Global review urges focus on low- and middle-income countries
3rd November 2025
A major international study, “Quality Indicators and Patient Outcome Measures for Palliative Care in Cancer Patients,” has revealed significant global gaps in how the quality of cancer palliative care is measured. The review, involving experts from ten countries and thirteen institutions (including King’s College London, Indiana University, and the African Palliative Care Association), analysed 41 studies and found that while patient outcome measures (POMs) such as symptom relief and emotional well-being are commonly used, quality indicators (QIs)—which assess care structure and processes—are underdeveloped, particularly in low- and middle-income countries. Over 90% of the studies originated in high-income settings.
Experts, including Dr. Eve Namisango, called for renewed focus on person-centred, high-quality palliative care, supported by better-defined and globally relevant indicators.
A WHO Evaluation Study led by Principal Investigator Professor Richard Harding, with co-authors Dr Mevhibe Hocaoglu and Dr Anna Peeler validated seven universal, patient-centred quality indicators—including pain, worry, weakness, mobility, appetite, need for help, and peace—across six culturally diverse countries. These indicators showed strong consistency and measurable impact across settings.
The review issued three major recommendations:
- Establish a global repository of palliative care quality indicators and patient outcomes, hosted by an independent institution to promote standardisation, clinical alignment, and research access.
- Expand research in low- and middle-income countries, where the need for palliative care is greatest but evidence is scarce, to develop context-appropriate tools.
- Foster innovation in research design—using ethically sound and practical models such as fast-track trials, action research, and mixed-method approaches—to better capture real-world patient and caregiver experiences.
Dr Eve Namisango (African Palliative Care Association) said:
“The need for palliative care in low-middle income countries is high, the development of services must be underpinned by a person-centred approach and should be of high quality. Our study highlights an urgent need to invest in research on developing measures to assess and evaluate the process and structural aspects of the quality of care.”
Dr Mev Hocaoglu commented:
“Our review calls for globally relevant, person-centred indicators. The WHO study delivers the evidence that it is possible—and urgently necessary—to define and track quality based on what matters most to patients.”
Ng CPY, Hegyi M, Lewison G, Pastrana T, Namisango E, Cleary J, Hasties B, Kabisa E, Musau H, Spangenberg K, Ruiz P, Ali Z, Mallafre-Larrosa M, Polo A, Torode J, Aggarwal A, Sullivan R, Hocaoglu M. Quality indicators and patient outcome measures for palliative care in cancer patients: a systematic review. Ecancermedicalscience. 2025 Jun 20;19:1929. doi: 10.3332/ecancer.2025.1929. PMID: 40606950; PMCID: PMC12221262.