Criteria for establishing a centre of excellence in oncology: a scoping review

Abstract

Background/Aim

Centres of Excellence (CoEs) are assumed to indicate centres that are leading in healthcare, research, and innovation. However, there is no consensus on the criteria or frameworks for defining CoEs. This review aims to identify which criteria have been mentioned in literature for CoEs in oncology, and what the evidence is for these criteria.

Methods

A scoping review was conducted in PubMed, Web of Science, and EMBASE, following PRISMA guidelines. Data extraction categorised findings into four pillars: medical care, organisation/management, research, and education.

Results

A total of 5717 records were retrieved, of which 20 papers were included in the review. CoE features in Medical care included: multidisciplinary team participation (10/20), specialised treatments (8/20), ICT interoperability (6/20), innovation (5/20), patient-centred care (5/20), and state-of-the-art equipment (3/20). For Organisation/Management notable features were strong HR policies for career development (4/20), high-performance teams (4/20), and frameworks promoting excellence (3/20). For Research we found: focused on international collaboration (5/20), clinical trials (4/20), and high-quality translational research (3/20). Education included residency and fellowship programs (7/20), comprehensive training programs (5/20), and continuous education (3/20). These findings emphasise the comprehensive approach necessary for achieving excellence in oncology care, although no papers were found where these criteria were correlated with outcome.

Conclusion

We found that most studies mentioned integrated care, and specific characteristics of organisation & operational management, research, and education when defining CoE in oncology, but these criteria have not been validated with outcome.

Background

The concept of excellence in healthcare

Healthcare organisations worldwide face the challenge to meet the rising demand high for quality care with growing financial, demographic and organisational challenges [1]. In response, there is a growing body of literature and practice has turned its attention to models that promise excellence not only in patient care, but also in research, education, and management and organisation. Among these, the concept of a Centre of Excellence (CoE) has emerged as a prominent, yet variably defined, construct. CoEs hold the promise of being leading in healthcare, research, and innovation, and offer a means to recognise care quality [2–4], and to improve access to research grants.

Current definitions and variability in practice

Despite the widespread use of the term “Centre of Excellence”, it lacks a unified definition. Existing studies indicate substantial variability in how CoEs are operationalised, particularly within healthcare. Some present CoEs as centres delivering highly specialised or multidisciplinary care; others emphasise their research infrastructure or training capacity [2, 5]. As a result, the CoE label is frequently adopted without consistent standards or validation mechanisms, which risks diluting its meaning and may even mislead patients seeking high-quality care [6, 7]. A scoping review by Manyazewal et al. [2] outlined 12 building blocks for CoEs, including research, innovation, and specialised expertise, placing a strong emphasis on patient-centred care and health system strengthening in low-resource environments. However, this review focused primarily on low-resource settings and was not tailored to oncology or Western healthcare systems, leaving an important conceptual gap in specialised cancer care contexts.

The idea that CoEs may offer improved clinical outcomes is supported by evidence suggesting that patients treated in such centres experience fewer complications and better survival rates [8–11]. Furthermore, CoEs are not only beneficial for patient care, but this designation can also have financial advantages [12] since it brings together highly skilled professionals and innovative technologies and techniques to increase efficiency and improve reimbursements [2]. Nevertheless, many of these studies fail to define what constitutes a CoE, raising critical questions about attribution: are the observed benefits due to the structure and function of a CoE, or merely associated with high-volume or academic centres.

The lack of a widely accepted conceptualisation of the prerequisites of CoEs creates uncertainty about what constitutes ‘excellence’, and is particularly pressing in the context of oncology, where complexity of care, research intensity, and the need multidisciplinary coordination are especially high. To date, no consensus exists on how to define or assess excellence in oncology-focused healthcare institutions, and no standardised framework is in place to guide organisations seeking to develop into a CoE.

In the absence of a unified conceptualisation, existing institutional models provide some reference points. In the Netherlands, hospitals are classified into university medical centres (UMC), top clinical hospitals, and general hospitals [13], although exact criteria to differentiate between top clinical hospitals and general hospitals are lacking. Top clinical hospitals provide both basic and complex care, specialise in one or more medical areas, and attract patients from a wider area compared to often smaller general hospitals. They conduct innovative research and serve as training centres for medical professionals. UMCs handle rare or complex treatments typically only performed there, being affiliated with universities through medical education and research [13]. These characteristics of top clinical hospitals and UMCs, care, research, and education, often align with those of CoEs.

Internationally, a Comprehensive Cancer Centre (CCC) is a healthcare institution that integrates research, patient care, and education to address all aspects of cancer treatment. In oncology, initiatives like the European Organisation for Cancer Institutes (OECI) provide guidelines through its Accreditation and Designation (A&D) programme for a similar concept: “Comprehensive Cancer Centres” (CCC). This programme offers comprehensive accreditation to CCCs for multidisciplinary oncology care, integrating prevention, care, research, education, networking, and patient involvement, unlike US and German systems that separate these areas [14]. Comprehensiveness, integrating all relevant competencies and resources, is the cornerstone of this OECI programme, aiming to achieve better outcomes in cancer care and research. The criteria for CCCs are focussed to their research capacity and capabilities [15]. According to the OECI, a CCC is characterised by its extensive integration of cancer research and patient care. These centres must have a well-established combination of fundamental and translational cancer research, along with a comprehensive portfolio of cancer care services that cover the entire care pathway. The OECI emphasises the importance of these centres in reducing inequalities in cancer diagnosis, treatment, and care, as well as in strengthening the quality of research and integrating clinical care with research [14, 15]. The criteria for these CCCs are defined based on consensus, and up until 2025 no studies have been performed to correlate these criteria with outcomes. A recent review highlights that CCCs demonstrate better patient outcomes, including higher survival rates, compared to non-CCCs, which can be attributed to their integration of research, clinical practice, and access to advanced treatments [16].

