Discharge of low risk non muscle invasive bladder cancer after one year: Results of a BAUS/BAUN national survey of the adoption of the NICE bladder cancer guidelines recommendations in the UK
The National Institute for Health and Care Excellence (NICE) produces guidelines for the National Health Service (NHS) in England to ensure that maximum gain is achieved from limited resources. In 2015 the NICE bladder cancer guidelines recommended that urologists in England should: Discharge to primary care people who have low-risk non-muscle-invasive bladder cancer (NMIBC) who have no recurrence within 12 months. This represented a significant change from the EAU NMIBC guidelines which recommend cystoscopic surveillance for 5 years and was therefore controversial. Although hospitals in the UK are expected to follow NICE guidelines, even after 2 years the level of adoption of this recommendation is unknown. Moreover the clinical consequences of such a policy with respect to re-presentation of patients with recurrences and possibly progression are unknown. A National survey of all urologists and urological nurses in the UK was carried out in an attempt to gain a national picture of the level of adoption of this recommendation and its clinical consequences.
In October 2017 the British Association of Urological Surgeons (BAUS) and the British Association of Urological Nurses (BAUN) sent out a joint e-mail questionnaire to their members. Members were asked whether their hospital had adopted the NICE guidelines and if so, if they had encountered any adverse outcomes as a result of this. In addition, if members had not adopted the NICE guidelines, they were asked which guideline (if any) they followed. The results were then mapped against all the urology departments in the UK.
A total of 165 responses were received (120 from BAUS and 45 from BAUN members respectively) representing 108 of 237 urology departments in the UK. 45% of respondents have adopted the NICE guidelines whereas 55% have not. Of those adopting the NICE guidelines, only 8 (4.8% of the overall total) had encountered an adverse outcome. Of these, 3 patients had confirmed low risk recurrence. Patient dissatisfaction at being discharged was the main reported adverse outcome. No respondents reported progression to a higher stage or grade. Of the 55% of respondents who have not adopted the NICE guidelines, 85% reported adhering to the EAU NMIBC guidelines.
Despite a strong central recommendation from NICE to discharge low risk NMIBC patients after 1 year, the majority of UK urology departments continue to use the EAU guidelines with discharge after 5 years. In those departments who are following the NICE recommendation, after 2 years the number of adverse outcomes is low with no reported cases of stage or grade progression.