Presentation (CTI)

OBJECTIVES: Timely diagnosis, efficient patient flow, and coordinated care are essential for delivering value-based treatment in urothelial carcinoma (UC). However, in many healthcare systems, fragmentation and limited multidisciplinary collaboration persist. To identify organizational bottlenecks and opportunities for improving the patient journey in UC care in Bulgaria, with a focus on the role of multidisciplinary teams (MDTs), referral patterns, and timeliness of care.
METHODS: A structured survey and in-depth interviews were conducted with 30 leading Bulgarian oncologists specializing in UC. The questionnaire, based on international best practices, assessed seven domains: patient flow, quality of life, health outcomes, patient satisfaction, symptom impact, unmet needs, and therapy trends. Responses were analyzed to extract key patterns and challenges.
RESULTS: The majority of patients are diagnosed at Stage I, primarily referred by urologists (97%). While most treatment decisions are made within tumor boards, 17% of UC cases lacked regular MDT discussions. Only 37% of oncology committees included a full multidisciplinary team (urologists, oncologists, radiologists, pathologists), while 20% were comprised solely of oncologists. Follow-up care relied almost exclusively on scheduled visits, with minimal use of digital monitoring tools. Despite generally fast treatment initiation (63% within 1-2 weeks of diagnosis), delays remain for a third of patients. Critical gaps were identified in patient education, data coordination, and post-treatment monitoring.
CONCLUSIONS: This research highlights systemic inefficiencies in the UC patient journey, particularly around multidisciplinary engagement and follow-up strategies. To align with value-based care principles, there is a pressing need to formalize MDT meetings, expand telemonitoring in follow-up, and implement integrated care pathways. These steps can significantly enhance care quality and patient outcomes in urothelial carcinoma.