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NICE has published its first guideline to look at how best to diagnose and manage bladder cancer. The aim is to help diagnose patients quickly and accurately so they receive the best possible care.

Each year in the UK, more than 10,000 people are diagnosed1 with bladder cancer and it kills 5,0002 people.  

Due to the number of people with the disease, the intensive treatment sometimes needed3 and the prolonged follow-up often done, it is thought to be one of the most expensive cancers for the NHS, but there is a wide variation across the country in terms of the treatments offered.

Commenting on the guideline recommendations, Professor Mark Baker, Centre for Clinical Practice director at NICE, said: “Bladder cancer is in the top ten most common cancers in the UK. There are a number of treatments available, but for some people a diagnosis is only made when they are admitted to hospital in an emergency – in these cases the outlook can be poor.

“Bladder cancer can have a profound impact on someone’s psychological wellbeing as well as their physical health. Both the tumours and the treatments can affect bowel, bladder and sexual function. This guideline aims to give people all the information they need about bladder cancer, to help them to make better decisions about their care, and improve their quality of life during and after treatment.”

Professor Julia Verne, chair of the group that developed the guideline, patient advocate and Director for Knowledge and Intelligence (South West) at Public Health England, said: “Until now there has been too much variation in survival from bladder cancer with women, the elderly and those from more deprived backgrounds having worse outcomes. These guidelines should help to reduce these variations.

“My own mother had bladder cancer and received excellent care but I have heard too many stories from people I know well whose parents or loved ones were not so lucky.

“I sincerely hope that these guidelines will raise the standards of treatment for everyone with bladder cancer from diagnosis, through treatment, to better end of life care.”

William Turner, member of the group that developed the guideline and Consultant Urologist at the Cambridge University Hospitals NHS Foundation Trust, said: “Bladder cancer presents a wide range of differing risk to different people who have it. This guideline makes recommendations to the NHS that should help us to focus much more on the risk to the individual, so that the correct level of assessment can be done, and the relevant treatment options can be set out by the appropriate clinical team. This should promote better shared decision making, including discussion of all aspects of the person’s particular cancer, and the pros and cons of treatment options, so that people can make more informed choices about their care. Our recommendations should also allow more targeted and effective use of NHS resource.”

There are two main types of bladder cancer: Non-invasive bladder cancer which develops only in the inner lining of the bladder and invasive bladder cancer has spread into the deeper walls of the bladder.

The guideline recommendations include:

Information and support for people with bladder cancer should be tailored to each person’s needs following a holistic needs assessment. This should identify a package of information and support for each person with bladder cancer and, if they wish, their partners, families or carers, at key points in their care such as:

• when they are first diagnosed
• after they have had their first treatment
• if their bladder cancer recurs or progresses
• if their treatment is changed
• if palliative or end of life care is being discussed.

Diagnosing bladder cancer: A CT or MRI staging should be considered before surgery to remove the tumour (transurethral resection of bladder tumour, TURBT) if muscle-invasive bladder cancer is suspected at cystoscopy. People with suspected bladder cancer should also be offered a single dose of intravesical mitomycin C given at the same time as the first TURBT – this reduces the risk of reoccurrence and also ensures people receive the full benefit of this time-dependent treatment.

Managing high-risk non-muscle invasive bladder cancer: The choice of intravesical BCG (Bacille Calmette-Guérin, a vaccine for tuberculosis that can also help stop some kinds of bladder cancer from spreading) or cystectomy (surgical removal of the bladder) should be offered to people with high-risk non-muscle-invasive bladder cancer, and base the choice on a full discussion with the person, the clinical nurse specialist and a urologist who performs both intravesical BCG and cystectomy.

Treating muscle-invasive bladder cancer:

Neoadjuvant chemotherapy for newly diagnosed muscle-invasive urothelial bladder cancer: If suitable, chemotherapy with a combination of drugs should be offered before radical cystectomy or radical radiotherapy. This is called ‘neoadjuvant’ chemotherapy. The person should have an opportunity to discuss the risks and benefits with an oncologist who treats bladder cancer.

Radical therapy for muscle-invasive urothelial bladder cancer: A choice of cystectomy or chemoradiotherapy should be offered to people with muscle-invasive bladder cancer for whom radical therapy is suitable. The choice should be based on a full discussion between the person and a urologist who performs cystectomy, a clinical oncologist and a clinical nurse specialist.

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

References

1. CRUK (2013a). Bladder cancer incidence statistics. (Online).  Available from:http://www.cancerresearchuk.org/cancer-info/cancerstats/types/bladder/incidence/.
2. CRUK (2013b). Bladder cancer mortality statistics. (Online).  Available from:http://www.cancerresearchuk.org/cancer-info/cancerstats/types/bladder/mortality/.
3. The intensive treatment needed for muscle-invasive bladder cancer and the prolonged hospital follow-up needed for bladder cancer mean that bladder cancer is one of the most expensive cancers to treat.

About the guideline

4. The guideline will be available at /Guidance/NG2 from 25 February 2015. Embargoed copies of the draft guidance are available from the NICE press office on request.
5. Clinical guidelines are applicable in England and Wales, but they are also usually disseminated in Northern Ireland after review.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.