The role of patient-reported outcomes in evaluating the quality of oncology care.

The science of oncology care is rapidly developing, resulting in considerable variation in treatment patterns and disparity in the quality of care. Efforts are under way to evaluate and improve the quality of oncology care, because the goals of care have progressed beyond reducing morbidity and mortality to include maximizing functional and cognitive status, improving health-related quality of life, and preserving productivity. Traditional indicators of quality of care were based on survival outcomes or the processes of care. Although these remain important, they are inadequate for evaluating the multidimensional goals of care. Although not commonly included, patient-reported outcomes (PROs) would enhance the evaluation of the quality of care by including a patient perspective. A model for measuring quality of care that incorporates outcomes, structures, and processes of care as well as patient characteristics is proposed. Methodology including PROs that are valid, reliable, sensitive, and feasible, as well as rigorous risk adjustment methods, is critical to quality of care studies that appropriately inform decision makers.