Mef Nilbert1,2, Mats Bläckberg3, Jeanette Ceberg2, Oskar Hagberg2, Rebecca Stenhoff4, Fredrik Liedberg5,6. 1. a Division of Oncology and Pathology , Institution of Clinical Sciences, Lund University , Lund , Sweden. 2. b Regional Cancer Centre South, Region Skåne , Lund , Sweden. 3. c Department of Urology , Helsingborg County Hospital , Helsingborg , Sweden. 4. d Department of Urology , Kristianstad County Hospital , Kristianstad , Sweden. 5. e Division of Urological Research , Institution of Translational Medicine , Malmö , Sweden. 6. f Department of Urology , Skåne University Hospital , Malmö , Sweden.
Abstract
OBJECTIVE: This study assessed a national healthcare intervention launched in Sweden in 2015 to reduce the time between macroscopic haematuria, diagnosis and treatment of urinary tract cancer. METHODS: The outcome of the first 11 months was evaluated in 1697 individuals referred to a standardized care pathway for urinary tract cancer compared with 174 patients with conventionally diagnosed urothelial carcinoma. RESULTS: Among the referred individuals, 317 (19%) were diagnosed with cancer, 1034 (61%) had a benign diagnosis and 345 (20%) had a negative evaluation. Bladder cancer was the most common malignant diagnosis [262/317 (83%)]. Cancers were diagnosed in 23% of males and 13% of females, and showed a strong correlation with age: cancer diagnosis in 2% aged <50 years and in 44% aged ≥90 years. Results were affected by bacteriuria but not by anticoagulant medication, with 12%/22% and 19%/19% cancer detection, respectively. The standardized care pathway shortened the diagnostic delay to a median of 25 days compared to 35 days for regular referral (p = .01). However, median time to treatment was unchanged: 39 days from referral to transurethral resection, 42 days from primary resection to re-resection for stage TaG3/T1 disease and 100 days from referral to curative treatment for muscle-invasive disease. CONCLUSIONS: Macroscopic haematuria had a cancer capture rate of 19%, with higher predictive values in men and at older age, whereas anticoagulant therapy did not influence the diagnostic yield. The demonstrated lack of effect on time to treatment underscores the need to consider the entire patient process when initiating healthcare reforms to improve outcome.
OBJECTIVE: This study assessed a national healthcare intervention launched in Sweden in 2015 to reduce the time between macroscopic haematuria, diagnosis and treatment of urinary tract cancer. METHODS: The outcome of the first 11 months was evaluated in 1697 individuals referred to a standardized care pathway for urinary tract cancer compared with 174 patients with conventionally diagnosed urothelial carcinoma. RESULTS: Among the referred individuals, 317 (19%) were diagnosed with cancer, 1034 (61%) had a benign diagnosis and 345 (20%) had a negative evaluation. Bladder cancer was the most common malignant diagnosis [262/317 (83%)]. Cancers were diagnosed in 23% of males and 13% of females, and showed a strong correlation with age: cancer diagnosis in 2% aged <50 years and in 44% aged ≥90 years. Results were affected by bacteriuria but not by anticoagulant medication, with 12%/22% and 19%/19% cancer detection, respectively. The standardized care pathway shortened the diagnostic delay to a median of 25 days compared to 35 days for regular referral (p = .01). However, median time to treatment was unchanged: 39 days from referral to transurethral resection, 42 days from primary resection to re-resection for stage TaG3/T1 disease and 100 days from referral to curative treatment for muscle-invasive disease. CONCLUSIONS: Macroscopic haematuria had a cancer capture rate of 19%, with higher predictive values in men and at older age, whereas anticoagulant therapy did not influence the diagnostic yield. The demonstrated lack of effect on time to treatment underscores the need to consider the entire patient process when initiating healthcare reforms to improve outcome.
Entities:
Keywords:
Bladder cancer; haematuria; lead time; standardized care pathways; treatment
Authors: Alessandro Tafuri; Akbar N Ashrafi; Suzanne Palmer; Aliasger Shakir; Giovanni E Cacciamani; Atsuko Iwata; Tsuyoshi Iwata; Jie Cai; Akash Sali; Chhavi Gupta; Luis G Medina; Mariana C Stern; Vinay Duddalwar; Manju Aron; Inderbir S Gill; Andre Abreu Journal: World J Urol Date: 2019-06-07 Impact factor: 4.226
Authors: George N Okoli; Otto L T Lam; Viraj K Reddy; Leslie Copstein; Nicole Askin; Anubha Prashad; Jennifer Stiff; Satya Rashi Khare; Robyn Leonard; Wasifa Zarin; Andrea C Tricco; Ahmed M Abou-Setta Journal: BMJ Open Date: 2021-11-09 Impact factor: 2.692
Authors: Yin Zhou; Marije van Melle; Hardeep Singh; Willie Hamilton; Georgios Lyratzopoulos; Fiona M Walter Journal: BMJ Open Date: 2019-10-03 Impact factor: 2.692