Does a fast-track protocol for haematuria improve care in a tertiary centre?

Abstract

Introduction and Objectives: Bladder cancer treatment delay has been linked to a worsening in survival. Visible haematuria is often the first sign and its degree indicates a more advanced-stage disease. The present study analysed the impact of a haematuria fast-track referral protocol for several bladder cancer diagnosis and treatment timepoints. Patients and Methods: A retrospective observational single-centre study comprising a cohort of 165 patients with bladder cancer referred for haematuria via a fast-track (FTW) or routine way (RW) was conducted. Timepoints of haematuria evaluation workup and bladder cancer treatment were evaluated. Patient pathways were divided into time to first evaluation (P1), time to transurethral resection of bladder tumour (TURBT) (P2), time to diagnosis (P3), time from referral to diagnosis (P4), and time to definitive treatment (P5). Results: Visible haematuria was the major referral cause in both groups (82.1% in FTW and 81.5% in RW), whereas non-visible haematuria comprised 5% of referrals (6% in FTW and 3.7% in RW). P1, 3, and 4 median times were lower in RW (62 days in FTW and 43 days in RW, p = 0.007, 40 days in FTW and 24 days in RW, p < 0.001, and 129,5 days in FTW and 105 days in RW, p < 0.001, respectively). P2 and 5 median times were similar between the two groups. Conclusions: A fast-track referral for haematuria is not essential in every centre and routine referral can be effective in some centres like ours. Urgent referral due to non-visible haematuria was found unwarranted.