The implications of rejecting referrals for asymptomatic non-visible haematuria prospectively for one year: an innovative interpretation of NICE guidance for 'urgent suspected cancer' (NG12)
Author(s):
Mr Adam Cox
,
Mr Adam Cox
Affiliations:
Mr Matthew Jefferies
,
Mr Matthew Jefferies
Affiliations:
Dr Mohamad Kamarizan
,
Dr Mohamad Kamarizan
Affiliations:
Ms Maureen Hunter
,
Ms Maureen Hunter
Affiliations:
Mr Jim Wilson
,
Mr Jim Wilson
Affiliations:
Mr Daniel Painter
,
Mr Daniel Painter
Affiliations:
Mr Adam Carter
Mr Adam Carter
Affiliations:
BAUS ePoster online library. Cox A. 06/26/17; 177329; P1-1 Disclosure(s): I have received honoraria from Astellas, Ferring and Kyowa Kirin to attend AUA 2017
Mr. Adam Cox
Mr. Adam Cox
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Abstract
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INTRODUCTION
After NICE published the controversial NG12 guidance for 'urgent suspected cancer' (USC) in 2015, we presented our early experience of declining referrals for asymptomatic non-visible haematuria (aNVH) at the 2016 BAUS AGM. We report the updated outcomes of entirely rejecting referrals for aNVH for one year.
PATIENTS AND METHODS
USC haematuria referrals to a UK cancer centre were analysed retrospectively prior to NG12 publication from July'14 to July'15 (cohort 1) and compared to prospective data following NG12 from July'15 to July'16 (cohort 2). After NG12, referrals for aNVH were declined in writing.
RESULTS
Over the study period, 1963 patients were seen in one-stop haematuria clinic (OSHC); 1105 in cohort 1, and 858 in cohort 2. 153 referrals for aNVH were rejected in writing during cohort 2. In cohort 1, 686 patients had visible haematuria (VH), 159 had symptomatic NVH (sNVH), and 260 had aNVH. More urothelial malignancies were diagnosed in cohort 2 (114 vs110) but proportions of high-risk non-muscle invasive bladder cancer (HRNMIBC) and muscle invasive bladder cancer (MIBC) were comparable in both cohorts. Were we to exclude patients with aNVH from cohort 1, only 3 low-risk non-muscle invasive bladder cancers would have evaded detection. Furthermore, after NG12, the average time from referral to first appointment fell from 35 days in July 15, to 17 days in July 16 (up to 50% improvement).
CONCLUSIONS
This study is the first to prospectively report that rejecting referrals for aNVH is safe, and results in the earlier detection of serious bladder cancers.
INTRODUCTION
After NICE published the controversial NG12 guidance for 'urgent suspected cancer' (USC) in 2015, we presented our early experience of declining referrals for asymptomatic non-visible haematuria (aNVH) at the 2016 BAUS AGM. We report the updated outcomes of entirely rejecting referrals for aNVH for one year.
PATIENTS AND METHODS
USC haematuria referrals to a UK cancer centre were analysed retrospectively prior to NG12 publication from July'14 to July'15 (cohort 1) and compared to prospective data following NG12 from July'15 to July'16 (cohort 2). After NG12, referrals for aNVH were declined in writing.
RESULTS
Over the study period, 1963 patients were seen in one-stop haematuria clinic (OSHC); 1105 in cohort 1, and 858 in cohort 2. 153 referrals for aNVH were rejected in writing during cohort 2. In cohort 1, 686 patients had visible haematuria (VH), 159 had symptomatic NVH (sNVH), and 260 had aNVH. More urothelial malignancies were diagnosed in cohort 2 (114 vs110) but proportions of high-risk non-muscle invasive bladder cancer (HRNMIBC) and muscle invasive bladder cancer (MIBC) were comparable in both cohorts. Were we to exclude patients with aNVH from cohort 1, only 3 low-risk non-muscle invasive bladder cancers would have evaded detection. Furthermore, after NG12, the average time from referral to first appointment fell from 35 days in July 15, to 17 days in July 16 (up to 50% improvement).
CONCLUSIONS
This study is the first to prospectively report that rejecting referrals for aNVH is safe, and results in the earlier detection of serious bladder cancers.
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