Ensuring the quality of care is a major objective of cancer control policy. The Cancer Control Act 2006 placed responsibility on the Japanese government to maintain the quality of cancer care nationwide. To function as centers providing high-quality care, designated cancer care hospitals (397 hospitals as of April 2012) were instituted nationwide. Although they meet the structural standards, such as the presence of radiation equipment and palliative care teams, it remains unclear whether the designation has led to appropriate provision of care and optimal patient outcomes. A national system to examine the processes and outcomes of cancer care is under development. In 2007 and 2008, the Japanese Association of Clinical Cancer Centers publicly disclosed the 5-year survival of their member facilities with strict data quality standards, including sufficient follow-up of patients' vital status. The network of designated cancer care hospitals will follow this lead to provide a national outcome monitoring system. The processes of care have also been addressed by a government-funded research project. With the collaboration of clinical experts, 206 quality indicators have been developed for five major cancers in Japan (breast, colorectal, liver, lung and stomach) and palliative care. Each indicator described the target patients and standards of care for the patients, the provision of which was considered an aspect of quality. In 2012, the Cancer Registry Chapter of the Association of Prefectural Designated Cancer Care Hospitals instituted quality measurement using these indicators. These activities will soon lead to effective quality monitoring and improvement in Japan.