1. Patient Journey Challenges

1.1 Diagnostic Delays: Significant delays from symptom onset—particularly hematuria—to diagnosis and treatment initiation. Many patients visit multiple institutions before specialist referral.

1.2 Fragmented Referral Systems: Private and public sectors operate in silos without integrated referral frameworks, complicating access to specialized care.

1.3 Late-Stage Presentations: Delays lead to advanced-stage diagnoses (muscle-invasive or metastatic), reducing treatment options.

2. Root Causes Identified

2.1 Public Awareness Gaps: Low awareness of hematuria as a cancer symptom delays care-seeking.

2.2 Primary Care Gaps: Generalists may misattribute red flags, leading to repeated antibiotics and missed opportunities.

2.3 System Inefficiencies: Bottlenecks, missing workups, and unclear specialty roles exacerbate delays.

2.4 Lack of Standardized Guidelines: Absence of national protocols for referral timelines and MDT engagement causes variability.

3. Solutions & Recommendations

3.1 National Referral Pathways: Implement clear referral criteria, mandatory checklists (imaging, cytology, PSA), and time benchmarks (specialist visit within 2 weeks, treatment initiation within 4 weeks).

3.2 Specialized Clinics: Establish hematuria clinics for same-day evaluation and regional centers of excellence for coordinated GU cancer care.

3.3 Multidisciplinary Tumor Boards: Require case discussions at MDTs with cross-sector and virtual participation.