This study aimed to understand clinical pathways for patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) from diagnosis to follow-up and to identify opportunities to improve care.
A cross-sectional survey was conducted via structured online interviews with consented NHS healthcare professionals (HCPs) from the United Kingdom (UK) between June and September 2025. Topics surveyed included MDT structures/roles, diagnostic timelines, adjuvant treatment, radical cystectomy (RC) decision making, current bladder-sparing treatment and clinical trial access. Quantitative data were analysed descriptively. Qualitative responses were analysed thematically.
Seventy HCPs were included and reported that typically; 88.5% of patients achieve diagnosis within 6-8 weeks of referral, and 11.4% reported delays beyond 8 weeks. BCG maintenance duration and completion rates varied. Following BCG induction, a median (IQR) of 20.0% (5.0-32.5%) and 60.0% (40.0-70.0%) of patients completed ≥2 or ≤1 years of maintenance, respectively; 1.0% (1.0-2.0%) failed to complete induction. For BCG-unresponsive HR-NMIBC, HCPs reported that a mean (SD) proportion of 53.4 (18.1)% of patients tend to be eligible for and consent to RC, 22.0 (12.6)% tend to be eligible but decline RC and 24.6 (14.9)% tend to be ineligible. Bladder-sparing options remain limited, with 60% of HCPs regarding further BCG as the most appropriate option. All respondents agreed that adherence to quality performance indicators (QPIs) and a national bladder cancer audit would be beneficial. Insufficient specialist nurse capacity to meet foreseeable demands of HR-NMIBC patient care was reported by 70% (n = 49) of HCPs.
Results reveal variability in real-world HR-NMIBC care within the NHS. Delays in diagnosis, inconsistent BCG maintenance duration, lack of evidence-based alternatives to BCG and a lack of bladder-sparing treatment and trial options in the BCG-unresponsive setting were identified. Findings highlight unmet needs in relation to MDT resourcing, diagnostic efficiency, trial access, QPI adherence and a national bladder cancer audit.
BJUI compass. 2026 Jun 28*** epublish ***
Jonathan Aning, James W F Catto, Rebecca Martin, Kathryn Chatterton, Paramananthan Mariappan, Edward Ottley, Joseph Hickey, Stephen McCormack, Simran Gill, Bernadett Szabados
Bristol Urological Institute North Bristol NHS Trust Bristol UK., Division of Clinical Medicine, School of Medicine and Population Health University of Sheffield Sheffield UK., The Royal Marsden NHS Foundation Trust London UK., Guy's and St Thomas' NHS Foundation Trust London UK., Edinburgh Bladder Cancer Surgery (EBCS), Western General Hospital University of Edinburgh Edinburgh UK., Real World Evidence OPEN Health Communications LLP London UK., J&J Innovative Medicine High Wycombe UK., University College London Hospitals NHS Foundation Trust London UK.