Standardized care pathway reshaped the diagnostic and therapeutic landscape of urinary bladder cancer. A 15-year...

This work aimed to evaluate the long-term impact of standardized care pathway (SCP) implementation for urinary bladder cancer (UBC) on tumour characteristics, diagnostic and treatment intervals and guideline adherence.

A retrospective cohort study was conducted including all patients with newly diagnosed UBC at the NU Hospital Group, Sweden, between 2010 and 2024. Patients were grouped into pre-SCP (2010-2015) and during-SCP (2016-2024) cohorts. Patient demographics, tumour characteristics, adherence to guideline-recommended care and diagnostic and treatment time intervals were analysed. Overall survival was assessed using Kaplan-Meier analysis and Cox proportional hazards regression.

Following SCP implementation, emergency presentations declined significantly (15% pre-SCP to 10% SCP, p = 0.003). Tumour characteristics shifted towards earlier-stage disease, with increased detection of small tumours ≤30 mm (56% to 71%, p < 0.001), fewer muscle-invasive cases (27% to 21%, p = 0.003) and a higher proportion of TaG1-2 tumours (42% to 52%, p = 0.003). Adherence to guidelines improved markedly, reflected in cT1 disease by increased second-look resections (36% to 69%, p < 0.001) and multidisciplinary team conference discussions (2% to 88%, p < 0.001). Diagnostic efficiency improved, with median referral-to-TURBT time reduced from 29 to 14 days (p < 0.001). In multivariable analysis, age, emergency admission, higher tumour stage and size and TURBT delay >18 days were independently associated with worse overall survival. Kaplan-Meier analysis revealed a temporal shift: Early rapid TURBT was associated with poorer survival in 2010-2015 but conferred a survival benefit in 2016-2024 (log-rank χ ² = 13.66, p = 0.003).

SCP implementation was associated with earlier detection, improved guideline adherence and sustained reductions in diagnostic delays. However, increasing delays to definitive treatment for muscle-invasive disease highlight emerging system-level constraints, underscoring the need to optimize downstream capacity to fully realize the benefits of early diagnosis.