A Deep Dive into Bladder Cancer Pathway Improvements

By Pamela McGowan

In a pivotal step toward creating a sustainable and enhanced care framework for bladder cancer patients, Fight Bladder Cancer's Exemplar Meeting 'Improving the Bladder Cancer Pathway' took place in Birmingham on 7th September 2023. The event brought the bladder cancer community together, facilitating an exchange of knowledge and information among key stakeholders, experts, advocates and patients alike, with the aim of developing concrete actions and recommendations for improving patient experience across the devolved nations.

The primary focus of the meeting was to build on findings and recommendations from the Exemplar Report (1), which took the form of discussing best practice and gaps in care, exploring critical issues and understanding the challenges faced, before proposing and prioritising actionable strategies for pathway improvement.

Exemplar Report

 

Spotlight on Bladder Cancer Misdiagnosis

Maintaining a patient focussed approach, data from a recent UK survey, co-commissioned by a group of bladder cancer patient organisations (including Fight Bladder Cancer and the World Bladder Cancer Patient Coalition) was unveiled at the Exemplar Review Meeting, revealing some concerning statistics…

Among the survey results, it was discovered that a staggering 63% of bladder cancer patients were initially misdiagnosed, with UTI's cited as the most common incorrect diagnosis and a propensity toward misdiagnoses among women, highlighting gender disparities. Notably, a substantial percentage of respondents visited their GP multiple times before receiving a referral to a specialist (2).

Patient Experience Survey

 

Why This Matters:

It is well established that delayed diagnosis leads to poorer outcomes, yet, whilst bladder cancer is a common form of cancer, it is often overlooked, and symptoms are not well understood. Patients continue to have their symptoms, such as frequent urination or pain, brushed aside, mistaken for less severe conditions, despite prompt diagnosis having considerable impact on prognosis and survival rates…

Data from the Office for National Statistics (ONS) underscores the crucial importance of early diagnosis for bladder cancer. The one-year survival rates for patients diagnosed at stage 1 are significantly higher: 95.9% for men and 93.1% for women. In contrast, survival rates drop to 77.8% for men and 64.5% for women when considering all stages of bladder cancer combined. This data is age-standardised and specific to patients diagnosed in England between 2013-2017, followed up to 2018. Note that these statistics do not encompass bladder cancer cases that may be coded under other ICD-10 codes outside of C67 (3,4).

An additional consideration, particularly for stakeholders, is that bladder cancer carries the highest cost of any cancer globally on a per-patient basis (5). Therefore, putting in place an exemplar pathway to improve bladder cancer services (including raising awareness, delivering faster referral and diagnosis for those with suspected bladder cancer, and encouraging implementation of a standardised pathway across the United Kingdom) would not only seek to improve patient outcomes but have a potentially significant impact on the cost of provision too.

 

Key Insights from The Exemplar Review Meeting include:

Dr Olena Mandrik, Research Fellow at ScHARR, University of Sheffield: An expert in healthcare decision science, Dr Mandrik focuses on evaluating public health programmes, especially cancer screening. She discussed significant findings from 2013-2019, emphasising the need for a national bladder cancer audit.

Diagnosis, treatment and survival from bladder, upper urinary tract, and urethral cancers: real-world findings from NHS England between 2013 and 2019

• Patient Experience Survey
• Exemplar Roundtable Report
• Exemplar policy & research report
• Policy priorities for action

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