State of the nation: understanding the current NHS treatment pathway to identify opportunities to advance future care of patients with high‐risk non‐muscle invasive bladder cancer in the UK (SPAN‐UK)

Objectives

This study aimed to understand clinical pathways for patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) from diagnosis to follow-up and to identify opportunities to improve care.

Materials and Methods

A cross-sectional survey was conducted via structured online interviews with consented NHS healthcare professionals (HCPs) from the United Kingdom (UK) between June and September 2025. Topics surveyed included MDT structures/roles, diagnostic timelines, adjuvant treatment, radical cystectomy (RC) decision making, current bladder-sparing treatment and clinical trial access. Quantitative data were analysed descriptively. Qualitative responses were analysed thematically.

Results

Seventy HCPs were included and reported that typically; 88.5% of patients achieve diagnosis within 6–8 weeks of referral, and 11.4% reported delays beyond 8 weeks. BCG maintenance duration and completion rates varied. Following BCG induction, a median (IQR) of 20.0% (5.0–32.5%) and 60.0% (40.0–70.0%) of patients completed ≥2 or ≤1 years of maintenance, respectively; 1.0% (1.0–2.0%) failed to complete induction. For BCG-unresponsive HR-NMIBC, HCPs reported that a mean (SD) proportion of 53.4 (18.1)% of patients tend to be eligible for and consent to RC, 22.0 (12.6)% tend to be eligible but decline RC and 24.6 (14.9)% tend to be ineligible. Bladder-sparing options remain limited, with 60% of HCPs regarding further BCG as the most appropriate option. All respondents agreed that adherence to quality performance indicators (QPIs) and a national bladder cancer audit would be beneficial. Insufficient specialist nurse capacity to meet foreseeable demands of HR-NMIBC patient care was reported by 70% (n = 49) of HCPs.

Conclusion

Results reveal variability in real-world HR-NMIBC care within the NHS. Delays in diagnosis, inconsistent BCG maintenance duration, lack of evidence-based alternatives to BCG and a lack of bladder-sparing treatment and trial options in the BCG-unresponsive setting were identified. Findings highlight unmet needs in relation to MDT resourcing, diagnostic efficiency, trial access, QPI adherence and a national bladder cancer audit.