Quality statement 5: Discussing treatment options for high‑risk non‑muscle‑invasive bladder cancer

Quality statement

Adults with high‑risk non‑muscle‑invasive bladder cancer discuss intravesical Bacille Calmette‑Guérin (BCG) and radical cystectomy with a urologist who performs both treatments and a clinical nurse specialist.

Rationale

Discussing the benefits and risks of intravesical BCG and radical cystectomy with a urologist who performs both treatments and a clinical nurse specialist helps adults to make an informed choice about which treatment would best suit them. It ensures that they are aware of the possible outcomes and implications of both treatments, including likely effects on their quality of life, body image, and sexual and urinary functions.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults with high‑risk non‑muscle‑invasive bladder cancer discuss intravesical BCG and radical cystectomy with a urologist who performs both treatments and a clinical nurse specialist before a treatment option is agreed.

Data source: Local data collection.

Process

The proportion of adults with high‑risk non‑muscle‑invasive bladder cancer who discuss intravesical BCG and radical cystectomy with a urologist who performs both treatments and a clinical nurse specialist before agreeing a treatment option.

Numerator – the number in the denominator who have a discussion about intravesical BCG and radical cystectomy with a urologist who performs both treatments and a clinical nurse specialist before agreeing a treatment option.

Denominator – the number of adults with newly diagnosed high‑risk non‑muscle‑invasive bladder cancer.

Data source: Local data collection.

Outcome

Satisfaction with explanation of treatment options reported by adults with high‑risk non‑muscle‑invasive bladder cancer.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care services) ensure that systems are in place for adults with high‑risk non‑muscle‑invasive bladder cancer to discuss intravesical BCG and radical cystectomy with a urologist who performs both treatments and a clinical nurse specialist before agreeing a treatment option.

Healthcare professionals (urologists who perform both intravesical BCG and radical cystectomy, and clinical nurse specialists) discuss both procedures with adults who have high‑risk non‑muscle‑invasive bladder cancer before agreeing a treatment option.

Commissioners (clinical commissioning groups) ensure that they commission services in which a clinical nurse specialist and a urologist who performs both intravesical BCG and radical cystectomy discuss both of these procedures with adults who have high‑risk non‑muscle‑invasive bladder before agreeing a treatment option.

What the quality statement means for patients and carers

Adults with bladder cancer that has not grown into the muscle wall of the bladder, but has a high risk of doing so, have a discussion with a clinical nurse specialist and a specialist bladder cancer doctor about having treatment either with a vaccine called BCG, which can stop the cancer growing, or by having their bladder removed in an operation called cystectomy. Knowing the benefits and risks of these treatment options, including the likely effects on their future quality of life, will help them to choose the option that is best for them.

Source guidance

Definitions of terms used in this quality statement

Discussion

Discussion should include:

  • the type, stage and grade of the cancer, the presence of carcinoma in situ, the presence of variant pathology, prostatic urethral or bladder neck status and the number of tumours

  • risk of progression to muscle invasion, metastases and death

  • risk of understaging

  • benefits of both treatments, including survival rates and the likelihood of further treatment

  • risks of both treatments

  • factors that affect outcomes (for example, comorbidities and life expectancy)

  • impact on quality of life, body image, and sexual and urinary functions.

[Bladder cancer (NICE guideline NG2) recommendation 1.3.6]

Equality and diversity considerations

Radical cystectomy may not be suitable for people who have problems with manual dexterity or cognitive function, or people who have visual impairment.