Given this landscape, it becomes evident that the CoE label in oncology is used inconsistently, and its empirical and conceptual foundations remain underdeveloped. The absence of a shared framework not only complicates institutional benchmarking and improvement but also hinders efforts to ensure transparency for patients and policymakers. There is a pressing need to articulate what constitutes ‘excellence’ in oncology, both in terms of what outcomes are expected and what processes are needed to achieve them.

Aim and scope

Previous literature has examined Centres of Excellence through various lenses. However, to our knowledge, no studies have been conducted that specifically focus on defining Centres of Excellence in oncology. Given the complexity of cancer care and the lack of standardised criteria in this field, our review addresses a unique gap by systematically mapping existing definitions and criteria for oncology-specific CoEs. Therefore, a scoping review of the literature on CoEs in oncology was performed. The main research question was: How is the concept of a Centre of Excellence defined in oncology and what are criteria for a Centre of Excellence in oncology? We aimed to provide an overview of the core characteristics of CoEs in oncology and identify criteria for achieving excellence in cancer care. Therefore, we performed a scoping literature review, aiming to provide an overview of the existing knowledge and data on the criteria for CoEs in oncology. This includes both the outcome-based criteria that define what is expected from a CoE and the process indicators that describe how excellence is achieved. Stakeholders may use this overview to enhance their oncology services.

Methods

Search strategy and sources

Given the exploratory nature of our research question and the diversity of literature on Centres of Excellence (CoEs) in oncology, including position papers, expert opinions, and guidelines rather than uniformly empirical studies, we chose a scoping review methodology. This approach, aligned with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, is more suitable than a traditional systematic review as it allows for the inclusion of a broad range of evidence types and aims to map key concepts, gaps, and types of evidence, rather than appraise the quality of interventions or outcomes. The PRISMA-ScR guidelines were used for this review [17]. The search was completed in PubMed, Web of Science and EMBASE on December 22nd of 2023 and updated until March 26th of 2025. The following search terms were used: (“academic medical centers” OR “cancer care facilities” OR “delivery of health care” OR “health facilities” OR “health services” OR “center*” OR “centre*”) AND “excellence” AND (“Neoplasms” OR “neoplas*” OR “tumor*” OR “tumour*” OR “cancer*” OR “lymphoma*” OR “malignan*” OR “oncolog*” OR “carcinom*” OR “melanom*”) The exact search strings per resources are included in Table 1.

Table 1.

Search strings

Search engine	Query
PubMed	(“academic medical centers“[MeSH Major Topic] OR “cancer care facilities“[MeSH Major Topic] OR “delivery of health care“[MeSH Major Topic] OR “health facilities“[MeSH Major Topic] OR “health services“[MeSH Major Topic] OR “center*“[Title/Abstract] OR “centre*“[Title/Abstract]) AND “excellence“[Title/Abstract] AND (“Neoplasms“[MeSH Terms] OR “neoplas*“[Title/Abstract] OR “tumor*“[Title/Abstract] OR “tumour*“[Title/Abstract] OR “cancer*“[Title/Abstract] OR “lymphoma*“[Title/Abstract] OR “malignan*“[Title/Abstract] OR “oncolog*“[Title/Abstract] OR “carcinom*“[Title/Abstract] OR “melanom*“[Title/Abstract])
Web of Science	(TS= ((centre* OR center*) AND excellence)) AND (TS= (neoplas* or tumor* or tumour* or cancer* or lymphoma* or malignan* or oncolog* or carcinom* or melanom*))
EMBASE	(exp *university hospital/or exp *cancer center/or exp *health care delivery/or exp *health care facility/or exp *health service/or (centre* or center*).ti, ab, kf.) and excellence.ti, ab, kf. and (exp neoplasm/or (neoplas* or tumor* or tumour* or cancer* or lymphoma* or malignan* or oncolog* or carcinom* or melanom*).ti, ab, kf.)

Study selection

Inclusion criteria for articles were as follows: aimed at hospitals/healthcare centres specialised in oncology, highlights the characteristics for excellence within these hospitals/healthcare centres, and describing criteria to identify a centre of excellence. Included articles were written in English and concerned Western countries (Table 2). Exclusion criteria were as follows: focus on a new treatment in a centre of excellence, comparing outcomes of centres with a centre of excellence, and focus on clinical study results (Table 2). We limited our review to studies from Western countries (Europe, North America, and Australia) for several reasons. First, healthcare systems in these regions typically possess advanced diagnostic infrastructure and comprehensive cancer registration systems, which allow for robust and timely data on oncology care. Second, cancer incidence in Western populations tends to be higher due to demographic, lifestyle, and environmental factors [18]. Third, Western countries generally have more established access to specialised oncology treatments and high-end medical technology [19, 20]. This focus facilitates a more consistent comparison of institutional standards and practices relevant to the conceptualisation of excellence in oncology care.

Table 2.

In- and exclusion criteria

Inclusion criteria

Aimed at hospitals/healthcare centres specialised in oncology Highlights what is expected from a CoE (in terms of outcome, whether these are formulated SMART or not) Highlights process indicators (detailing what a CoE can do to achieve what is expected in terms of outcome) Written in English Focused on Western countries (Europe, North America, and Australia)

Exclusion criteria

Focus on a new treatment in a centre of excellence Comparing outcomes of centres with a centre of excellence Focus on clinical study results

Data collection

Once search terms and in- and exclusion criteria were defined, duplicate publications were removed and two researchers (RS and FH) independently screened titles and abstracts. The full texts of the remaining articles were independently screened by two researchers (RS and FH) for eligibility. Any discrepancies were discussed and resolved. Data were organised in an Excel spreadsheet. The review and the protocol were not prospectively registered. No data from the review are currently publicly available.

