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Ragonese M, Fettucciari D, Carbone L, Gavi F, Montesi M, Scarciglia E, Russo P, Sanesi DM, Marino F, Foschi N, Pinto F, Franceschi F, Racioppi M, Sacco E, Covino M. Predictive Factors for Major Complications and Urological Cancer Diagnosis in Older Adults (≥80 Years) Admitted to the Emergency Department for Hematuria. J Clin Med 2024; 13:2874. [PMID: 38792416 PMCID: PMC11122226 DOI: 10.3390/jcm13102874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Gross Hematuria is a relevant cause of admission to the emergency department in the general population and particularly in older adults (≥80 years). This specific urological symptom is often underestimated and usually associated with benign conditions such as urinary infections or poor hydration. Nevertheless, hematuria could lead to severe acute complications or be the first symptom of urological cancers. Methods: We retrospectively analyzed clinical data from 1169 patients aged ≥80 years consecutively admitted to the emergency department for hematuria. The primary endpoint of the study was to identify risk factors for major complications, and the secondary endpoint was to analyze risk factors for urological cancer diagnosis. The median age was 85 years (IQR 82-88 years), and 908 (77%) were males. Among them, 449 (38.4%) had a past medical history of urological neoplasm (kidney, ureter, bladder, prostate, or urethral cancer). Results: Overall, 87 patients (7.4%) had major complications (patient death, septic shock, and admission to the intensive care unit). Worse vital signs at admission, fever, and confusion (p < 0.001, OR 18.0 IC 95% [5.5-58.7]; p = 0.015, OR 2.0 IC 95% [1.1-3.5]; p = <0.001, OR 4.2 IC 95% [1.9-3.5], respectively), as well as lower hemoglobin values and higher Charlson comorbidity index (p < 0.001, OR 0.8 IC 95% [0.7-0.9]), p = 0.002, OR = 1.2 [1.1-1.3]) were independent predictive factors for major complications. The multivariate analysis identified as risk factors for diagnosis of urological cancer older age, male sex and higher comorbidity (OR 1.05 IC95% [1-1.09]; OR 2.19 IC95% [1.42-3.39] and OR 1.11 IC95% [1.2-1.2], respectively); interestingly the presence of indwelling vesical catheter (IVC) (OR 0.44 IC95% [0.24-0.82]) resulted as an independent factor for absence of urological cancers. Conclusions: Hematuria is a frequent symptom in older adults admitted to the emergency department. While this is often associated with benign conditions, there are some risk factors for major complications and for urological cancer that must be taken into account to identify the patients who need further evaluation or prompt hospital admission.
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Affiliation(s)
- Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
| | - Daniele Fettucciari
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Luigi Carbone
- Department of Emergency Medicine, Ospedale Fatebenefratelli Isola Tiberina, Gemelli Isola, 00186 Rome, Italy
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Marco Montesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Eros Scarciglia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Domenico Maria Sanesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
| | - Francesco Pinto
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
| | - Francesco Franceschi
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
| | - Emilio Sacco
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
- Department of Urology, Ospedale Fatebenefratelli Isola Tiberina, Gemelli Isola, 00186 Rome, Italy
| | - Marcello Covino
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
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2
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Culpan M, Keser F, Acar HC, Otunctemur A, Kucuk EV, Erdem S, Ozer M, Sen UT, Degirmenci E, Ergul R, Atis RG, Yildirim A. Impact of delay in cystoscopic surveillance on recurrence and progression rates in patients with non-muscle-invasive bladder cancer during the COVID-19 pandemic. Int J Clin Pract 2021; 75:e14490. [PMID: 34117682 PMCID: PMC8420249 DOI: 10.1111/ijcp.14490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.
