scholarly journals Impact of the 2015 NICE guidance for urgent assessment of patients with non-visible haematuria

2019 ◽  
Vol 13 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Joseph B John ◽  
Saliya Wijeyaratne ◽  
Mark Speakman
Keyword(s):  
Transitional Cell ◽  
High Rate ◽  
Muscle Invasive Bladder Cancer ◽  
Level Of Evidence ◽  
Referral Criteria ◽  
Nice Guidance ◽  
Diagnosis Rate ◽  
Muscle Invasive ◽  
The Impact ◽  
Low Rate

Objectives: To assess the impact of the 2015 National Institute of Health and Care Excellence (NICE) guidance for referral of non-visible haematuria (NVH) and to compare diagnostic findings in patients referred using 2005 and 2015 guidance. Patients and method: Review of the referral details and diagnostic findings for urgent NVH referrals was assessed over a 27-month period. Referrals continued to be received under 2005 and 2015 NICE guidance during this period, and the diagnostic findings from each pathway were compared. Results: The number of urgent haematuria referrals reduced by 34% over the 27-month period. NVH referrals fell from 144 in the first quarter to 30 in the last quarter. The transitional cell carcinoma (TCC) diagnosis rate was low in patients referred using 2005 and 2015 criteria (1.7 and 1.9% respectively). No muscle-invasive bladder cancer (MIBC) was diagnosed. There was a high rate of benign urological findings. Non-adherence to referral criteria was high in the 2015 pathway (56%). Conclusion: The reduction in NVH referrals following introduction of 2015 NICE guidance could allow resource re-allocation. Low adherence to referral criteria should be investigated. The absence of MIBC and low rate of TCC diagnosis is reassuring and consideration should be given to investigating NVH patients semi-urgently. Level of evidence: 2C

scholarly journals Moving towards Personalized Medicine in Muscle-Invasive Bladder Cancer: Where Are We Now and Where Are We Going?

2020 ◽  
Vol 21 (17) ◽  
pp. 6271 ◽  
Author(s):  
Juan Carlos Pardo ◽  
Vicenç Ruiz de Porras ◽  
Andrea Plaja ◽  
Cristina Carrato ◽  
Olatz Etxaniz ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Predictive Biomarkers ◽  
Conclusive Evidence ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Level Of Evidence ◽  
Recommended Treatment ◽  
Appropriate Treatment ◽  
Muscle Invasive ◽  
The Impact

Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy is the recommended treatment, with the highest level of evidence, for patients with muscle-invasive bladder cancer (MIBC). However, only a minority of patients receive this treatment, mainly due to patient comorbidities, the relatively small survival benefit, and the lack of predictive biomarkers to select those patients most likely to benefit from this multimodal approach. In addition, adjuvant chemotherapy has been recommended for patients with high-risk MIBC, although randomized trials have not provided conclusive evidence on the impact of this approach. At present, however, this situation is changing, largely due to our improved knowledge of the molecular biology of bladder cancer, which has enabled us to identify new prognostic and predictive biomarkers that can be used to select the most appropriate treatment for each patient. Moreover, new active treatments, especially immunotherapy, have shown promising results in the neoadjuvant setting. In addition, the gene expression profile of bladder tumors can be used to classify them into different subtypes, which correlate with specific clinical-pathological characteristics and with treatment response or resistance. Therefore, the main objective for the near future is to introduce these translational breakthroughs into routine clinical practice in order to personalize treatment for each patient.

scholarly journals The Impact of Non-Compliance to a Standardized Risk-Adjusted Protocol on Recurrence, Progression, and Mortality in Non-Muscle Invasive Bladder Cancer

2021 ◽  
Vol Volume 13 ◽  
pp. 2937-2945
Author(s):  
Faris Abushamma ◽  
Zain Khayyat ◽  
Aya Soroghle ◽  
Sa’ed H Zyoud ◽  
Ahmad Jaradat ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive ◽  
The Impact

