Implementation of Quality Improvement Interventions in Medical Oncology: A Systematic Review.

Abstract

Purpose: As global cancer rates rise, the demand for effective, high-quality delivery of systemic anticancer therapy (SACT) is crucial. However, quality improvement (QI) research in medical oncology remains limited. This systematic review aims to identify and characterize QI interventions addressing quality deficits in medical oncology practice, focusing on intervention types, methodologies, and outcomes.

Methods: A systematic search of EMBASE and MEDLINE was conducted from January 2000 to November 2024, following PRISMA guidelines (PROSPERO: CRD42024579992). Studies were included if they evaluated a QI intervention in medical oncology using a baseline measurement and aiming to address a predefined quality deficit in patient-related outcomes. Data on study design, intervention types, quality deficits, and outcomes were extracted, and study quality was assessed using the QI Minimum Quality Criteria Set (QI-MQCS).

Results: Of the 11,655 studies identified, 28 met the inclusion criteria. Five key themes emerged: waiting times for SACT delivery at infusion visits, delays in commencement of initial SACT, optimal utilization of SACT, side effects of SACT, and safety. Most studies were conducted in the United States (n = 17), at a single center (n = 27) with only one national-level study. Funding was reported in three studies (two industry-sponsored, one philanthropic). All studies demonstrated a positive impact on at least one patient-related outcome measure. QI-MQCS scores ranged from 11 to 16 of 16.

Conclusion: Although cancer treatment continues to evolve, QI strategies in medical oncology remain underexplored. While all identified interventions were beneficial, generalizability is limited by single-center settings and methodological constraints. Expansion of QI research beyond the United States, adoption of stronger study designs, and increased investment in QI training and infrastructure are needed. Multilevel support and sustainable funding are essential to scale up evidence-based QI efforts and improve oncology care globally.