Data analysis

Two researchers (FH and AG) independently performed the data extraction. The main outcome was the characteristics and features which define a centre of excellence. In addition, details regarding study type, level of evidence (Table 3), study duration and number and type of healthcare organisations were collected. The University of Oxford’s levels of evidence scale (ranging from 1, highest, to 5, lowest) was used to assess the quality of evidence in the articles included in the final review. This scale was chosen because it is widely recognized and considers not only the study design but also the quality of the underlying data [21–23].

Table 3.

The university of Oxford’s levels of evidence scale [24]

Level of evidence
I	1a: Systematic review (with homogeneity) of randomized controlled trials (RCTs) 1b: Individual RCT (with narrow confidence interval) 1c: “All or none” case-series (e.g., all patients died before a treatment was available, but some survive when treated)
II	2a: Systematic review (with homogeneity) of cohort studies 2b: Individual cohort study (including low-quality RCTs, e.g., < 80% follow-up) 2c: Outcomes research; ecological studies
III	3a: Systematic review (with homogeneity) of case-control studies 3b: Individual case-control study
IV	Case-series and poor-quality cohort and case-control studies
V	Expert opinion without explicit critical appraisal, or based on physiology, bench research, or “first principles”

To structure our findings, we used the three pillars of ‘top clinical’ hospitals, namely medical care, education, and research [13]. To provide a more comprehensive analysis, we supplemented these with a fourth pillar: organisation and operational management. This addition acknowledges the critical role that efficient operations play in delivering high-quality healthcare. Operational excellence involves optimising processes, eliminating waste, and improving resource allocation, all of which are essential for enhancing patient outcomes and ensuring the sustainability of healthcare institutions [25]. The identified criteria for a CoE were categorised into process and outcome indicators, and additionally, it has been assessed whether they are objective measurable criteria or whether they are open to more subjective interpretation. Outcome, in this study, was defined as (a) effectiveness in terms of patient outcomes, patient safety and patient service (e.g. for the medical pillar patient outcomes, for the organisational pillar expert teams, for the research pillar number of publications, and for the education pillar having a good educational programme) (b) efficiency (e.g. cost-effectiveness in relation to success), and (c) good social policy (e.g. personnel with continuous practice, high workload, and proven outcomes) [26].

Results

PRISMA and study characteristics

From all sources combined, 5717 records were retrieved (Fig. 1). After removing duplicates, 3505 publications remained. Screening of titles and abstracts resulted in the exclusion of 3360 records. The full text of 145 records was examined and finally, 20 records were included.

Fig. 1.

PRISMA flowchart for search results

The relevant characteristics of included publications (n = 20) are presented in Table 4. Articles were published between 2012 and 2021. The most frequent type of article was a review (55%) and most of them focused on oncology in general (45%). The duration of the study and the number of included organisations were, respectively, only specified in three and five articles. All included articles had a level of evidence of V, the lowest possible level.

Table 4.

Study characteristics

Article	Type of article	Level of Evidence	Type of condition	Number of health care organisations	Type of healthcare organisation	Country/region
Casanueva et al. 2017 [27]	Position paper	V	Pituitary cancer	NS	Pituitary Tumour Centres	USA
Deriu et al. 2013 [28]	Position paper	V	Oncology	11	Cancer Research institutes	Italy
Elrod et al. 2017 [12]	Debate	V	NS	1	Healthcare provider	USA
Frara et al.2020 [6]	Review	V	Pituitary cancer	NS	Healthcare provider	USA
Ida et al. 2021 [29]	Review	V	Oncology	NS	Supportive care centres	USA
Kennedy et al. 2019 [30]	Perspective	V	Oncology	NS	Forensic mental health services	NS
Kolb, 2005 [31]	Review	V	Breast cancer	NS	Healthcare provider	USA
McLaughlin et al. 2012 [7]	Preliminary proposal	V	Pituitary cancer	NS	Healthcare provider	USA
Oberst, 2019 [32]	Review	V	Oncology	NS	Comprehensive Cancer Centres	Europe
Palombo et al. 2015 [33]	Short communication	V	Oncology	18	Institutes for research and patient care	Italy
Rajan et al. 2013 [34]	Mixed methods research article	V	Oncology	70	Comprehensive Cancer Centres, Cancer Research Centres, Clinical Cancer Centres, Cancer Units, Patient Organisations and Cancer networks	Europe
Rajan et al. 2016 [35]	Perspective	V	Oncology	3	Comprehensive Cancer Centres	Europe
Silver et al. 2014 [36]	Review	V	Placenta accreta	NS	Healthcare provider	USA
McKean and Sullivan, 2022 [37]	Review	V	Pituitary cancer	NS	Healthcare provider	USA
Antonuzzo et al. 2023 [38]	Review	V	Oncology	20	Supportive care centres	NS
Touhami et al. 2022 [39]	Review	V	Placenta accreta	NS	Healthcare provider	Canada
Couselo et al. 2022 [40]	Article	V	Oncology	NS	Healthcare provider	Spain, Italy
Nieva-Posso et al. 2024 [41]	Review	V	Urologic cancer	NA	Comprehensive Cancer Centres	NS
Kandasamy et al. 2024 [42]	Review	V	NS	NS	Healthcare provider	NS
Marques et al. 2024 [43]	Review	V	Pituitary cancer	NS	Healthcare provider	Europe

NS not specified, NA not applicable

How is a centre of excellence defined in literature

Of the 20 articles included in this study, only 5 provide a definition of a CoE. Elrod et al. [12] defined a CoE as ‘a program within a healthcare institution which is assembled to supply an exceptionally high concentration of expertise and related resources centred on a particular area of medicine, delivering associated care in a comprehensive, interdisciplinary fashion to afford the best patient outcomes possible’. Frara et al. [6] refer to the definition as formulated by Elrod et al. [12]. Similarly, McLaughlin et al. [7] described a CoE as ‘a cohesive team of specialists who promote collaboration and apply best practices in a specific focus area to improve results and overall outcomes. Nieva-Posso et al. [41] define a Cancer Centre of Excellence as a highly specialized and multidisciplinary space that provides quality and humanized care to patients suffering from an oncological process. According to Kandasamy et al. [42] a CoE is an organisation providing ‘clinical excellence’ and deliver exceptional patient care. This study also refers to the definition of a CoE as defined by Elrod et al. [12].