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Affiliation(s)
- Meftun Culpan
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Ferhat Keser
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Hazal Cansu Acar
- Department of Public HealthCerrahpasa Faculty of MedicineIstanbul University‐CerrahpasaIstanbulTurkey
| | - Alper Otunctemur
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Eyup Veli Kucuk
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Selcuk Erdem
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Murat Ozer
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Ugur Tolga Sen
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Enes Degirmenci
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Rifat Ergul
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ramazan Gokhan Atis
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Asif Yildirim
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
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3
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Bryan RT, Catto JWF, Jefferson KP, Patel P, James ND, On Behalf Of The BladderPath Trial Management Group. Reply to Trey Durdin, Alvin Goh, and Eugene Pietzak. Can an Imaging-guided Pathway Replace the Current Paradigm for Muscle-invasive Bladder Cancer? Eur Urol 2021; 80:18-19. [PMID: 33972095 DOI: 10.1016/j.eururo.2021.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Richard T Bryan
- Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | | | - Prashant Patel
- Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicholas D James
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
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4
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Reynolds BR, McCombie S, Botha E, Hawks C, Brown M, Hayne D. Ten-year outcomes of the first 'one-stop haematuria clinic' in an Australian public hospital. ANZ J Surg 2020; 91:565-570. [PMID: 33236477 DOI: 10.1111/ans.16439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Urgent assessment of haematuria is critical to exclude malignancy. The utilization of haematuria clinics in Australia remains in its infancy. It is hoped that the streamlined investigative service will achieve earlier diagnosis of urological malignancy and subsequently decrease morbidity and mortality. We report the 10-year prospectively collected outcomes from Australia's first dedicated one-stop haematuria clinic (OSHC). METHODS Since its commencement in May 2008 through to July 2018, all consecutive patients assessed in the OSHC were included in the analysis. Data collected included demographics, presentation, wait times, investigation, assessment, initial treatment, referral and histopathology. RESULTS A total of 3008 patients were seen in the OSHC with non-visible haematuria (1024, 34%) and visible haematuria (1984, 66%). Three hundred and twenty-seven (10.9%) patients were diagnosed with urothelial malignancy. In all, 306 (10.2%) patients had lower tract disease and 21 (0.7%) had upper tract disease. Urothelial cases were compiled of 123 (37.6%) Ta LG, 39 (11.9%) Ta HG, 21 (6.4%) Tis, 67 (20.5%) T1 and 77 (23.6%) T2-4. Urothelial malignancy was diagnosed more often in males (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.35-2.25), older patients elder than 60 years (OR 1.97, 95% CI 1.47-2.64) and patients with visible haematuria (OR 5.42, 95% CI 3.73-7.86). In all, 53.4% of patients were discharged after a single visit to the OSHC. CONCLUSION The OSHC has served as an effective tool for rapid, streamlined assessment of patients presenting with haematuria. This model of care has been subsequently adopted by numerous public centres across Australia. Current funding structures present a barrier to this excellent approach for rapid access diagnostics.
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Affiliation(s)
- Bradley R Reynolds
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Steve McCombie
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Erica Botha
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Cynthia Hawks
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Brown
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dickon Hayne
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
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5
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Non-visible haematuria for the Detection of Bladder, Upper Tract, and Kidney Cancer: An Updated Systematic Review and Meta-analysis. Eur Urol 2020; 77:583-598. [DOI: 10.1016/j.eururo.2019.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
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6
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Qu LG, Nzenza T, McMillan K, Sengupta S. Delays in prostate cancer care within a hospital network in Victoria, Australia. ANZ J Surg 2019; 89:1599-1604. [PMID: 31786815 DOI: 10.1111/ans.15554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/02/2019] [Accepted: 10/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND To characterize and identify interval delays for patients referred to a tertiary hospital with prostate-specific antigen (PSA) elevation, as delays in prostate cancer diagnosis may result in worse outcomes. PATIENTS AND METHODS We retrospectively reviewed consecutive referrals to our urology unit for abnormal PSA assessments, over a 24-month period. Demographics, PSA measurements, clinical staging, biopsy grade and treatment were recorded. Referral, review, biopsy and treatment intervals were calculated. Associations were analysed using Wilcoxon rank-sum tests. RESULTS Two hundred and thirty men were included, with median age 65 years and PSA 7.6 ng/mL at referral, of whom 197 (85.7%) men had cancer on biopsy. The median referral, review, biopsy and treatment intervals were 8.1 (range 0.1-109.9), 1.7 (0.1-19.4), 1.9 (0.0-31.5) and 1.9 (0.2-17.3) months respectively. One hundred and seven patients (56.6%) had more than one abnormal PSA prior to referral. Eighty-five (60.7%) patients had referral delay ≥3 months, and were found to be: older (66 versus 63 years, P = 0.02), less likely to have family history (12 versus 24%, P = 0.07) and have a prior abnormal PSA (93 versus 0%, P < 0.0001). Treatment intervals ≥1 month occurred in 104 (70.3%) patients, associated with higher clinical stage (P = 0.0002) and biopsy grade (P < 0.0001). CONCLUSION Our results indicate frequent referral delays, which in some cases may be reflective of older age or a lower risk profile. However, treatment delays are associated with higher risk disease, possibly reflecting time needed for staging and treatment discussions. Further efforts are needed to optimize timely referral, investigation and treatment of men with elevated PSA.
