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

OBJECTIVES: To quantify and examine the causes of delays in the diagnosis and initial treatment of patients with bladder cancer in Western Australia. SUBJECTS AND METHODS: 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 general practitioners 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. RESULTS: Of 1 365 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 (range) waiting time from initial bleeding to surgery was 69.5 (9-1 165) days. This was comprised of a median (range) pre-referral waiting time of 12 (0-1 137) days, assessment waiting time of 23.5 (0-207) days, and treatment waiting time of 20 (1-69) days. 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. CONCLUSION: Many patients experience significant delays in the diagnosis and treatment of their bladder cancer in Western Australia, and this probably reflects national trends. These concerning data warrant consideration of how delays can be reduced to improve outcomes for these patients.

'One stop' haematuria clinic in Fremantle Hospital, Western Australia: a report of the first 500 patients.

UNLABELLED: What's known on the subject? and What does the study add? Haematuria is a symptom of urologic cancer particularly bladder cancer and timely diagnosis can prevent disease from progression to a more advanced or incurable stage. The 'One Stop' Haematuria clinic is the first rapid assessment clinic for haematuria in a public hospital in Western Australia. The results from this study have confirmed that it is an efficient and effective model in the streamlined care of patients with haematuria and provides evidence to support a more widespread adoption of this model of care. OBJECTIVE: • To report the prospective outcomes and clinic process for the first 500 patients at a new 'one stop' Haematuria Clinic (OSHC) in a Western Australian public hospital. PATIENTS AND METHODS: • The first 500 patients who attended the weekly OSHC between May 2008 and February 2011 were included in this paper. • Patients with haematuria were referred by various specialties. Gender, age, outcomes following OSHC attendance, diagnoses and wait times were recorded. RESULTS: • In all, 311 males and 189 females presented to the clinic with visible haematuria (296 cases) and microscopic haematuria (204 cases). • Sixty-six new cancers (13.2%) were diagnosed, 63 urological and three non-urological. • Fifty-one patients (10.2%) were diagnosed with transitional cell carcinoma of the bladder. Further breakdown of staging for bladder transitional cell carcinoma diagnoses were stage Ta (23 patients), stage T1 (21 patients) and stage 2-4 (seven patients). • Sixty-nine patients (13.8%) were diagnosed with urological pathologies requiring surgery. Thirty-four patients (6.8%) were followed up by the nurse practitioner or continence advisors. In all, 61.2% of patients were discharged after a single visit to the OSHC. • Excluding those requiring surgery only 3.4% patients required further urologist follow-up. CONCLUSION: • The results have demonstrated that the first OSHC in a public Western Australian hospital is an efficient and effective model for the streamlined care of patients with haematuria. • We encourage that similar models are adopted in other public hospitals in the region.