BJUI compass · 2026
State of the nation: Understanding the current NHS treatment pathway to identify opportunities to advance future care of patients with high-risk non-muscle invasive bladder cancer in the UK (SPAN-UK).
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Aning Jonathan, Catto James W F, Martin Rebecca, Chatterton Kathryn, Mariappan Paramananthan, Ottley Edward, Hickey Joseph, McCormack Stephen, Gill Simran, Szabados Bernadett
Аннотация
OBJECTIVES: This study aimed to understand clinical pathways for patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) from diagnosis to follow-up and to identify opportunities to improve care.
MATERIALS AND METHODS: A cross-sectional survey was conducted via structured online interviews with consented NHS healthcare professionals (HCPs) from the United Kingdom (UK) between June and September 2025. Topics surveyed included MDT structures/roles, diagnostic timelines, adjuvant treatment, radical cystectomy (RC) decision making, current bladder-sparing treatment and clinical trial access. Quantitative data were analysed descriptively. Qualitative responses were analysed thematically.
RESULTS: Seventy HCPs were included and reported that typically; 88.5% of patients achieve diagnosis within 6-8 weeks of referral, and 11.4% reported delays beyond 8 weeks. BCG maintenance duration and completion rates varied. Following BCG induction, a median (IQR) of 20.0% (5.0-32.5%) and 60.0% (40.0-70.0%) of patients completed ≥2 or ≤1 years of maintenance, respectively; 1.0% (1.0-2.0%) failed to complete induction. For BCG-unresponsive HR-NMIBC, HCPs reported that a mean (SD) proportion of 53.4 (18.1)% of patients tend to be eligible for and consent to RC, 22.0 (12.6)% tend to be eligible but decline RC and 24.6 (14.9)% tend to be ineligible. Bladder-sparing options remain limited, with 60% of HCPs regarding further BCG as the most appropriate option. All respondents agreed that adherence to quality performance indicators (QPIs) and a national bladder cancer audit would be beneficial. Insufficient specialist nurse capacity to meet foreseeable demands of HR-NMIBC patient care was reported by 70% (n = 49) of HCPs.
CONCLUSION: Results reveal variability in real-world HR-NMIBC care within the NHS. Delays in diagnosis, inconsistent BCG maintenance duration, lack of evidence-based alternatives to BCG and a lack of bladder-sparing treatment and trial options in the BCG-unresponsive setting were identified. Findings highlight unmet needs in relation to MDT resourcing, diagnostic efficiency, trial access, QPI adherence and a national bladder cancer audit.
MATERIALS AND METHODS: A cross-sectional survey was conducted via structured online interviews with consented NHS healthcare professionals (HCPs) from the United Kingdom (UK) between June and September 2025. Topics surveyed included MDT structures/roles, diagnostic timelines, adjuvant treatment, radical cystectomy (RC) decision making, current bladder-sparing treatment and clinical trial access. Quantitative data were analysed descriptively. Qualitative responses were analysed thematically.
RESULTS: Seventy HCPs were included and reported that typically; 88.5% of patients achieve diagnosis within 6-8 weeks of referral, and 11.4% reported delays beyond 8 weeks. BCG maintenance duration and completion rates varied. Following BCG induction, a median (IQR) of 20.0% (5.0-32.5%) and 60.0% (40.0-70.0%) of patients completed ≥2 or ≤1 years of maintenance, respectively; 1.0% (1.0-2.0%) failed to complete induction. For BCG-unresponsive HR-NMIBC, HCPs reported that a mean (SD) proportion of 53.4 (18.1)% of patients tend to be eligible for and consent to RC, 22.0 (12.6)% tend to be eligible but decline RC and 24.6 (14.9)% tend to be ineligible. Bladder-sparing options remain limited, with 60% of HCPs regarding further BCG as the most appropriate option. All respondents agreed that adherence to quality performance indicators (QPIs) and a national bladder cancer audit would be beneficial. Insufficient specialist nurse capacity to meet foreseeable demands of HR-NMIBC patient care was reported by 70% (n = 49) of HCPs.
CONCLUSION: Results reveal variability in real-world HR-NMIBC care within the NHS. Delays in diagnosis, inconsistent BCG maintenance duration, lack of evidence-based alternatives to BCG and a lack of bladder-sparing treatment and trial options in the BCG-unresponsive setting were identified. Findings highlight unmet needs in relation to MDT resourcing, diagnostic efficiency, trial access, QPI adherence and a national bladder cancer audit.