# Standardized care pathway reshaped the diagnostic and therapeutic landscape of urinary bladder cancer. A 15‐year population‐based study

## TL;DR

A 15-year study in Sweden shows that implementing a standardized care pathway for bladder cancer led to earlier detection, better treatment adherence, and faster diagnosis, but highlighted challenges in treating more severe cases.

## Contribution

This study demonstrates the long-term impact of a standardized care pathway on bladder cancer outcomes through a population-based analysis.

## Key findings

- Emergency presentations for bladder cancer decreased significantly after SCP implementation.
- Earlier-stage tumors were more frequently detected following SCP adoption.
- Diagnostic efficiency improved, with faster referral-to-treatment times.

## Abstract

This work aimed to evaluate the long‐term impact of standardized care pathway (SCP) implementation for urinary bladder cancer (UBC) on tumour characteristics, diagnostic and treatment intervals and guideline adherence.

A retrospective cohort study was conducted including all patients with newly diagnosed UBC at the NU Hospital Group, Sweden, between 2010 and 2024. Patients were grouped into pre‐SCP (2010–2015) and during‐SCP (2016–2024) cohorts. Patient demographics, tumour characteristics, adherence to guideline‐recommended care and diagnostic and treatment time intervals were analysed. Overall survival was assessed using Kaplan–Meier analysis and Cox proportional hazards regression.

Following SCP implementation, emergency presentations declined significantly (15% pre‐SCP to 10% SCP, p = 0.003). Tumour characteristics shifted towards earlier‐stage disease, with increased detection of small tumours ≤30 mm (56% to 71%, p < 0.001), fewer muscle‐invasive cases (27% to 21%, p = 0.003) and a higher proportion of TaG1–2 tumours (42% to 52%, p = 0.003). Adherence to guidelines improved markedly, reflected in cT1 disease by increased second‐look resections (36% to 69%, p < 0.001) and multidisciplinary team conference discussions (2% to 88%, p < 0.001). Diagnostic efficiency improved, with median referral‐to‐TURBT time reduced from 29 to 14 days (p < 0.001). In multivariable analysis, age, emergency admission, higher tumour stage and size and TURBT delay >18 days were independently associated with worse overall survival. Kaplan–Meier analysis revealed a temporal shift: Early rapid TURBT was associated with poorer survival in 2010–2015 but conferred a survival benefit in 2016–2024 (log‐rank χ
2 = 13.66, p = 0.003).

SCP implementation was associated with earlier detection, improved guideline adherence and sustained reductions in diagnostic delays. However, increasing delays to definitive treatment for muscle‐invasive disease highlight emerging system‐level constraints, underscoring the need to optimize downstream capacity to fully realize the benefits of early diagnosis.