Purpose: With the rise in global cancer incidence, inadequate access to pathology and laboratory medicine (PALM) is one of the largest gaps in the cascade of cancer care, especially in low- and lower-middle-income countries. Quality indicators (QIs) are essential to evaluate the accuracy, completeness, timeliness and cost-effectiveness of PALM services to ensure access and quality. To identify strengths and gaps, this review systematically identifies and synthesises published PALM-specific cancer QIs across cancer types and geography.
Methods: Following Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines, a search of PubMed inclusive of Medline between 1990 and 2024 was conducted for studies that developed, applied or evaluated QIs for anatomical and molecular cancer pathology. Studies limited to chemopathology, immunopathology, haematopathology, haemato-oncology and paediatric oncology were excluded. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions tool.
Results: Of 8,685 records screened, 40 (0.5%) studies were included; 24 (61.5%) had moderate risk of bias. Nearly all the studies (97.5%) originated from high- or upper-middle-income countries, predominantly Europe and North America. Gynaecological and breast cancers were most frequently studied (n = 12 and 10), while prostate and lung cancers were underrepresented (n = 4 and 1, respectively). Most QIs focussed on diagnostic accuracy in the analytic phase (n = 26). Very few QIs assessed timeliness or cost-effectiveness (n = 2 and 3), particularly in pre-analytic and post-analytic phases.
Conclusion: Evidence for PALM-specific cancer QIs for timeliness and cost-effectiveness, in pre- and post-analytic phases, and across resource-limited settings is deficient. To facilitate global harmonisation, stakeholders from all resource settings should review international guidance to standardise QIs that are feasible, applicable and stratified to resource level. At the national level, Delphi processes are recommended to develop context-specific QIs, which inform national diagnostic strategy and cancer control planning.