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Affiliation(s)
- Liang G Qu
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia.,Young Urology Researchers Organisation, Melbourne, Victoria, Australia
| | - Tatenda Nzenza
- Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia.,Young Urology Researchers Organisation, Melbourne, Victoria, Australia.,Department of Urology, Eastern Health, Melbourne, Victoria, Australia
| | - Kevin McMillan
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Urology, Eastern Health, Melbourne, Victoria, Australia
| | - Shomik Sengupta
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia.,Department of Urology, Eastern Health, Melbourne, Victoria, Australia
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7
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Zhou Y, van Melle M, Singh H, Hamilton W, Lyratzopoulos G, Walter FM. Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review. BMJ Open 2019; 9:e029143. [PMID: 31585970 PMCID: PMC6797416 DOI: 10.1136/bmjopen-2019-029143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/27/2019] [Accepted: 07/24/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In urological cancers, sex disparity exists for survival, with women doing worse than men. Suboptimal evaluation of presenting symptoms may contribute. DESIGN We performed a systematic review examining factors affecting the quality of the diagnostic process of patients presenting with symptoms of bladder or kidney cancer. DATA SOURCES We searched Medline, Embase and the Cochrane Library from 1 January 2000 to 13 June 2019. ELIGIBLE CRITERIA We focused on one of the six domains of quality of healthcare: timeliness, and examined the quality of the diagnostic process more broadly, by assessing whether guideline-concordant history, examination, tests and referrals were performed. Studies describing the factors that affect the timeliness or quality of the assessment of urinary tract infections, haematuria and lower urinary tract symptoms in the context of bladder or kidney cancer, were included. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment were independently performed by two authors. Due to the heterogeneity of study design and outcomes, the results could not be pooled. A narrative synthesis was performed. RESULTS 28 studies met review criteria, representing 583 636 people from 9 high-income countries. Studies were based in primary care (n=8), specialty care (n=12), or both (n=8). Up to two-thirds of patients with haematuria received no further evaluation in the 6 months after their initial visit. Urinary tract infections, nephrolithiasis and benign prostatic conditions before cancer diagnosis were associated with diagnostic delay. Women were more likely to experience diagnostic delay than men. Patients who first saw a urologist were less likely to experience delayed evaluation and cancer diagnosis. CONCLUSIONS Women, and patients with non-cancerous urological diagnoses just prior to their cancer diagnosis, were more likely to experience lower quality diagnostic processes. Risk prediction tools, and improving guideline ambiguity, may improve outcomes and reduce sex disparity in survival for these cancers.