Criteria of a centre of excellence

Table 5 presents a comprehensive overview of the extracted criteria for defining a CoE in oncology. In the medical care pillar, 29 criteria were identified in the literature of which 10 were measurable. Twenty-two criteria were classified as process-indicators, and 7 criteria were classified as expected from a CoE. In the pillar for organisation and operational management also 29 criteria were identified, of which 18 concerned process-indicators and 11 were classified as expected from a CoE, of which four were objective measurable criteria. For the research pillar, we found 16 process indicators and 8 indicators that were classified as expected from a CoE, of which six were objectively measurable. Finally, the education pillar included seven criteria of which six were objectively measurable. Three criteria were process indicators, and 4 were classified as expected from a CoE. While most criteria found were open to interpretation, some indicators are marked as measurable. Yet, most of these were not formulated in a SMART way, limiting their clarity, specificity, and utility in driving improvement and performance assessment. The most frequently cited factors within each of the four pillars are summarised in Fig. 2.

Table 5.

Features of a centre of excellence

Features of a CoE	References (n = 17)*	Expected from a CoE (outcome in terms of effectiveness, efficiency and good social policy) or process indicator	Measurable or open to interpretation
Medical care
Experienced multidisciplinary team	10 [6, 31, 32, 36–42]	Process	Open to interpretation, but could be defined further
Deliver outstanding, specialised care tailored to specific cancer types	8 [12, 27–29, 32, 33, 38, 42]	Expected from a CoE (outcome)– effectiveness	Open to interpretation
Multidisciplinary collaboration, including ICT interoperability, extends to other healthcare entities such as hospitals, primary care, and supportive services	5 [6, 7, 32, 40, 43]	Process	Open to interpretation, but could be defined further
Continuous innovation (e.g. treatments, equipment, care process)	5 [28, 31, 32, 34, 43]	Expected from a CoE (outcome)– effectiveness	Open to interpretation, but could be defined further
Patient-centred care	5 [12, 29, 38, 40, 42]	Expected from a CoE (outcome)– effectiveness	Open to interpretation
Tailored care facilities, including high-quality outpatient and inpatient services for an optimal patient experience	4 [12, 32, 36, 41]	Expected from a CoE (outcome)– effectiveness	Open to interpretation
State of the art equipment and instruments (including safe, efficient, accurate)	3 [7, 12, 32]	Process	Open to interpretation
Ongoing optimisation efforts	3 [33, 34, 39]	Process	Open to interpretation
Robust e-hospital systems facilitate the collection of clinical data, seamlessly linked with Big Data analytics for research	3 [7, 32, 43]	Process	Measurable (but not SMART)
Comprehensive care is consolidated within a singular location or subunit, ensuring a seamless continuum of services	3 [6, 12, 32]	Process	Measurable (but not SMART)
The centre offers personalised care, including comprehensive follow-up with a database and palliative support	2 [6, 7]	Expected from a CoE (outcome)– effectiveness	Measurable (but not SMART)
Defined clinical pathways and standard operating procedures	2 [7, 31]	Process	Measurable (but not SMART)
Routine outcome measurement is ingrained in standard practice, seamlessly integrated into service governance and decision-making processes	2 [30, 37]	Process	Measurable (but not SMART)
Adherence to (international) guidelines	2 [29, 38]	Process	Measurable (but not SMART)
Integrated with national prevention, actively engaged in screening and early detection, employing cancer risk reduction strategies	1 [32]	Process	Measurable (but not SMART)
A dynamic organisation, capable of swift adaptation to the rapidly evolving landscape of treatments	1 [29]	Process	Open to interpretation
Excel in treating three major cancer types at an international standard	1 [34]	Expected from a CoE (outcome)– effectiveness	Open to interpretation, but could be defined further
Seamless integration of information	1 [31]	Process	Open to interpretation
Draw insights from non-healthcare sectors to enhance practices	1 [31]	Process	Open to interpretation
Standard practice grounded in evidence-based principles	1 [30]	Process	Measurable (but not SMART)
Service-wide governance guides crucial decision-making	1 [30]	Process	Open to interpretation
Defining, developing, delivering, and evaluating multimodal treatments is standard practice	1 [30]	Process	Open to interpretation but could be defined further
Seamless integration of procedures	1 [31]	Process	Open to interpretation
Responsive critical care support	1 [7]	Expected from a CoE (outcome)– effectiveness	Open to interpretation
Pre-defined targets for surgical experience and volumes	1 [7]	Process	Measurable (but not SMART)
Continuous improvement of the quality of patient care processes	1 [34]	Process	Open to interpretation
Outcome focus prioritised, based on treated patient mix	1 [34]	Process	Open to interpretation
Standardised policy for patient access to supportive disciplines	1 [37]	Process	Measurable (but not SMART)
Coordination of time and space	1 [37]	Process	Open to interpretation
Organisation and Operational Management
Clear HR policy promoting excellence in career advancement, recruitment, staffing, and appraisal	4 [7, 29, 32, 34]	Process	Open to interpretation, but could be defined further
Personnel with continuous practice, high workload, and proven outcomes	4 [6, 27, 39, 40]	Expected from a CoE (outcome)– good social policy	Open to interpretation
Employees possess skills specific to addressed medical conditions	3 [12, 39, 40]	Expected from a CoE (outcome)– good social policy	Open to interpretation
Dedicated organisational frameworks	3 [29, 37, 38]	Process	Open to interpretation
Institutional commitment to excellence	2 [7, 28]	Process	Open to interpretation
Collective self-evaluation for continuous improvement	2 [28, 40]	Process	Open to interpretation
Efficient financial management and support in excellence	2 [34, 37]	Process	Open to interpretation
Continuous quality monitoring assurance	1 [33]	Process	Open to interpretation, but could be defined further
Personnel with qualified call coverage	1 [7]	Expected from a CoE (outcome)– good social policy	Open to interpretation
Expert teams, organised for exceptional care, fostered by open communication	1 [12]	Expected from a CoE (outcome)– good social policy	Open to interpretation
Independent of health authorities and for-profit entities	1 [27]	Expected from a CoE (outcome) - effectiveness	Open to interpretation
Efficiencies and reimbursements maximised in clinical and administrative processes	1 [12]	Expected from a CoE (outcome)– efficiency	Open to interpretation
Synergies harnessed for improved financial performance	1 [12]	Process	Open to interpretation
Designated medical director/leadership	1 [7]	Expected from a CoE (outcome)– good social policy	Measurable (but not SMART)
Performance assessment in clinical and research domains	1 [33]	Process	Open to interpretation, but could be defined further
