Diagnosis, treatment and survival from bladder, upper urinary tract, and urethral cancers: real-world findings from NHS England between 2013 and 2019

Abstract

Objective: We report NHS England data for patients with bladder cancer (BC), upper tract urothelial cancer (UTUC: renal pelvic and ureteric), and urethral cancers from 2013 to 2019.

Materials and methods: Hospital episode statistics, waiting times, and cancer registrations were extracted from NHS Digital.

Results: Registrations included 128 823 individuals with BC, 16 018 with UTUC, and 2533 with urethral cancer. In 2019, 150 816 persons were living with a diagnosis of BC, of whom 113 067 (75.0%) were men, 85 117 (56.5%) were aged >75 years, and 95 553 (91.7%) were Caucasian. Incidence rates were stable (32.7-34.3 for BC, 3.9-4.2 for UTUC and 0.6-0.7 for urethral cancer per 100 000 population). Most patients 52 097 (mean [range] 41.3% [40.7-42.0%]) were referred outside the 2-week-wait pathway and 15 340 (mean [range] 12.2% [11.7-12.6%]) presented as emergencies. Surgery, radiotherapy, chemotherapy, or multimodal treatment use varied with disease stage, patient factors and Cancer Alliance. Between 27% and 29% (n = 6616) of muscle-invasive BCs did not receive radical treatment. Survival rates reflected stage, grade, location, and tumour histology. Overall survival rates did not improve over time (relative change: 0.97, 95% confidence interval 0.97-0.97) at 2 years in contrast to other cancers.

Conclusion: The diagnostic pathway for BC needs improvement. Increases in survival might be delivered through greater use of radical treatment. NHS Digital data offers a population-wide picture of this disease but does not allow individual outcomes to be matched with disease or patient features and key parameters can be missing or incomplete.

Keywords: NHS statistics; bladder cancer; cancer outcome; urothelial cell carcinoma.

Fig. 1

Route to diagnosis for all urinary cancers (including urethral, n = 2138; BC, n = 110 228; and UTUC, n = 13 633) from 2013 to 2018.

Fig. 2

Cancer stage (stratified into NMI, MI, and unknown) at diagnosis for BC, UTUC, and urethral cancer from 2013 to 2019.

Fig. 3

Distribution of individual treatment(s) for (A) 25 268 pT1 NMIBCs and (B) 23 373 MIBCs from 2013 to 2018. CT, chemotherapy; RT, radiotherapy.

Fig. 4

Use of chemotherapy, radiotherapy, surgery in isolation or combination in patients with BC from 2013 to 2018. Percentage of individuals receiving each option is shown according to (A) age, (B) sex, (C) Charlson Comorbidity Index, (D) stage, (E) social deprivation, and (F) ethnicity.

Fig. 5

Overall survival plotted using the Kaplan–Meier method for patients with (A) BC with respect to stage, (B) sex, (C) MIBC with respect to histology, and (D) UCC with respect to location (bladder [BC] and upper urothelial tract [UTUC]) and stage.