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.
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.
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.
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.
Scandinavian journal of urology. 2018 Nov 09 [Epub ahead of print]
Mef Nilbert, Mats Bläckberg, Jeanette Ceberg, Oskar Hagberg, Rebecca Stenhoff, Fredrik Liedberg
a Division of Oncology and Pathology , Institution of Clinical Sciences, Lund University , Lund , Sweden., c Department of Urology , Helsingborg County Hospital , Helsingborg , Sweden., b Regional Cancer Centre South, Region Skåne , Lund , Sweden., d Department of Urology , Kristianstad County Hospital , Kristianstad , Sweden., e Division of Urological Research , Institution of Translational Medicine , Malmö , Sweden.