Patient Flow and Multidisciplinary Coordination in Urothelial Carcinoma: Insights from Bulgarian Oncologists

Objectives: Timely diagnosis, efficient patient journey, and well-coordinated multidisciplinary care are essential foundations for optimizing treatment outcomes in urothelial carcinoma. This study aims to identify key organizational characteristics and development areas within the patient journey of urothelial carcinoma (UC) in Bulgaria, with a particular focus on the role of multidisciplinary teams (MDTs), referral patterns, and the timeliness of therapeutic decision-making. Methods: This study employed a structured survey and in-depth interviews with 30 leading Bulgarian oncologists across different medical facilities specialized in the treatment of urothelial carcinoma. The survey was developed according to international best practices and included seven key domains: patient flow, quality of life, health outcomes, patient perception of satisfaction, symptom impact, unmet needs, and trends and changes in therapy. Quantitative survey data were analyzed using descriptive statistics and cross-tabulations, while qualitative interview data were analyzed using thematic analysis to identify key patterns and challenges. Results: Most patients entered the care pathway at early disease stages. Referrals were primarily initiated by urologists (71%), while multidisciplinary team involvement was reported in all participating centers, although organizational practices varied. Treatment was initiated within 1-2 weeks following diagnosis in 69% of cases, and follow-up was predominantly conducted through scheduled clinical visits (81%). Respondents identified coordination between healthcare facilities, reduction in waiting times, and improved access to diagnostic tools as the most important areas of progress and ongoing development within urothelial carcinoma care. Conclusions: The findings highlight several areas within the urothelial carcinoma patient journey where coordination can be further strengthened, particularly in relation to MDT engagement, meeting regularity, referral pathways, and follow-up practices. Strengthening multidisciplinary collaboration and implementing integrated care pathways may support further improvements in coordination and consistency of care.