Alignment with Indices of A Care Pathway Is Associated with Improved Survival: An Observational Population-based Study in Colon Cancer Patients.

•Factors accounting for cancer outcome disparities both between within and between countries in well-resourced health systems remain elusive.•In Australia, a nationally accepted evidenced based pathway of cancer care (the Optimal Care Pathway- OCP) has been developed through a multi-disciplinary clinician consensus based process, to establish the elements of quality care that should be offered to cancer patients. A project to assess the impact of the care that conforms with OCP standards on patient outcomes was undertaken.•A robust survival improvement was seen in the group of patients whose care was aligned to the OCP. This improvement in outcome did not depend on new diagnostic tests or treatments.•Alignment with pre-diagnosis pathway recommendations was associated with lower stage of disease at presentation, less emergency surgery and improved long term survival.•These findings have policy implications as it is demonstrated that subtle system level variation of care could impact favourably on outcomes.