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Affiliation(s)
- Yin Zhou
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marije van Melle
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Georgios Lyratzopoulos
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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8
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Sell V, Ettala O, Montoya Perez I, Järvinen R, Pekkarinen T, Vaarala M, Seppänen M, Liukkonen T, Marttila T, Aaltomaa S, Kaasinen E, Boström PJ. Symptoms and diagnostic delays in bladder cancer with high risk of recurrence: results from a prospective FinnBladder 9 trial. World J Urol 2019; 38:1001-1007. [PMID: 31177305 PMCID: PMC7154016 DOI: 10.1007/s00345-019-02841-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/03/2019] [Indexed: 02/04/2023] Open
Abstract
Purpose To investigate the symptoms and delays in the clinical pathway of bladder cancer (BC). Methods This is a substudy of a prospective, randomized, multicenter phase III study (FinnBladder 9, NCT01675219) where the efficacy of photodynamic diagnosis and 6 weekly optimized mitomycin C instillations are studied in pTa bladder cancer with high risk for recurrence. The data of presenting symptoms and critical time points were prospectively collected, and the effect of factors on delays was analyzed. Results At the time of analysis, 245 patients were randomized. Analysis included 131 patients with primary bladder cancer and their complete data. Sixty-nine percent had smoking history and 67% presented with macroscopic hematuria. Median patient delay (from symptoms to health-care contact) was 7 days. The median general practice delay (from health-care contact to urology referral) was 8 days. Median time from urology referral to cystoscopy was 23 days and from cystoscopy to TUR-BT 21 days. Total time used in the clinical pathway (from symptom to TUR-BT) was 78 days. Current and former smokers had non-significantly shorter patient-related and general practice delays compared to never smokers. TUR-BT delay was significantly shorter in patients with malignant cytology (16 days) compared to patients with benign cytology (21 days, p = 0.03). Conclusions Patient-derived delay was short and most of the delay occurred in the referral centers. The majority had macroscopic hematuria as the initial symptom. Surprisingly, current and past smokers were more prone to contact the health-care system compared to never smokers.
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Affiliation(s)
- Ville Sell
- Department of Urology, Turku University Hospital, Turku, Finland.
| | - Otto Ettala
- Department of Urology, Turku University Hospital, Turku, Finland
| | | | - Riikka Järvinen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Tarmo Pekkarinen
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Markku Vaarala
- Department of Urology, Oulu University Hospital, Oulu, Finland
| | - Marjo Seppänen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Tapani Liukkonen
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - Timo Marttila
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Sirpa Aaltomaa
- Department of Urology, Kuopio University Hospital, Kuopio, Finland
| | - Eero Kaasinen
- Department of Surgery, Hospital of Hyvinkää, Hyvinkää, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
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9
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Sutton AJ, Lamont JV, Evans RM, Williamson K, O’Rourke D, Duggan B, Sagoo GS, Reid CN, Ruddock MW. An early analysis of the cost-effectiveness of a diagnostic classifier for risk stratification of haematuria patients (DCRSHP) compared to flexible cystoscopy in the diagnosis of bladder cancer. PLoS One 2018; 13:e0202796. [PMID: 30138462 PMCID: PMC6107278 DOI: 10.1371/journal.pone.0202796] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background Urothelial bladder cancer (UBC) is the 5th most common cancer in Western societies. The most common symptom of UBC is haematuria. Cystoscopy the gold standard for UBC detection, allows direct observation of the bladder, but is expensive, invasive, and uncomfortable. This study examines whether an alternative new urine-based diagnostic test, the DCRSHP, is cost-effective as a triage diagnostic tool compared to flexible cystoscopy in the diagnosis of UBC in haematuria patients. Methods A model-based cost-utility analysis using cost per quality adjusted life year and life year gained, parameterised with secondary data sources. Results If the DCRSHP is targeted at haematuria patients at lower risk of having bladder cancer e.g. younger patients, non-smokers, then it can be priced as high as £620, and be both effective and cost-effective. Sensitivity analysis found that DCRSHP is approximately 80% likely to be cost-effective across all willingness to pay values (for a QALY) and prevalence estimates. Conclusion This analysis shows the potential for a non-invasive test to be added to the diagnostic pathway for haematuria patients suspected of having UBC. If the DCRSHP is applied targeting haematuria patients at low risk of UBC, then it has the potential to be both effective and cost-effective.
