Quality statement 6: Discussing treatment options for muscle‑invasive urothelial bladder cancer

Quality statement

Adults with muscle‑invasive urothelial bladder cancer discuss neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist.

Rationale

Discussing the benefits and risks of neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist helps adults to make an informed choice about the treatments that would best suit them. It ensures that they are aware of the possible outcomes and implications of the 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 muscle‑invasive urothelial bladder cancer discuss neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist.

Data source: Local data collection.

Process

The proportion of adults with muscle‑invasive urothelial bladder cancer who discuss neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist before agreeing a treatment option.

Numerator – the number in the denominator who have a discussion about neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist before agreeing a treatment option.

Denominator – the number of adults with muscle‑invasive urothelial bladder cancer.

Data source: Local data collection.

Outcome

Satisfaction with explanation of treatment options reported by adults with muscle‑invasive urothelial 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 muscle‑invasive urothelial bladder cancer to discuss neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist before agreeing a treatment option.

Healthcare professionals (urologists who perform radical cystectomy, clinical oncologists and clinical nurse specialists) discuss neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with adults who have muscle‑invasive urothelial bladder cancer before agreeing a treatment option.

Commissioners (NHS England and clinical commissioning groups) ensure that they commission services in which a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist discuss neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with adults who have muscle‑invasive urothelial bladder cancer before agreeing a treatment option.

What the quality statement means for patients, service users and carers

Adults with bladder cancer that has grown into the muscle wall of the bladder have a discussion with a clinical nurse specialist and specialist bladder cancer doctors about either having their bladder removed (cystectomy) or having radiotherapy (high-energy rays that destroy cancer cells). They also discuss having chemotherapy (treatment with anticancer drugs) before having either of these treatments. 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

  • Bladder cancer (2015) NICE guideline NG2, recommendations 1.5.2 and 1.5.3

Definitions of terms used in this quality statement

Discussion

Adults with newly diagnosed muscle‑invasive urothelial bladder cancer for whom cisplatin‑based chemotherapy is suitable should be offered neoadjuvant chemotherapy using a cisplatin combination regimen before radical cystectomy or radical radiotherapy. They should have an opportunity to discuss the risks and benefits with an oncologist who treats bladder cancer.

[Bladder cancer (NICE guideline NG2) recommendation 1.5.2]

Adults with muscle‑invasive urothelial bladder cancer for whom radical therapy is suitable should be offered a choice of radical cystectomy or radiotherapy with a radiosensitiser, and have their choice of treatment based on a discussion with a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist.

The discussion includes:

  • the prognosis with or without treatment

  • the limited evidence about whether surgery or radiotherapy with a radiosensitiser is the most effective cancer treatment

  • the benefits and risks of surgery and radiotherapy with a radiosensitiser, including the impact on sexual and bowel functions and the risk of death as a result of the treatment.

[Bladder cancer (NICE guideline NG2) recommendation 1.5.3]

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.