Benchmarking comprehensive cancer care

The number of cancer patients and survivors is steadily increasing and despite or perhaps because of rapid improvements in diagnostics and therapeutics, important inequalities in cancer survival exist within and between different countries in Europe. Improving the quality of care is part of the approach to reduce suboptimal cancer survival and minimize inequalities in Europe. The aim of this thesis was to contribute to the knowledge on how to develop and use benchmarking for quality improvement of cancer care, the BENCH-CAN project. To inform the development of this tool a scoping literature review was performed on benchmarking specialty hospitals. Secondly a survey was performed to get an overview of existing quality assessments and which indicators they use. o account for the patients perspective in quality of care we developed and tested the European Cancer Consumer Quality Index. Chapter 5 and 6 discuss the main research objectives of this study; the development and use of two benchmark tools. Chapter 5 describes the development and pilot of a benchmark tool for the whole institute. The second tool benchmarked cancer care pathways and was used to assess the degree towards Integrated Practice Units in cancer centers in Europe. For chapter 7 we applied a relatively new method (fuzzy-set qualitative comparative analysis (fsQCA)) within health service research to identify performance features of cancer centers in the European Union using the data collected through the benchmark tools. This method represents cases (cancer centers) as a combination of explanatory and outcome conditions and is a method to identify the importance of quantitative performance features and how they relate to outcomes. An overview of actual prices of cancer drugs in European countries does, to our knowledge, not exist, and anecdotal evidence suggested that differences in price levels might be high. Therefore we benchmarked the prices for several cancer drugs in European countries. We noted substantial price differences in the prices of cancer drugs in this illustrative example from 15 European countries.