Excellence driven mission and vision	1 [35]	Process	Open to interpretation
Evident commitment to national and international collaboration	1 [35]	Process	Open to interpretation but could be defined further
Supportive community for patients (patient support group)	1 [7]	Process	Open to interpretation
Patient participation, collaboration with patient organisations	1 [35]	Process	Measurable (but not SMART)
Recognised by global healthcare professionals and societies	1 [27]	Expected from a CoE (outcome) - effectiveness	Open to interpretation
External verification by accredited agencies	1 [28]	Process	Measurable (but not SMART)
Healthcare providers as industry authorities	1 [12]	Process	Open to interpretation
Highlighting comprehensive service offerings	1 [12]	Process	Open to interpretation
Local initiatives for condition awareness	1 [7]	Process	Open to interpretation
Internationally competitive facilities and expertise	1 [34]	Process	Open to interpretation
Top 10% international reputation	1 [34]	Expected from a CoE (outcome) - effectiveness	Open to interpretation
Acknowledged as research institutes with certified quality	1 [28]	Expected from a CoE (outcome) - effectiveness	Measurable (but not SMART)
Extensive leadership engagement at all levels	1 [28]	Expected from a CoE (outcome)– good social policy	Open to interpretation
Sustainability; advocate for realignment and augmentation of resources, as well as for devising Lean models for efficiency and patient satisfaction	1 [37]	Process	Open to interpretation
Research
Contribute to advancing the science of the specific cancer types through prolific publication, active participation in international meetings, and a knowledge transfer program within the cancer centre, promoting and disseminating clinical research projects and results	5 [6, 27, 32, 33, 41]	Expected from a CoE (outcome) - effectiveness	Open to interpretation
Well-designed clinical trials and robust infrastructure, ensuring patient enrolment in clinical trials	4 [7, 32, 34, 42]	Expected from a CoE (outcome) - effectiveness	Open to interpretation, but could be defined further
High-quality translational research, demonstrating both breadth and depth by bridging preclinical science to clinical implementation	3 [7, 32, 33]	Expected from a CoE (outcome) - effectiveness	Open to interpretation, but could be defined further
Established shared resource facilities to bolster research programs	2 [35, 37]	Expected from a CoE (outcome)– efficiency	Open to interpretation
Dedicated to financing high-risk/high-reward projects for innovative research opportunities, with a sizeable portion of income sourced from funding bodies utilising a rigorous review process	2 [34, 35]	Process	Open to interpretation
Enhancing the efficiency of clinical trials	1 [33]	Expected from a CoE (outcome)– efficiency	Open to interpretation
Monitoring of research process	1 [33]	Process	Open to interpretation, but could be defined further
Demonstrating excellence across Basic, Translational, and Clinical research through integrated evidence	1 [34]	Expected from a CoE (outcome) - effectiveness	Open to interpretation
Research has led to shifts in clinical perspectives and practices, with a particular emphasis on physician investigators	1 [34]	Expected from a CoE (outcome) - effectiveness	Open to interpretation
The centre undergoes regular global peer reviews, including assessments by funding bodies, fostering continuous improvement in program quality, leadership, shared facilities, and research/clinical studies	1 [35]	Process	Open to interpretation but could be defined further
Establishing an updated and fully annotated biospecimen bank with an integrated IT system for specimen tracking and linkage to clinical outcomes and follow-up data Biobanking is conducted according to defined procedures	1 [35]	Process	Open to interpretation
A thorough exhibition of sustained capability and a clearly expressed commitment to harnessing funding and/or resources acquired through an “excellent” designation	1 [35]	Process	Open to interpretation
The autonomy of Principal Investigators is explicitly outlined	1 [34]	Process	Measurable (but not SMART)
Principal Investigators’ research programs undergo regular assessments	1 [34]	Process	Open to interpretation; but could be defined further
Integrate population-based informatics research samples and multicentre trials into systematic treatment, alongside epidemiological studies, addressing diagnosis, prediction, personalised approaches, and national-level services	1 [30]	Expected from a CoE (outcome) - effectiveness	Open to interpretation
Anatomical studies	1 [7]	Process	Measurable (but not SMART)
Outcomes and quality of life studies	1 [7]	Process	Measurable (but not SMART)
Access to high-quality basic science in cancer, encompassing biological and physical sciences, as well as mathematics	1 [32]	Process	Measurable (but not SMART)
Established mechanisms engage both basic researchers and clinicians in translational research, fostering collaboration with external research teams	1 [34]	Process	Open to interpretation
The centre employs an internal review system to identify the most innovative and promising research protocols	1 [34]	Process	Measurable (but not SMART)
Illustrating a commitment to at least three multidisciplinary programs pursued with depth, spanning from basic discovery through pre-clinical development to clinical studies	1 [35]	Process	Measurable (but not SMART)
Commitment to a collaborative team science approach, unifying basic and applied scientists for translational goals, and ensuring structured cooperation between researchers and clinicians	1 [35]	Process	Open to interpretation
Capability and dedication to conduct hypothesis-driven and hypothesis-generating clinical and population studies	1 [35]	Process	Open to interpretation
Illustration of an ample patient population supporting bench-to-bedside studies across all programmatic areas mentioned	1 [35]	Process	Open to interpretation
Education
Serve as a training centre for residents in the condition’s treatment and host teaching programs (residency and/or fellowship training programs)	7 [6, 7, 27, 29, 35, 39, 41]	Expected from a CoE (outcome)– good social policy	Measurable
Comprehensive programs covering the education and training of patients, clinicians, employees, and scientists	5 [7, 27, 32, 38, 43]	Expected from a CoE (outcome) - good social policy	Open to interpretation
Conduct continuous medical education activities and comprehensive educational programs for cancer clinicians and scientists	3 [7, 32, 37]	Expected from a CoE (outcome) - good social policy	Measurable (but not SMART)
Commitment to training new translational scientists and retraining established scientists shifting to translational cancer research	2 [35, 41]	Process	Measurable (but not SMART)
Offer specialised nursing certifications	1 [7]	Expected from a CoE (outcome) - good social policy	Measurable
Actively participate in condition-specific meetings	1 [7]	Process	Measurable (but not SMART)
Institutional members actively share insights and experiences to enhance understanding and initiate improvements based on lessons learned	1 [12]	Process	Measurable (but not SMART)

