Guidance on bladder cancer needs to be more specific still

Last year, the Getting it Right First Time programme published guidance on improving care for patients with bladder cancer^[1]. The move followed its 2018 national speciality report on urology, which highlighted wide variation in practice across the NHS and the need for improvement.

Bladder cancer is the fifth most common cancer in Europe^[2]. From 2013-17, 46 per cent of people in England diagnosed with the disease could expect to survive for 10 years or more^[3]. But survival rates vary dependent on the specific nature of the diagnosis.

Those with muscle-invasive bladder cancer – in which cancer cells have spread into or through the muscle layer of the bladder wall – are less likely to survive than those in which cancer cells are confined to the bladder’s inner lining.^[4]

At a recent roundtable run by Wilmington Healthcare, initiated and funded by Bristol Myers Squibb, panellists considered how care might be improved for this specific group of patients. The group agreed the current pathway is often inefficient, leading to the slow diagnosis of MIBC – a condition in which speed is particularly important, as delays to treatment are associated with worse outcomes.^[5]

The event focused on three distinct phases of the pathway: diagnostics (cystoscopy and imaging), triage, and multidisciplinary team discussions. It was emphasised that, too often, these elements are not working as well as they should.

With enormous demand for diagnostics, the focus can sometimes be on getting through as many patients as possible rather than on more sophisticated risk stratification that might improve care. This, in turn, means a lack of sophisticated triage and then means that MDT time is split more or less equally for every case. It may be more appropriate to use more time discussing the more complex cases – in other words, MIBC patients.

Panellists agreed it is important for MIBC clinical “champions” to be present within the pathway. These individuals, not least clinical nurse specialists, can support the swift identification of high-risk patients and ensure the MDT is used in the most effective way.

The challenge in many instances, panellists said, is that there is simply insufficient resource to allow trusts to adopt these approaches. This in turn means MIBC patients are not receiving the best possible care.

Solving resource issues is part of addressing much wider workforce planning challenges within the NHS. In the short term, however, panellists agreed that clinical guidance on bladder cancer should separate out MIBC and recognise the specific challenges here. It would be an excellent starting point in efforts to improve outcomes for this specific group of patients at risk of poor outcomes.

A white paper was produced from the roundtable event detailing its conclusions, which is available here. Clicking this link will take you to an external website hosted by Bristol Myers Squibb.

References

^[1] GIRFT (2022) Urology: Towards better care for patients with bladder cancer – A practical guide to improving bladder cancer management. Available here. Accessed 31 May 2023

^[2] European Commission. ECIS European Cancer Information Systems. Estimates of cancer incidence and mortality in 2020 for all cancer sites. Available here. (Accessed June 2023)

^[3] Cancer Research UK Bladder cancer statistics. Available here. Accessed 31 May 2023

^[4] American Society of Clinical Oncology (2023) Cancer.Net – Bladder Cancer: Statistics. Available here. Accessed 31 May 2023

^[5] NIHR Applied Research Collaborative South West Peninsula. Streamlining the bladder cancer pathway at RCHT. Available here. Accessed 31 May 2023