Surveillance for bladder cancer: the management of 4.8 million people

Abstract

Objective To document the workload of bladder cancer surveillance on the British urologist. Methods Thirty-one consultant urologists serving a population of 4.8 million were sent postal questionnaires eliciting their views on the management of super®cial bladder cancer. The number, type and outcome of cystoscopies performed over a 6-week period throughout the region was then assessed prospectively. Results One person in 1450 in the South-west region is undergoing follow-up for bladder cancer. Of the responding consultants, 36% would give a single dose of intravesical chemotherapy within 24 h of resection for a G1/2 pTa tumour and 84% would perform the ®rst check cystoscopy at 3±4 months. Over the 6-week period of the study, 696 cystoscopies were performed; there was considerable variation among centres in the choice of cystoscopy type, with 3±80% being rigid cystoscopies. Overall, there was a positive ®nding in 31% of the assessments. Conclusion This study documents the practice of a signi®cant number of UK urologists in the management of super®cial bladder cancer. There are considerable variations among individuals in the type and timing of check cystoscopy. Keywords Carcinoma of the bladder, cystoscopy, health economics, epidemiology, practice IntroductionVarious strategies for the surveillance of super®cial bladder cancer have been suggested, but despite this, the actual practice of follow-up for super®cial bladder cancer in the UK is poorly documented. The timing and type of check cystoscopy has economic implications for healthcare providers and possibly for the risk of detecting progression of super®cial disease. The South-west region of the UK has a population of about 4.8 million [1]. Of these, 18% are over pensionable age (<65 years) compared with 8% in 1990. The population is served by 31 consultant urologists (CUs) with, on average, 156 000 persons per CU. The practice of this group in managing the follow-up of bladder cancer was assessed. MethodsPostal questionnaires were sent to each CU in the South-west Region of the UK; the questionnaire was divided into two parts. The ®rst enquired about the number of check cystoscopies on the`®rm' book and the CU's views on the management of the follow-up of super®cial bladder cancer. The second part collected data on the number, type and outcome of check cystoscopies carried out for the 6-week period 1 January 1998 to 13 February 1998. ResultsAll the CUs responded; there were 3303 patients on the waiting lists for check cystoscopy throughout the region, with a mean (range) of 70 (20±97)% of patients being listed for¯exible cystoscopy. In answer to the questioǹ Do you ever discharge patients from a check cystoscopy follow-up?', 88% of CUs answered`yes' with a`5-year tumour-free period' and`elderly patients' as the most commonly stated reason for discharge.In response to questions about the management of G1/2 pTa tumours, 36% of CUs would give a single dose of intravesical chemotherapy within 24 h of resection and 84% would perform the ®rst check cystoscopy at 3±4...

Bladder cancer biomarkers and their role in surveillance and screening

“…Furthermore, the risk of developing a urinary tract infection is around 10% 3,4 . It has been estimated that one in every 1450 people in the western world are under surveillance for bladder cancer by cystoscopy and cytology 5 . This and the long life expectancy of these patients make bladder cancer the most costly cancer on a per patient basis 6 .…”

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“…The European Association of Urology recommended two cystoscopies in the first year after diagnosis and then annual CU for up to 5 years in low-risk patients, but there is considerable variation in practice [4]. The effectiveness of CUS on survival was reported previously [5][6][7][8].…”

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