Benchmarking cancer outcomes in Europe: a scoping review of methodologies and case-mix adjustments

• Published in: ESMO REAL WORLD DATA AND DIGITAL ONCOLOGY Vol. 9; p. 100176
• Main Authors: Thurell, J., Doppelbauer, L., Verheul, E.M., Petrov, I., Karsten, M.M., Koppert, L.B., Bergh, J., Fredriksson, I., Lindgren, P., Kiani, N., Hedayati, E.
• Format: Journal Article Publication
• Language: English
• Published: Elsevier Ltd 01.09.2025; Elsevier
• Subjects: benchmarking; Europe; health care; neoplasms; Oncology; quality indicators; risk adjustment; systematic review; benchmarking; Europe; risk adjustment; quality indicators; neoplasms; systematic review; health care
• ISSN: 2949-8201; 2949-8201
• DOI: 10.1016/j.esmorw.2025.100176

Benchmarking hospital outcomes is crucial for identifying inequities and improving cancer care. Meaningful comparisons require selecting relevant outcomes and adjusting for case-mix factors such as age, comorbidity, and stage. Without case-mix adjustment, hospitals may be unfairly assessed based on patient mix rather than care quality. No prior review has examined benchmarking practices in European cancer care. This scoping review addresses: (i) Which health outcomes are frequently benchmarked? (ii) What case-mix factors are commonly used for adjustment? (iii) Which statistical approaches are utilized? (iv) How are case-mix models developed and evaluated? We conducted a systematic scoping review searching OVID MEDLINE, Web of Science, and EMBASE. Eligible studies focused on benchmarking populations with a cancer diagnosis, involved European hospitals, and evaluated health outcomes like survival. Abstract screening and full-text appraisal were done independently by two authors. Data were extracted into a pre-specified matrix, and results synthesized by research question. After screening 4953 abstracts, 65 studies were included. Key gaps include a lack of validated case-mix models, under-representation of long-term outcomes, and a tendency to ‘over-adjust’ by including treatment factors in case-mix models, potentially obscuring true differences in performance. Regression modeling remains the gold standard for adjustment. A consensus is needed on reporting and evaluating case-mix models, akin to TRIPOD guidelines. A shift toward standardized, validated benchmarking practices is essential to drive health care improvements. Only through rigorous methodologies, standardized reporting, and international collaboration can hospital benchmarking become a transformative tool for improving cancer care quality and patient outcomes. •Cancer benchmarking lacks clear standards on methods for case-mix adjustment.•Benchmarking is concentrated in two countries, limiting learning across Europe.•Lack of long-term survival and patient-reported outcomes in benchmarking studies.•Case-mix models lack validation and clear reporting, undermining fair comparisons.•We propose practical guidance on case-mix modeling to support fair benchmarking.