Setting standards for cystectomy using the British Association of Urological Surgeons Complex Operations Reports, 2016–2018

2021 ◽  
pp. 205141582110334
Author(s):  
Joseph B John ◽  
John Pascoe ◽  
Sarah Fowler ◽  
Edward Rowe ◽  
Alexandra Colquhoun ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Surgical Margin ◽  
Public Understanding ◽  
British Association ◽  
Invasive Bladder Cancer ◽  
Positive Surgical Margin ◽  
Muscle Invasive Bladder Cancer ◽  
Level Of Evidence ◽  
T Stage ◽  
Muscle Invasive

Objective: To produce comprehensive standards for cystectomy using contemporary data collected across a nation. Patients and methods: Surgical departments upload cystectomy data to the British Association of Urological Surgeons (BAUS) Complex Operations Database. Analysis of 2016–2018 data was performed for all recorded 5288 patients undergoing cystectomy in England. Logistic regression with general linear models was used to assess differences in patient selection between operative modalities. Analysis involved assessment of case selection, operative decisions and outcomes, case volume and pathological outcomes. Results: Using national Hospital Episode Statistics, the BAUS cystectomy dataset was estimated 93% complete. Median age was 70 years (interquartile range 63–75) and 75% were male. Charlson comorbidity index ⩽2 was reported in 87%. Primary treatment of muscle-invasive bladder cancer accounted for 46% of cases. Commonest preoperative disease stages were T2N0 and T1N0 (35% and 25% respectively). Robotic-assisted (RAC), laparoscopic (LC) and open cystectomy (OC) were performed in 41%, 5.5% and 54% of cases respectively. T-stage distribution differed by operative modality. Transfusion rates were 3.7% for RAC, 6.0% for LC and 18% for OC. Increasing positive surgical margin rates were observed with increasing T-stage, up to T3. The conversion-to-open rate for minimally-invasive surgery was 1.7%. Median annual centre and surgeon case volumes were highest for RAC. Median length of stay was 7, 10 and 10 days for RAC, LC and OC respectively. Postoperative histological upstaging was common (33% of cT1, 50% of cT2 cases). Lymph node positive rates were 28% for muscle-invasive bladder cancer. Conclusion: Analysis of this data provides understanding of ‘real-world’ cystectomy practice. Presentation of data specific to operative modality allows surgeons and centres to benchmark their respective practices. These findings offer to enhance patient and public understanding beyond that currently facilitated by publicly-facing information sources. They carry relevance by describing a near-complete and large volume of modern practice in a publicly funded healthcare system. Level of evidence: 2b

The impact of squamous histology on survival in patients with muscle-invasive bladder cancer

2019 ◽  
Vol 37 (6) ◽  
pp. 353.e17-353.e24 ◽  
Author(s):  
Justin T. Matulay ◽  
Solomon L. Woldu ◽  
Amy Lim ◽  
Vikram M. Narayan ◽  
Gen Li ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive ◽  
The Impact

scholarly journals The British Association of Urological Surgeons radical cystectomy audit 2014/2015: An update on current practice, and an analysis of the effect of centre and surgeon case volume

2018 ◽  
Vol 12 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Sinan Khadhouri ◽  
Catherine Miller ◽  
Joanne Cresswell ◽  
Edward Rowe ◽  
Sarah Fowler ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Transitional Cell ◽  
High Volume ◽  
Median Number ◽  
British Association ◽  
Case Volume ◽  
Level Of Evidence ◽  
Laparoscopic Cystectomy ◽  
Open Radical Cystectomy ◽  
Muscle Invasive

