Outcomes of haematuria referrals: two-year data from a single large university hospital in Denmark

Elmussareh, Muhammad; Young, Matthew; Sundelin, Maria Ordell; Bak-Ipsen, Camilla Brinkmann; Graumann, Ole; Jensen, Jørgen Bjerggaard

doi:10.1080/21681805.2017.1310759

Cited by 16 publications

(26 citation statements)

References 20 publications

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“…This report describes the first evaluation of the standardized care pathway for urothelial cancer, which reflects the first 11 months after initiation of the system. The inclusion criteria resulted in a cancer capture rate of 19%, which is comparable to a rate of 23% achieved in a recent study conducted in Denmark for patients with macroscopic haematuria [11]. Of the malignancies, 83% were urothelial cancers, but several other urological and gynaecological cancers were also diagnosed through this route (Table 1).…”

Section: Discussionsupporting

confidence: 58%

“…International guidelines for the evaluation of patients with suspected urinary tract cancer are based on microscopic haematuria, which differs from the Swedish guidelines that require macroscopic haematuria for the initiation of cancer care pathways [17,18]. A study in Denmark found that cancer was diagnosed in only in 3% of 564 patients with microscopic haematuria and in 1.5% of patients without lower urinary tract symptoms or loin pain, and all diagnoses were made in patients aged >60 years [11]. Hence, selective referral is recommended in the UK and Denmark for patients aged >60 years with microscopic haematuria [19,20].…”

Section: Discussionmentioning

confidence: 99%

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

Nilbert

Bläckberg

Ceberg

et al. 2018

Scandinavian Journal of Urology

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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 ¼ .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. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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

Nilbert

Bläckberg

Ceberg

et al. 2018

Scandinavian Journal of Urology

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“…Based on two publications [15,16], Danish national guidelines were changed to effective from January 2016. Thereafter, asymptomatic patients with MiH were no longer to be investigated, irrespective of age, as the overall risk of malignancy was shown to be very low and did not exceed the expected incidence found by opportunistic screening in an age-matched cohort.…”

Section: Denmarkmentioning

confidence: 99%

Progress towards a Nordic standard for the investigation of hematuria: 2019

Malmström

Haug

Boström

et al. 2019

Scandinavian Journal of Urology

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Objective: To describe the management of patients with hematuria in the Nordic countries in relation to bladder cancer epidemiology, especially in the context of introducing fast track pathways with the aim of proposing a common guideline. Materials and methods: Epidemiological data on bladder cancer from each country, and the combined cancer registry, Nordcan, were analyzed. The evolution of the different national recommendations and the introduction of fast track pathways were assessed. Patients' demographics, type of hematuria and cancer detection rates were analysed if available. Results: The crude incidence of bladder cancer has increased substantially since the 1960s, while the age standardized incidence has been stable during recent decades. The relative survival has increased in all countries, while the mortality has been stable. For those with microscopic hematuria there has been a clear trend towards less rigorous investigations. In the fast track pathways, introduced in three of five countries, about one in five patients with macroscopic hematuria had a cancer diagnosis. Data show that time to diagnosis has been reduced. Conclusions: The number of patients with bladder cancer is increasing in the Nordic region. The introduction of fast track pathways has been important in improving the management of patients with suspicion of the disease. Our recommendation is to focus on macroscopic hematuria in the fast track pathways. Microhematuria without any symptoms should not be an indication for cystoscopy. However, urinary tract symptoms accompanied by microhematuria can still be investigated according to respective guidelines but not necessarily within fast track pathways.

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“…In recent years, it has become clear that the evidence for this is weak 2,3 . The most recent study 4 found that the malignancy rate for patients referred with asymptomatic microscopic hematuria was 1,5 %, and the cancers were all detected in patients aged > 60 recommend examination of asymptomatic microscopic hematuria, some even recommend 36-month follow-up for patients with negative evaluation. Especially the latter is controversially.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, it has become clear that the evidence for such an approach is weak [2][3][4] . Still many national guidelines 5,6 recommend urological examination for patients with asymptomatic hematuria, some even suggest a 36-month follow-up if an initial urological examination is negative 5 .…”

Section: Introductionmentioning

confidence: 99%