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Diagnostic pathway efficacy for urinary tract cancer : population-based outcome of standardized evaluation for macroscopic haematuria

Nilbert, Mef LU ; Bläckberg, Mats LU ; Ceberg, Jeanette; Hagberg, Oskar LU ; Stenhoff, Rebecca and Liedberg, Fredrik LU (2018) In Scandinavian Journal of Urology 52(4). p.237-243
Abstract

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:... (More)

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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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bladder cancer, haematuria, lead time, standardized care pathways, treatment
in
Scandinavian Journal of Urology
volume
52
issue
4
pages
237 - 243
publisher
Taylor & Francis
external identifiers
  • scopus:85057339560
ISSN
2168-1805
DOI
10.1080/21681805.2018.1498124
language
English
LU publication?
yes
id
deb613f1-ff77-41d2-b25d-5030708fc226
date added to LUP
2018-12-06 09:23:30
date last changed
2019-01-14 14:51:39
@article{deb613f1-ff77-41d2-b25d-5030708fc226,
  abstract     = {<p>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 &lt;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.</p>},
  author       = {Nilbert, Mef and Bläckberg, Mats and Ceberg, Jeanette and Hagberg, Oskar and Stenhoff, Rebecca and Liedberg, Fredrik},
  issn         = {2168-1805},
  keyword      = {Bladder cancer,haematuria,lead time,standardized care pathways,treatment},
  language     = {eng},
  month        = {11},
  number       = {4},
  pages        = {237--243},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Urology},
  title        = {Diagnostic pathway efficacy for urinary tract cancer : population-based outcome of standardized evaluation for macroscopic haematuria},
  url          = {http://dx.doi.org/10.1080/21681805.2018.1498124},
  volume       = {52},
  year         = {2018},
}