Objective: The Consultant Outcomes Publication has made it mandatory to submit surgeon-level data on radical cystectomy (RC) practice in England. The current analysis describes contemporary surgical practice and compares this by surgeon and centre case volume. Materials and methods: Between 1 January 2014 and 31 December 2015, data on 3742 RCs performed by 161 surgeons over 84 centres were recorded on the British Association of Urological Surgeons audit and data platform. Centre case volumes were grouped as high (> 60), medium (30–60) and low (< 30), while surgeon case volumes were grouped as high (> 30), medium (8–30) and low (< 8). All data averages were for the combined 2-year period. Results: The median number of RCs performed was 16/surgeon and 31/centre; 45.4% of cases were performed for muscle-invasive transitional cell carcinoma (TCC). The commonest performed urinary diversion was ileal conduit (85.2%), followed by orthotopic bladder substitution (5.7%). Open radical cystectomy (ORC) was performed in 67.8%, robotically-assisted cystectomy (RARC) in 20.6% and laparoscopic cystectomy (LRC) in 9.1% of cases. RARC was more likely to be performed by high-volume surgeons and centres. The majority of patients underwent a lymph node dissection (LND), with rates varying from 79.5% to 90.3%. Reported rates of high-grade complication were generally low across all groups, suggesting under-reporting. There was a trend towards higher reported transfusion rates as centre volumes decreased. The median length of stay (LOS) was 7–9 days for minimally invasive approaches compared to open surgery, which was 11–12 days. Mortality rates were low across all groups. Conclusions: Compliance with the data registry is high. ORC remains the most common approach. High-case volume surgeons and centres more commonly offer RARC. The majority of patients undergo LND. There is a trend towards higher reported rates of transfusion as centre volume decreases. LOS is shorter in RARC and LRC in comparison to ORC, but is otherwise similar across centres and surgeons. Level of evidence: 2b

Removing hospital-based triage from suspected colorectal cancer pathways: the impact and learning from a primary care-led electronic straight-to-test pathway

2020 ◽  
pp. bmjqs-2019-009975
Author(s):  
Philippa Orchard ◽  
Nitin Arvind ◽  
Alison Wint ◽  
James Kynaston ◽  
Ann Lyons ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Dramatic Improvement ◽  
Hospital System ◽  
Cancer Data ◽  
Cancer Pathways ◽  
Referral Criteria ◽  
Nice Guidance ◽  
Referral Form ◽  
The Impact

BackgroundThe 2-week wait referral pathway for suspected colorectal cancer was introduced in England to improve time from referral from a general practitioner (GP) to diagnosis and treatment. Patients are required to be seen by a hospital clinician within 2 weeks if their symptoms meet the criteria set by the National Institute for Health and Care Excellence (NICE) and to start cancer treatment within 62 days. To achieve this, many hospitals have introduced a straight-to-test (STT) strategy requiring hospital-based triage of referrals. We describe the impact and learning from a new pathway which has removed triage and moved the process of requesting tests from hospital to GPs in primary care.MethodAn electronic STT pathway was introduced allowing GPs to book tests supported by a decision aid based on NICE guidance eliminating the need for a standard referral form or triage process. The hospital identified referrals as being on a cancer pathway and dealt with all ongoing management. Routinely collected cancer data were used to identify time to cancer diagnosis compared with national dataResults11357 patients were referred via the new pathway over 3 years. Time from referral to diagnosis reduced from 39 to 21 days and led to a dramatic improvement in patients starting treatment within 62 days. Challenges included adapting to a change in referral criteria and developing a robust hospital system to monitor the pathway.ConclusionWe have changed the way patients with suspected colorectal cancer are managed within the National Health Service by giving GPs the ability to order tests electronically within a monitored cancer pathway halving time from referral to diagnosis

The relationship between ABO blood group type and tumor grade, stage, recurrence and progression in transitional cell carcinoma of the bladder: A preliminary report

2019 ◽  
Vol 13 (3) ◽  
pp. 205-209
Author(s):  
Deviprasad Tiwari ◽  
Harshit Garg ◽  
Brusabhanu Nayak ◽  
Prabhjot Singh ◽  
Amlesh Seth
Keyword(s):  
Bladder Cancer ◽  
Blood Group ◽  
Bladder Carcinoma ◽  
Statistical Significance ◽  
Transitional Cell ◽  
Abo Blood Group ◽  
Level Of Evidence ◽  
Muscle Invasive ◽  
Blood Grouping

