Login to Access Video or Poster Abstract: MP04-08
Sources of Funding: None

Introduction

The 2015 UK NICE guidance (NG12) for &[prime]urgent suspected cancer&[prime] (USC) referrals suggested that asymptomatic microhematuria (AMH) need not be seen as USC._x000D_ _x000D_ We hypothesized that declining referrals for AMH was safe, and would help to address our unacceptably long wait for the one-stop hematuria clinic (OSHC). We present the outcome of rejecting referrals for AMH entirely for one year, the first study of its kind to adopt this innovative approach.

Methods

Hematuria referrals to a UK cancer center (catchment population >600K) were analyzed 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 AMH were declined in writing. Bladder cancer was categorized as per the European Organisation for Research and Treatment of Cancer risk stratification.

Results

Over the study period, 1963 patients were seen in a OSHC; 1105 prior to NG12 (cohort 1), and 858 after (cohort 2). In cohort 1, 686 had gross hematuria (GH), 159 had symptomatic microhematuria (SMH), and 260 had AMH. Cancers were diagnosed in 132 cohort 1 patients; 83% (110 patients) had urothelial malignancies, of which 107 (97%) presented with GH or SMH, and only 3 with AMH. Twenty-six patients (23%) were diagnosed with high-risk non-muscle invasive bladder cancer (HRNMIBC), 21 patients (19%) with muscle invasive bladder cancer (MIBC), and 4 (4%) with upper tract TCC (UTTCC)._x000D_ _x000D_ In cohort 2, 137 cancers were diagnosed, of which 114 (83%) were urothelial malignancies. These included 26 HRNMIBCs (23%), 24 MIBCs (21%), 3 metastatic bladder cancers (3%), and 7 UTTCCs (6%). One-hundred and fifty-three referrals for AMH were rejected in writing during cohort 2._x000D_ _x000D_ By excluding patients with AMH from cohort 1, only 3 low-risk non-muscle invasive bladder cancers would have remained undetected after implementing NG12 (in addition to 2 small renal tumors). 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% reduction)._x000D_

Conclusions

Prior to NICE guideline NG12 implementation, no significant cancers were detected in patients referred with AMH in our study. After NG12, and rejecting referrals with AMH entirely, patients with bladder cancer were seen and treated earlier._x000D_ _x000D_ While such a novel approach to AMH may attract criticism, this study outlines for the first time, that declining to accept such referrals in a state-funded healthcare system is an effective approach for rationalization of resources.

Funding

None