Diagnosis, treatment and survival from bladder, upper urinary tract and urethral cancers: Real world findings from NHS England between 2013 and 2019

Abstract

Objective
We report NHS England data for patients with bladder cancer (BC), upper tract urothelial (UTUC: renal pelvic and ureteric) and urethral cancers from 2013 to 2019.

Materials and methods
Hospital episode statistics, waiting times and cancer registrations were extracted from NHS Digital.

Results
Registrations included 128,823 individuals with BC, 16,018 with UTUC and 2,533 with urethral cancer. In 2019, 150,816 persons were living with a diagnosis of BC, of whom 113,067 (75.0%) were men, 85,117 (56.5%) aged over 75 yrs, and 95,553 (91.7%) Caucasian. Incidence rates were stable (32.7-34.3 for BC, 3.9-4.2 for UTUC and 0.6-0.7 for urethral cancer per 100,000 population). Most patients (52,097 (41.3% (40.7-42.0%)) were referred outside the two week wait pathway and 15,340 (12.2% (11.7-12.6%)) presented as emergencies. Surgery, radiotherapy, chemotherapy or multimodal treatment use varied with disease stage, patient factors and Cancer Alliance. Between 27-29% (6,616) of muscle-invasive BCs did not receive radical treatment. Survival rates reflected stage, grade, location and tumour histology. Overall survival rates did not improve over time (relative change: 0.97 (95%CI: 0.97-0.97) at 2 years) in contrast to other cancers.

Conclusion
The diagnostic pathway for BC needs improvement. Increases in survival might be delivered through greater use in radical treatment. NHS Digital data offers a population-wide picture of this disease but does not allow individual outcomes to be matched with disease or patient features and key parameters can be missing or incomplete.