Delay and survival in bladder cancer

Abstract

Objective To assess in detail and evaluate the effect on survival of delays in the diagnosis and treatment of cancer (which might lead to a worse prognosis), dividing the delay from onset of symptoms to first treatment into several components, comprising patient delay, general practitioner (GP) delay, and two or more periods of hospital delay. Patients and methods Data were prospectively collected on 1537 new cases of urothelial cancer in the West Midlands from 1 January 1991 to 30 June 1992. Death information was obtained from the West Midlands Cancer Intelligence Unit and censored at 31 July 2000. The influence of delay times on survival was explored. Results The median delay from onset of symptoms to GP referral was 14 days (Delay 1), from GP referral to first hospital attendance was 28 days (Delay 2), and from first hospital attendance to first transurethral resection of bladder tumour was 20 days (Delay 3). The median hospital delay (Delay 2 + 3) was 68 days and the median total delay (Delay 1 + 2 + 3) was 110 days. Patients with a shorter Delay 1 had a lower tumour stage and a 5% better 5‐year survival. Patients with a shorter hospital delay had worse survival; total delay had no effect on survival. Conclusions There was significantly better survival for patients referred to hospital within 14 days of the onset of symptoms. The relationship between delay and survival in bladder cancer is complex. Hospital delays may be influenced more by comorbidity than by the characteristics of the tumour. However, the adverse effects of delay seem to be most pronounced for patients with pT1 tumours.

Clinical features of bladder cancer in primary care

“…There is some evidence to suggest that better survival is seen in those with shorter times to diagnosis. 4,5 This may be particularly relevant to the UK and other countries with a gatekeeper system, where access to specialist care requires referral from primary care clinicians. These countries have worse cancer outcomes.…”

The impact of the two-week wait rule on the diagnosis and management of bladder cancer in a single UK institution

“…6,7 It has been shown for bladder cancer that delays in treatment from the onset of symptoms have a complex relationship with survival. 8 Waiting times in the patient pathway comprise several components: time taken for patient to present to their GP, time from GP referral to first specialist consultation, time to first investigation and time to treatment. Following the implementation of the 2-week wait rule, the time from GP referral to hospital appointment should be minimised such that patients do not have to wait longer than 2 weeks to see a specialist.…”

Stratifying Patients with Haematuria into High or Low Risk Groups for Bladder Cancer: a Novel Clinical Scoring System

“…The 5-year survival mucosa. But any delay in the treatment was shown to have a detrimental effect on the survival of T1 bladder cancer (Wallace et al, 2002). Once there is muscle invasion, the al., 2005).…”

“…To date, there is no single test that can replace the list of investigations that a patient with haematuria has to go through. Neither is there a method that can safely exclude the presence of bladder cancer in a patient with haematuria, without the use of CE (Khadra et al, 2000;Messing, 2007;Lotan et al, 2009 (Wallace et al, 2002;Gore et al, 2009). Bearing in when detected and treated at an early stage, this usually compels us to perform the investigations as soon as possible (Grossman et al, 2005;Messing, 2007;Madeb and Messing, 2008).…”