SMART Specific, Measurable, Achievable, Relevant and Time-bound

^*Numbers in this column refer to the number of studies the factor is mentioned in

Fig. 2.

Characteristics of a centre of excellence

The medical care pillar emerged as the most prominent category, where the importance of a multidisciplinary team dedicated to providing specialised care for different cancer types was emphasised in most papers. CoEs combined this expertise with continuous innovation to enhance patient-centred care. A key feature was the use of ICT interoperability to facilitate collaboration and streamline patient referrals. Advanced diagnostic and treatment equipment, along with efforts to optimise care delivery, were mentioned to ensure that patients receive high-quality care in advanced well-equipped facilities.

For the organisation and operational management pillar most papers mentioned robust human resources (HR) policies that support career advancement and that ensure high standards in staffing and recruitment. CoEs were expected to emphasise personnel with extensive practice, proven outcomes, and condition -specific expertise. Commitment to organisational frameworks, financial management, and continuous self-evaluation further were mentioned to demonstrate institutional dedication to excellence.

In the research pillar, criteria for CoEs were to actively contribute to advancing oncology through prolific publications, international participation, and clinical research. High-quality translational research and well-designed clinical trials should then be supported by shared resource facilities and innovative research projects. The pillar underscores that CoEs should focus on impactful research, often funded through competitive review processes.

For the education pillar, the literature highlighted the role of CoEs as training centres for residents and fellows, offering programs on specific cancer types. CoEs were supposed to implement comprehensive education programs for patients, clinicians, employees, and scientists, ensuring that knowledge and skills of healthcare professionals remain up to date through continuous medical education and dynamic training programs.

Discussion

This study was conducted as a scoping review rather than a systematic review to better accommodate the heterogeneity and predominantly non-empirical nature of the available literature. In this scoping review we aimed to summarise the critical components and factors for the definition of a CoE in oncology, as mentioned in literature. The findings highlight that most papers agree that a CoE in oncology should invest in four primary pillars, namely medical care, organisation and operational management, research, and education. Among these, medical care is most frequently mentioned as an important pillar, followed by research, organisation and operational management, and lastly, education. In summary, the mentioned criteria for a CoE in oncology are multifaceted, and each of these pillars are assumed to play a vital role in ensuring that CoEs provide the highest quality of care, foster innovation, and contribute to the continuous advancement of oncology as a field. However, a key gap in existing frameworks is the lack of focus on health equity and governance in networked systems, a focus that is essential for ensuring equitable access to cancer care [44, 45]. Most CoEs and CCCs are concentrated in well-funded institutions, risking exacerbation of disparities by benefiting urban centres while rural and underserved populations remain disadvantaged [45, 46]. The World Health Organization (WHO) mandates health equity as a core system norm, urging structured governance to address these disparities [47]. However, formal governance frameworks for equity-driven CoEs remain undefined in the literature [48]. This could be addressed by incorporating health equity performance indicators to track impact across diverse populations. Furthermore, the Achilles heel of these criteria however remains that most of these criteria are process indicators, not easily measured, and consequently no evident relationship with outcome has been established.

Core pillars, similarities and subtle differences and of a CoE in oncology vs. CCC

The characteristics of a CoE found in this review show significant overlap with the criteria for CCC as outlined by the OECI. This overlap raises the question about the distinction between a CoE and a CCC, particularly since OECI-accredited cancer centres often use the term CoE. According to the OECI criteria, CCCs should focus on clinical care (delivering high-quality, patient-centred services), research (advancing innovative research and applying findings in practice), education and training (providing ongoing education for oncology professionals), organisational governance (ensuring effective leadership and management), patient involvement (engaging patients in their care and policy development) and quality improvement (continuously enhancing services through quality assurance) [15]. These are also core focus areas for a CoE, but the differences lie in the details.

