PURPOSE: Cultural differences and their effect on international collaboration have been studied in several industries but only recently in health care. Understanding these differences can significantly influence the outcomes of ASCO's international co-operation initiatives focused on quality improvement. METHODS: This manuscript is a scoping literature review examining how cultural differences influence the quality and safety of oncology care, and what strategies can be implemented to improve quality and outcomes in multicultural settings using cultural traits outlined by Hofstede's dimensions of culture. Power distance index (PDI
the ability to speak up without embarrassment) emerged in other industries as the most relevant trait affecting quality and team performance. RESULTS: Few publications are available addressing such perspective, and the literature to date revealed that cultures with small PDI tend to perform better in health care safety and quality, and leadership behavior is a dominant feature in this condition. New techniques adopting psychological safety practices can mitigate cultural traits like PDI that hinder quality practices in oncology. CONCLUSION: The authors consider that psychological safety practices are a culturally sensitive strategy to ASCO's Quality Programs that can mitigate local cultural barriers and develop leadership behaviors that enable safety and quality strategies, and foster more effective international collaboration in ASCO Quality Programs in the future.