Review of Cancer-Specific Quality Measures Promoting the Avoidance of Low-Value Care

Background With rising healthcare costs and campaigns aimed at avoiding low-value care, reducing cancer overtreatment has emerged as an important measure of cancer care quality. The extent to which avoidance of low-value care has been incorporated in cancer-specific quality measures is unknown. We aimed to identify and characterize cancer quality measures that promote the avoidance of low-value care, and identify gaps that may guide future measure development. Methods We systematically identified cancer-specific quality measures from leading quality measure organizations [e.g., National Quality Forum (NQF), National Quality Measures Clearinghouse (NQMC)]. We reviewed measures promoting the avoidance of low-value cancer care and subclassified them into disease site- or non-disease site-specific categories and the phase of care they targeted. Results We reviewed 313 quality measures from six organizations. Of these, 18% ( n = 55) focused on avoidance of low-value care. Quality measures focused on end-of-life care were most likely to focus on low-value care [ n = 13 (50%)], followed by breast [ n = 12 (18%)], lung [ n = 9 (31%)], colon [ n = 8 (20%)], prostate [ n = 5 (38%)], general cancer care [ n = 4 (3%)], symptoms and toxicities [ n = 2 (40%)], and palliative cancer care [ n = 2 (11%)] measures. The phases of care quality measures targeted included low-value screening [ n = 5 (9%)], diagnostic testing and staging [ n = 7 (13%)], treatment [ n = 19 (34%)], surveillance [ n = 6 (11%)], and clinical outcomes [ n = 18 (33%)]. All categories had a treatment-specific quality measure, but no category had a representative measure for every phase of care. Discussion A minority of cancer quality measures are aimed at avoiding low-value care, and multiple evidence-based recommendations targeting low-value care have not been incorporated.