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Published on: January 10, 2013
Diagnostic pathway efficacy for urinary tract cancer: population-based outcome of standardized evaluation for
Mef Nilbert1,2, Mats Bläckberg3, Jeanette Ceberg2
1a Division of Oncology and Pathology , Institution of Clinical Sciences, Lund University , Lund , Sweden.
Insights
A Swedish healthcare initiative reduced diagnostic delays for urinary tract cancer, but did not shorten treatment times. This highlights the need to optimize the entire patient journey for better outcomes.
Area of Science:
- Urology
- Oncology
- Healthcare Management
Background:
- Macroscopic haematuria is a key symptom prompting investigation for urinary tract cancer.
- Timely diagnosis and treatment are crucial for improving patient outcomes in urothelial carcinoma.
- Sweden implemented a national healthcare intervention in 2015 to streamline the diagnostic and treatment pathway for urinary tract cancer.
Purpose of the Study:
- To assess the effectiveness of a standardized care pathway for urinary tract cancer.
- To evaluate the impact of the intervention on reducing the time from macroscopic haematuria to diagnosis and treatment.
- To determine the cancer yield and influencing factors within the standardized pathway.
Main Methods:
- A comparative study evaluating 1697 individuals on a standardized care pathway versus 174 patients with conventional diagnosis over 11 months.
- Analysis of diagnostic delay, cancer detection rates, and time to treatment.
- Inclusion of factors such as patient demographics, bacteriuria, and anticoagulant medication.
Main Results:
- The standardized pathway diagnosed cancer in 19% of referred individuals, with bladder cancer being the most common (83%).
- Cancer detection rates were higher in men (23%) and older individuals (44% in ≥90 years).
- The pathway significantly shortened diagnostic delay (25 vs. 35 days, p=0.01) but did not alter the median time to treatment.
Conclusions:
- Macroscopic haematuria has a 19% cancer detection rate, with higher predictive value in men and the elderly.
- Anticoagulant therapy did not impact diagnostic yield.
- Healthcare reforms must consider the entire patient process, not just initial diagnosis, to improve outcomes.
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.
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