Global, regional, and national trends in 34 cancers through a novel burden–quality-of-care framework: a cross-sectional study

Background: Current unidimensional cancer evaluation systems limit precise cancer control. This study establishes a novel burden–quality framework that integrates disease burden and quality-of-care index (QCI) to better assess cancer management effectiveness globally. Methods: The QCI was derived by principal component analysis of six standardized indicators using the Global Burden of Disease data (1990–2021). A four-quadrant framework integrated QCI with disease burden to classify 34 cancers across 204 countries/regions. The sociodemographic index (SDI) and gender disparity ratios (GDR) were used to assess inequalities. Results: Substantial heterogeneity exists in the burden and QCI across 34 cancers. Highly fatal cancers such as TBL cancers (tracheal, bronchus, and lung cancers) and pancreatic cancers are persistently trapped in a “high burden-low quality” dilemma. In contrast, high-burden breast cancer and low-burden thyroid cancer demonstrate superior QCI, though the latter may carry overtreatment risks. Socioeconomic factors have a profound influence on intervention equity, with SDI exhibiting a strong positive correlation with QCI ( r = 0.90, P < 0.001) but a significant negative correlation with GDR ( r = −0.71, P < 0.001). Notably, the trend of QCI improvement and overall reduction in cancer burden is asynchronous: high-survival cancers and high-SDI regions showed slow QCI gains, middle-SDI regions exhibited substantial increases, while low-SDI areas remained persistently disadvantaged. Demographic disparities further exacerbated these inequities – older populations bore a disproportionate disease burden yet achieved the fastest QCI improvements, whereas adolescent groups maintained high baseline quality but stagnated in progress. Additionally, gender disparities were pervasive, with females receiving better-quality care for most cancers and across most regions. Conclusion: This multidimensional burden–quality framework shifts cancer evaluation from singular evaluation to precision intervention. It emphasizes: (1) optimizing resources for high-burden–low-quality cancers, (2) avoiding overtreatment in low-burden cancers, and (3) reducing inequities linked to socioeconomic disparities and vulnerable groups (especially elderly and male patients). This research provides a foundation for precise and equitable global cancer control.