For example, OECI criteria emphasise human resources management, such as maintaining appropriate staffing levels and a robust appraisal system for staff [15]. In contrast, the HR policy of a CoE should promote excellence not only in staffing and appraisal but also in career advancement and recruitment [7, 29, 32, 34]. Similarly, while OECI standards require a CCC to be adequately equipped with safe and efficient medical technology [15], a CoE should have state-of-the-art equipment that goes beyond basic requirements [7, 12, 32]. The distinction between a CCC and a CoE is subtle; however, a CoE represents a further advancement beyond the scope of a CCC, other distinctions between the features of a CoE in oncology and a CCC are listed in Table 6.

Table 6.

Differences between a CoE and a CCC

Feature	CoE	CCC
Care
Scope of Care	Focuses on specialised care for specific cancer types with continuous innovation and state-of-the-art equipment [7, 12, 27–29, 32, 33, 38, 42].	Provides comprehensive care across the entire spectrum of oncological services [15].
Multidisciplinary Teams	Teams are tailored to specific cancer types and are highly specialised [6, 31, 32, 36–42].	Teams cover a broader range of cancer types and treatments [15].
Innovation and Equipment	Prioritises continuous innovation and the latest technology [28, 31, 32, 34, 43].	Requires safe and efficient equipment but does not explicitly prioritise continuous innovation [15].
Patient-Centred Care	Strong focus on personalised care and integration within a singular location [12, 29, 38, 40, 42].	Essential patient involvement within a comprehensive service model, with less emphasis on personalised services [15].
External Collaboration	Extends multidisciplinary collaboration and ICT interoperability with other healthcare entities [6, 7, 32, 40].	Focuses on comprehensive care across cancer types within a broader healthcare network [15].
Quality and Outcome Measurement	Routine outcome measurement and continuous optimisation of patient care processes [30, 37].	Continuous quality improvement with less emphasis on routine outcome measurement [15].
Organisation and Operational Management
Operational Management	Emphasises clear HR policies, high workload management, and skill-specific training [7, 29, 32, 34].	Focuses on maintaining staffing levels and appraisals with a broader HR management scope [15].
Research
Research Focus	Significant contribution to specific cancer research, high-quality translational research, and resources for high-risk projects [6, 27, 32–35].	Encourages research with a focus on translating findings into practice rather than high-risk or specific cancer research [15].
Research Infrastructure	Heavy investment in research infrastructure, such as biobanks and shared resources, with regular global peer reviews [35].	Research is a key component but within a broader framework without the same level of specialised infrastructure [15].
Education
Education and Training	Specialised training and continuous education focused on specific cancer conditions [6, 7, 27, 29, 35, 39, 41].	Ongoing education for a wide range of oncology professionals across various cancer types [15].

A CCC provides comprehensive, high-quality care to a large population across the entire spectrum of oncological services [14]. “Comprehensive” in this context refers to providing complete and thorough cancer care services, which differentiates a CCC from a CoE. A CoE, in contrast, is often a specialised unit within a hospital that focuses on a specific treatment or disease [2, 49]. While not all centres need to be comprehensive or achieve excellence in every area, it is essential that all centres deliver high-quality care, and patients should have access to at least one CoE. In summary, a CCC provides state-of-the-art care across all aspects of cancer treatment, while a CoE achieves excellence and innovation in a specific area of oncology. Together, CCCs and CoEs complement each other in enhancing the overall quality of cancer care.

Importance of patient and organisational outcomes in CoEs

Research, innovation, and development necessary for teaching, and training drive excellence in a CoE, expected to lead to an improved outcome [22]. The term “Centre of Excellence” reflects a commitment to achieving exceptional results, with patient outcomes serving as a key metric for evaluating success. These outcomes include e.g. successful treatments, reduced complications, improved quality of life, patient satisfaction and overall positive health results [12, 49]. The emphasis on patient outcomes is a defining feature of healthcare facilities striving for excellence and continuous improvement in care delivery [50, 51]. However, the results of this literature review identified criteria of which the majority was a process indicator.

Challenges in measuring excellence

Furthermore, most of the criteria found in this study are open to interpretation, not clearly defined, and not formulated in a SMART way, which limits their clarity and measurability, making it difficult to objectively assess performance and improvement in outcomes over time. To accurately measure the quality of care clearly defined process and outcome indicators are needed [52]. However, establishing a direct link between process indicators and patient outcomes is inherently challenging due to the multifaceted nature of healthcare delivery. Patient outcomes are influenced by numerous factors beyond the immediate control of healthcare providers, including the diversity of patient characteristics such as age, severity of illness, and comorbidities, as well as other contextual variables like socioeconomic status and support systems. These complexities can obscure the direct impact of specific care processes on outcomes. Therefore, while process indicators are valuable for assessing the quality of care delivery, attributing changes in patient outcomes solely to these processes requires careful consideration of these influencing factors [52]. However, despite the challenge, developing a comprehensive framework to assess relevant outcomes would be essential for evaluating success and driving improvement in excellence in oncology. Such a framework could be categorised into two primary domains. The first domain being patient-related outcomes such as improved overall survival, enhanced quality of life, increased patient satisfaction, and greater cost-effectiveness. The second domain being organisational outcomes including e.g. higher staff satisfaction, reduced turnover rates, and increased applicant interest. Implementing such a structured framework would enable CoEs to systematically evaluate and enhance both patient care and operational efficiency, leading to sustained improvements in excellence [53, 54]. A framework with criteria for excellence can also serve as a strategic tool for healthcare leadership, guiding decision-making, and the establishment of long-term goals in cancer care. For management, it provides a structured approach to evaluating institutional performance across various domains, such as clinical care, research, education, and operational processes. This enables leaders to align strategic planning and resource allocation with the institution’s pursuit of excellence. For patients, a framework could offer transparency in the expected quality of care and highlight areas in which the institution excels, enhancing patient confidence. Additionally, it facilitates the integration of diverse medical and scientific disciplines, enabling a comprehensive evaluation of what constitutes high-quality care. Furthermore, a framework promotes continuous self-assessment, providing a foundation for benchmarking and refining performance standards, driving improvements in both patient outcomes and institutional excellence.