Objectives: ABO blood grouping is a well-proven prognostic factor in many malignancies. This study aims to study the association and impact of ABO blood group on disease recurrence and progression in bladder carcinoma. Material and methods: Patients with bladder carcinoma undergoing transurethral resection of bladder tumor (TURBT) were studied prospectively for at least 1-year follow-up for recurrence and progression of the disease. Demographic profile along with blood group was noted. Results: Two hundred patients were included in the study and 194 patients were included in the final analysis. Muscle-invasive bladder cancer was present in 39 (20.1%) patients and the high-grade tumor was present in 88 (45.3%) patients. There was no statistical significance between the association of blood grouping and grade ( p=0.29) and stage of the disease ( p=0.20). During the follow-up period, there were 100 (64.5%) recurrences and 15 (9.7%) patients with non-muscle-invasive bladder carcinoma had progression. The association of blood group with recurrence ( p=0.66) and progression ( p=0.11) of disease was not statistically significant. Conclusion: There is no association between bladder cancer and ABO blood group in terms of grade and stage of the disease. The recurrence and progression of the disease did not differ significantly in different blood groups. Level of Evidence: 2b

Is radical radiotherapy effective for elderly patients with muscle invasive bladder cancer?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 506-506 ◽  
Author(s):  
James Price ◽  
Mayuran Sivanandan ◽  
Rania Elmusharaf ◽  
Prabir R Chakraborti ◽  
Mike Smith-Howell ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Elderly Patients ◽  
Systemic Therapy ◽  
Transitional Cell ◽  
Concurrent Chemotherapy ◽  
Invasive Bladder Cancer ◽  
Radical Radiotherapy ◽  
Muscle Invasive Bladder Cancer ◽  
Female Ratio ◽  
Muscle Invasive

506 Background: Radical radiotherapy (RT) is a curative option for muscle-invasive bladder cancer (MIBC), and offers the chance of bladder preservation. RT and radical cystectomy have not been compared in an RCT, but landmark trials of RT +/- concurrent systemic therapy have demonstrated outcomes comparable to surgery. In clinical practice, patients are often older and less fit compared to trials, and consequently may not be fit for concurrent chemotherapy which may impact treatment outcomes. Methods: A retrospective review of all patients aged 70 years or older treated with radical RT for MIBC from January 2010 – October 2016. Minimum 12 months follow-up. iSOFT manager for used for clinical data and MOSAIQ for radiotherapy parameters. Statistical analysis performed using Stata version 11.2. Results: 71 patients were identified. Male: female ratio 3:1 and median age 79 (range 71 – 93). Median performance status (PS) 1. 81.7% of patients had pT2 disease or greater, 77.5% of patients underwent TURBT prior to RT and 97.2% had transitional cell-carcinoma histology. 38 patients were treated to 60-64Gy/30-32 fractions and 33 patients to 52.5-55Gy/20 fractions. 6 patients (8.5%) received neoadjuvant chemotherapy and 15 (21.1%) received concurrent chemotherapy. Of the 53 patients who did not receive chemotherapy, all were deemed not suitable. 23 of 71 patients (32.4%) developed a loco-regional relapse, either in the bladder (n = 18), pelvic lymph nodes (n = 4), or on cytology alone (n = 1). 24 patients (33.8%) developed distant metastases, only 7 of these were fit for palliative chemotherapy. The median progression-free survival (PFS) was 17 months (95% C.I. 10 – 34 months). Neoadjuvant and concurrent chemotherapy use was not associated with an increased PFS (p = 0.99 and p = 0.97, log rank). The median overall survival was 18 months (95% C.I. 14 – 27 months). Conclusions: Our data demonstrate RT produces favourable outcomes for elderly patients and reasonably well tolerated without significant toxicities. Use of concurrent systemic therapy did not significantly improve outcomes, but numbers were small.

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