Delays in the diagnosis and initial treatment of bladder cancer in Western Australia

Steve P. McCombie, Haider K. Bangash, Melvyn Kuan, Isaac Thyer, Fran Lee, Dickon Hayne

To quantify and examine the aetiology of delays in the diagnosis and initial treatment of patients with bladder cancer in Western Australia. All attendances at a one-stop haematuria clinic at a public tertiary-level hospital in Western Australia between May 2008 and April 2014 were reviewed retrospectively. All patients diagnosed with a bladder tumour over this period were identified. These patients and their GPs were contacted retrospectively and invited to participate in telephone interviews, with additional data collected from clinical records as required. Waiting times to presentation, referral, assessment, and initial treatment were established for patients who presented with visible haematuria. Of 1365 attendances, 151 patients were diagnosed with a bladder tumour and 100 of these were both suitable and agreed to participate in the study. For patients with visible haematuria the median waiting time from initial bleeding to surgery was 69.5 days (range 9 - 1165). This was comprised of a median (range) pre-referral waiting time of 12 days (0 - 1137), assessment waiting time of 12.5 days (0 - 207), and treatment waiting time of 20 days (1 - 69). Reasons for prolonged waiting times included poor public awareness, patient fear and anxiety, delayed and non-referral from primary care, administrative delays, and resource limitations. Many patients experience significant delay in the diagnosis and treatment of their bladder cancer in Western Australia, and this data likely reflects national trends. This concerning data warrants consideration of how delays can be reduced in order to improve outcomes for these patients. This article is protected by copyright. All rights reserved.