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Affiliation(s)
- Andrew J. Sutton
- Test Evaluation Group, Institute of Health Sciences, University of Leeds, NIHR Diagnostic Evidence Cooperative Leeds, Leeds, United Kingdom
- * E-mail:
| | - John V. Lamont
- Randox Laboratories Ltd, Molecular Biology, Crumlin, County Antrim, Northern Ireland
| | - R. Mark Evans
- Department of Urology, Belfast City Hospital, Belfast, Northern Ireland
| | - Kate Williamson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - Declan O’Rourke
- Department of Pathology, Belfast City Hospital, Belfast, Northern Ireland
| | - Brian Duggan
- Ulster Hospital Dundonald, South Eastern Trust, Belfast, Northern Ireland
| | - Gurdeep S. Sagoo
- Test Evaluation Group, Institute of Health Sciences, University of Leeds, NIHR Diagnostic Evidence Cooperative Leeds, Leeds, United Kingdom
| | - Cherith N. Reid
- Randox Laboratories Ltd, Molecular Biology, Crumlin, County Antrim, Northern Ireland
| | - Mark W. Ruddock
- Randox Laboratories Ltd, Molecular Biology, Crumlin, County Antrim, Northern Ireland
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10
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Lough T, Luo Q, Luxmanan C, Anderson A, Suttie J, O'Sullivan P, Darling D. Clinical utility of a non-invasive urine test for risk assessing patients with no obvious benign cause of hematuria: a physician-patient real world data analysis. BMC Urol 2018. [PMID: 29523118 PMCID: PMC5845194 DOI: 10.1186/s12894-018-0327-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The non-invasive Cxbladder urine test system has demonstrated clinical utility in ruling out urothelial carcinoma (UC) in patients with asymptomatic microscopic hematuria (AMH), suggesting that the number of invasive diagnostic tests, including cystoscopy, used in this patient population may be reduced by Cxbladder testing prior to conducting a full urological work-up. The aim of this study was to demonstrate the enhanced clinical utility of communicating objective information on diagnostic decisions made by individual physicians on individual patients with AMH. Methods Three hundred ninety-six physician-patient decisions were generated from twelve participant physicians evaluating real world case notes from the same 33 patients presenting with AMH. Each physician reviewed and recommended diagnostic tests and procedures based on each patient’s referral data and then re-evaluated their clinical recommendation following disclosure of the non-invasive Cxbladder urine test result. Changes assessed were the total number of requested diagnostic procedures and the number of invasive procedures, including cystoscopy, following addition of information from Cxbladder in the Triage and Triage and Detect modalities. Results Physicians made significant changes to their diagnostic behavior for patients with AMH when presented with Cxbladder test results, including a reduction in the number of total and invasive procedures including cystoscopy for individuals identified as having a low probability of UC. The intensity of investigation was targeted and increased, including use of total procedures and cystoscopy, for patients identified by Cxbladder tests as having a high probability of UC: urologists increased the level of investigation for both total procedures and invasive procedures. The outcome resulted in patients with a high risk of UC receiving appropriate guideline-recommended invasive diagnostic tests. Patients who tested negative were offered fewer and significantly less invasive procedures. This change in physician behavior results in an increased clinical and patient utility, lower risk of missed UC and invasive test-related harm incidents. Conclusions This study demonstrated the potential for increased clinical resolution and significantly enhanced patient management, when physicians consider Cxbladder test results in their clinical evaluation. The change in physician behavior led to more appropriate diagnostic procedure selection and resource allocation to the benefit of both patients and healthcare systems. Electronic supplementary material The online version of this article (10.1186/s12894-018-0327-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tony Lough
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand
| | - Qingyang Luo
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand
| | - Carthika Luxmanan
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand.,University of Otago, Dunedin, New Zealand
| | - Alastair Anderson
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand
| | - Jimmy Suttie
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand.
| | - Paul O'Sullivan
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand.,Merck, Sharpe & Dohme, Auckland, New Zealand
| | - David Darling
- Pacific Edge Limited, 87 St David Street, Dunedin, 9016, New Zealand
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11
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Evaluation of the NMP22 BladderChek test for detecting bladder cancer: a systematic review and meta-analysis. Oncotarget 2017; 8:100648-100656. [PMID: 29246009 PMCID: PMC5725051 DOI: 10.18632/oncotarget.22065] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background We examined the usefulness of the nuclear matrix protein 22 (NMP22) BladderChek test for detecting bladder cancer. Materials and Methods A literature search was performed using PubMed, Embase, the Cochrane Library, and Web of Science. The diagnostic accuracy of the NMP22 BladderChek test was evaluated via pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under curve (AUC). Inter-study heterogeneity was explored using meta-regression and subgroup analyses. Results We included 23 studies in the systematic review and 19 in the quantitative meta-analysis. Overall sensitivity and specificity were 56% (52-59%) and 88% (87-89%), respectively; pooled PLR and NLR were 4.36 (3.02-6.29) and 0.51 (0.40-0.66), respectively; DOR was 9.29 (5.55-15.55) with an AUC of 0.8295. The mean sensitivity for Ta, T1, ≥ T2, Tis, G1, G2, and G3 disease was 13.68%, 29.49%, 74.03%, 34.62%, 44.16%, 56.25%, and 67.34%, respectively. Conclusions The NMP22 BladderChek test shows good discrimination ability for detecting bladder cancer and a high-specificity algorithm that can be used for early detection to rule out patients with higher bladder cancer risk. It also has better potential for screening higher-grade and higher-stage tumors, and better diagnostic performance in Asians.