Strengths and limitations

To the best of our knowledge, this is the first review to summarise criteria/characteristics for a CoE in oncology as mentioned in literature. This review methodologically followed the PRISMA guidelines [55, 56]. A key strength of this study lies in its systematic approach to inventorying the existing knowledge on the characteristics of a CoE, providing a comprehensive overview of the factors that define excellence in oncology. Another strength is the broad scope of this review, which extends beyond clinical care and research to include organisation and operational management. This comprehensive approach enables a holistic assessment of the institution, rather than focusing solely on specific aspects of its performance. However, a key limitation of this study is the limited availability of data and data on outcome indicators in the literature on this topic. Another limitation was that we only included articles which were free accessible. Although the initial search yielded multiple articles, only a small number of articles met the inclusion criteria and described the characteristics of a CoE. Looking at the quality of the included articles (100% level of evidence V), it can be concluded that there is limited, and low-quality evidence for what it entails to be an CoE in oncology. Articles included are mostly position papers, perspectives, and guidelines. A total of five reviews are included in this study. More high-quality research is needed on this subject. By establishing clearly defined, quantifiable metrics and grounding evaluations in real-world data, such as the criteria used for a CCC, we can define what constitutes a CoE in a more structured, measurable, and actionable manner. Attention must also be paid to how process indicators can be measured and how they contribute to better patient outcomes. This approach would help bridge the gap between the aspirational goals of an organisation to be a CoE and measurable outcomes.

Contributions and future research

This study contributes to the field of oncology by reviewing and summarising the critical components that define a CoE in oncology, as outlined in the literature. The research offers an integrated perspective on the four primary pillars of a CoE: medical care, organisation and operational management, research, and education. By identifying these core areas, the study highlights the multifaceted nature of excellence in oncology care and provides a clearer understanding of how CoEs can serve as models for delivering high-quality, innovative cancer treatment. Furthermore, this work contributes to theory by clarifying the distinctions and overlaps between CCCs and CoEs, and by highlighting the conceptual gap between process indicators and measurable outcomes. This underscores the need for more precise, outcome-oriented definitions and criteria within the discourse on excellence in healthcare. By identifying limitations in existing literature, such as the inconsistent use of terminology and reliance on low-quality evidence the study also lays a foundation for future theoretical refinement and model development.

From a practical perspective, this study provides healthcare professionals, policymakers, and institutional leaders with a structured overview of the essential components that define a CoE in oncology. It identifies critical operational and organisational features that can serve as benchmarks for institutions aiming to improve or obtain CoE status. By offering insights into both outcome and process indicators, the review supports more informed decision-making regarding the design, evaluation, and continuous improvement of cancer care services. The findings may help institutions align their strategies with recognised standards of excellence, facilitate better resource allocation, and ultimately contribute to improved patient care and system performance.

Future research should focus on several aspects.

1. The development of a standardised framework. Future studies should aim to build a consensus-based framework that distinguishes between outcome and process indicators and ensure they are measurable, specific, and linked to patient and organisational outcomes. Current literature is heavily reliant on process indicators, but there is a need to develop specific, actionable metrics that directly correlate with improvements in patient care and outcomes, such as survival rates, quality of life, and patient satisfaction. More high-quality studies are needed to explore how process indicators, when consistently implemented, contribute to better outcomes in cancer treatment and care. Additionally, research should aim to bridge the gap between clinical, organisational, and operational excellence, and their impact on institutional success and patient outcomes.

2. The empirical validation of CoE criteria. There is a need for longitudinal or comparative studies that test whether proposed CoE features (e.g. multidisciplinary teams, research output, or education programs) are associated with improved outcomes such as survival, quality of life, staff satisfaction, or operational efficiency.

3. Researchers should explore how indicators can be made SMART (Specific, Measurable, Achievable, Relevant, Time-bound) to facilitate benchmarking and policy application. Mixed-methods designs could capture both quantitative outcomes and qualitative insights into implementation.

Furthermore, our findings can guide more focused systematic reviews or meta-analyses. Potential questions could be: What is the impact of CoE-designated institutions on cancer survival and complication rates compared to non-CoEs? Which organisational or structural features of oncology centres are most consistently associated with better patient outcomes? What governance models support sustainable excellence in oncology care across diverse healthcare systems?

Conclusion

This scoping review identified key criteria that have been mentioned to define a Centre of Excellence (CoE) in oncology, emphasising four primary pillars: medical care, organisation and operational management, research, and education. A CoE is expected to deliver specialised, patient-centred care, foster continuous innovation, and utilise state-of-the-art equipment. It should demonstrate a strong commitment to high-quality research, including well-designed clinical trials and securing funding for high-risk projects. Organisational excellence is also critical, with robust HR policies and a skilled workforce. Additionally, a CoE should serve as a training centre, providing a comprehensive education for medical professionals and continuous medical education. However, the evidence supporting these criteria is limited, with most data derived from position papers and guidelines. More rigorous research is needed to establish clear, evidence-based standards, ensuring that CoEs effectively enhance cancer care, research, and education, improving patient outcomes.

Authors’ contributions

RS: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Validation; Visualization; Roles/Writing - original draft & editing. LB: Writing - review & editing, Supervision. RF: Writing - review & editing, Supervision. PC: Writing - review & editing, Supervision. FH: Data curation; Formal analysis; MJ: Conceptualization; Methodology; Writing - review & editing, Supervision.

Funding

Not applicable.

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.