American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

National Quality Forum

History of the NQF Endorsed Measures for Quality of Cancer Care for Breast and Colorectal Cancers

The Commission on Cancer (CoC) submitted quality of care measures for breast and colorectal cancer to the National Quality Forum (NQF) in response to its calls for proposed breast measures in late 2004 and colorectal measures in early 2005. Measures were reviewed by the CoC’s breast and colorectal disease site teams prior to submission to the NQF for consideration.

NQF Evaluation Criteria

An NQF Steering Committee for quality of cancer care measures was charged with ensuring that pertinent stakeholders had appropriate opportunity to review and provide input on the measures under consideration. Two technical panels made up of breast and colorectal experts in the areas of surgery, radiotherapy, medical oncology, health care consumers, and health services research—assembled by the NQF—provided technical evaluation of the proposed measures. The NQF Steering Committee and technical panels reviewed measures using four criteria:

  • Importance: The extent to which a measure reflects variation that has the potential for improvement
  • Scientific acceptability: That a measure is reliable, valid, precise, and adaptable to patient preference
  • Usability: Information produced as part of the measure could be used to make decisions and/or take actions, and that reported performance levels were statistically, and clinically, meaningful
  • Feasibility: That data can be obtained within the normal flow of clinical care and that implementation of the measure was achievable.

The CoC's Proposed Measures

Eight measures proposed by the CoC (four breast cancer, three colon cancer, and one rectal cancer) were reviewed by the NQF. In response to specific comments from the NQF, the CoC examined additional data and made revisions to the originally proposed measures. Five measures were determined to meet the evaluation criteria established by the NQF.

Four measures were endorsed by the NQF as accountability measures, meaning that these measures can be used for such purposes as public reporting, payment incentive programs, and the selection of providers by consumers, health plans, or purchasers. Quality improvement measures are intended to be used for internal monitoring of performance within an organization or group so that analyses and subsequent remedial actions can be taken, as appropriate. Surveillance measures can be used at the community, regional, and/or national level to monitor patterns and trends of care in order to guide policymaking and resource allocation.

Through a parallel process the American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) developed a similar set of measures for breast and colorectal cancer. Facilitated by the NQF, CoC, ASCO, and NCCN agreed to synchronize their developed measures to ensure that a unified set were put forth to the public. 

The National Quality Forum

The National Quality Forum (NQF) is a not-for-profit membership organization that develops and implements national strategies for health care quality measurement and reporting. Membership in the NQF has broad public and private participation, including but not limited to health care consumers, purchasers (both private and public), employers, health care professionals, health plans, and organizations involved in health care research or quality improvement. The members of the NQF work to promote common approaches to measuring health care quality and promoting quality improvement. Funding support for the development of the National Voluntary Consensus Standards for Diagnosis and Treatment of Breast and Colon Cancer was provided by the following Federal agencies: Agency for Healthcare Research and Quality, the National Cancer Institute, the Centers for Medicare and Medicaid Services, and the Centers for Disease Control and Prevention.

For questions related to the release of these quality measures, please contact the NCDB at