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12
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McCombie SP, Bangash HK, Kuan M, Thyer I, Lee F, Hayne D. Delays in the diagnosis and initial treatment of bladder cancer in Western Australia. BJU Int 2017; 120 Suppl 3:28-34. [DOI: 10.1111/bju.13939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Melvyn Kuan
- Fiona Stanley Hospital; Murdoch WA Australia
| | - Isaac Thyer
- Fiona Stanley Hospital; Murdoch WA Australia
| | - Fran Lee
- Fiona Stanley Hospital; Murdoch WA Australia
| | - Dickon Hayne
- Fiona Stanley Hospital; Murdoch WA Australia
- University of Western Australia; Perth WA Australia
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13
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Chang TC, Marcq G, Kiss B, Trivedi DR, Mach KE, Liao JC. Image-Guided Transurethral Resection of Bladder Tumors - Current Practice and Future Outlooks. Bladder Cancer 2017; 3:149-159. [PMID: 28824942 PMCID: PMC5545914 DOI: 10.3233/blc-170119] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Transurethral resection of bladder tumor (TURBT) under white light cystoscopy (WLC) is the cornerstone for the diagnosis, removal and local staging of non-muscle invasive bladder cancer (NMIBC). Despite technological improvements over the decades, significant shortcomings remain with WLC for tumor detection, thereby impacting the surgical quality and contributing to tumor recurrence and progression. Enhanced cystoscopy modalities such as blue light cystoscopy (BLC) and narrow band imaging (NBI) aid resections by highlighting tumors that might be missed on WLC. Optical biopsy technologies such as confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) characterize tissue in real-time to ensure a more thorough resection. New resection techniques, particularly en bloc resection, are actively under investigation to improve the overall quality of resections and aid pathologic interpretation. Moreover, new image processing computer algorithms may improve perioperative planning and longitudinal follow-up. Clinical translation of molecular imaging agents is also on the horizon to improve optical diagnosis of bladder cancer. This review focuses on emerging technologies that can impact the quality of TURBT to improve the overall management of NMIBC.
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Affiliation(s)
- Timothy C Chang
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Gautier Marcq
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Bernhard Kiss
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Dharati R Trivedi
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Kathleen E Mach
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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14
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Ngo B, Perera M, Papa N, Bolton D, Sengupta S. Factors affecting the timeliness and adequacy of haematuria assessment in bladder cancer: a systematic review. BJU Int 2017; 119 Suppl 5:10-18. [DOI: 10.1111/bju.13821] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brian Ngo
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Marlon Perera
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Nathan Papa
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Damien Bolton
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Shomik Sengupta
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
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15
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Ngo B, Papa N, Perera M, Bolton D, Sengupta S. Bladder cancer diagnosis during haematuria investigation - implications for practice guidelines. BJU Int 2017; 119 Suppl 5:53-54. [DOI: 10.1111/bju.13870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Brian Ngo
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Nathan Papa
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Marlon Perera
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Damien Bolton
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Shomik Sengupta
- Department of Surgery; The University of Melbourne; Parkville Vic. Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
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16
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Affiliation(s)
- Nathan Lawrentschuk
- Department of Surgery and Olivia Newton-John Cancer Research Institute; Austin Hospital; University of Melbourne; Melbourne Vic. Australia
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
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