura F, Saruki N, Sobue T. Establishing a quality measurement system for cancer care in Japan. Jpn J Clin Oncol. 43(3):225–32, 2013. [PubMed]

Monitoring Equity in Cancer Care

To establish a comprehensive system for measuring the quality of cancer care, various approaches have been explored. Initially, data were collected from medical records to calculate adherence rates to standard treatments based on QIs, including an investigation into the reasons for non-adherence. However, this method was extremely labor-intensive and unsustainable at scale.

In response, we introduced a new system in 2013 through the Cancer Registry Subcommittee of the Council of Prefectural Cancer Care Hospitals. This system links data from hospital-based cancer registries and Diagnosis Procedure Combination (DPC) surveys in an anonymized format, significantly reducing the workload for participating institutions while enabling broader data collection and analysis.

Currently, the project is under implementation as a commissioned initiative by the Ministry of Health, Labour and Welfare. Our research group is working in collaboration with academic societies to develop new QI items and revise existing ones. Recognizing the importance of understanding the reasons behind non-adherence to standard care, these are now assessed using DPC-based data following initial calculations.

Hospitals that submit cancer registry data to the National Cancer Center for nationwide aggregation are eligible to participate. In 2021, 649 facilities took part in the project—including 422 designated cancer care hospitals—resulting in a participation rate of 93%.

Participating institutions receive feedback comparing adherence rates across facilities. A collaborative framework is also being developed to help institutions use this data to strengthen their own Plan-Do-Check-Act (PDCA) cycles.

Development and Utilization of a Linked Database Combining Hospital-Based Cancer Registries, Site-Specific Cancer Registries, and DPC Data.

To develop evidence-based cancer control strategies, building a robust and appropriate database is essential. Among the major cancer-related data sources, hospital-based cancer registries and DPC survey data are particularly valuable. The former provides key information for case identification—such as diagnosis date, case classification, and ICD-O-3 coding—while the latter offers detailed records of clinical procedures. These two sources complement each other and in combination can produce synergistic insights. We explore opportunities to link with site-specific cancer registries and other databases.

To enable this data linkage, we developed a software as part of this research project and distributed to participating institutions. The software assigns a common anonymized ID to both DPC data and hospital-based cancer registry data within each institution, ensuring secure and consistent data integration.

While the primary objective is to collect data and build an infrastructure for research on cancer care quality indicators, the initiative also supports additional important activities, including:

• Providing participating institutions with useful data to support their PDCA cycles;
• Gaining a nationwide overview of actual clinical practices beyond what is captured by QIs.