Table 3.

Defining bladder cancer Centres of Expertise

A. Comprehensive centre of expertise
Criteria		Method of evaluation
A. A Level 1 Centre of Expertise in bladder cancer in Canada is defined as a healthcare institution that provides comprehensive clinical care for patients diagnosed with all stages of bladder cancer, with the following:
i.	Availability of a team of health professionals dedicated to bladder cancer (defined as postgraduate training, majority of practice, or academic focus), including one or more of each of the following:	CV
	a. Urologic oncologist
	b. Radiation oncologist
	c. Medical oncologist
	d. Genitourinary pathologist
	e. Genitourinary radiologist
	f. Nurse practitioner, navigator, or pivot nurse
	With availability of the following professional services
	g. Colorectal, vascular, gynecologic, plastic surgeons with expertise in reconstruction	Letters of attestation
	h. Intensive/critical care
	i. Interventional radiology
	j. Advanced imaging (MRI, PET)
	k. Stoma therapy
	l. Clinical psychology/sexology
	m. Social work
	n. Supportive and palliative care
ii.	Provides guidance and support to a regional network of primary and secondary care urologists and other physicians	Documentation, letters of attestation
iii.	Serves as a referral centre for complex genitourinary cancer patient care
iv.	Provides care in an interdisciplinary fashion	Letters of attestation clinic schedules, minutes of interdisciplinary team meetings
v.	Establishes or adopts, and adheres to evidence-based standards	Guidelines, institutional
vi.	Conducts regular multidisciplinary tumour boards or conferences with the presence at minimum of urologist(s), medical oncologist(s), radiation oncologist(s), radiologist, and GU pathologist	Minutes, schedules
vii.	Conducts clinical trial research in bladder cancer	Documentation of active trials in past 3 years
viii.	Publishes clinical and/or laboratory-based research in bladder cancer	List of publications over last 3 years
ix.	Measures and reports several indicators of clinical performance, including outcomes, compliance to guidelines, etc. that can be benchmarked	Quality of care audits with benchmarks over past 2 years
x.	Provides education to trainees, nurses, and continued medical education	Documentation
xi.	Royal College-accredited training program in urology, radiation oncology and medical oncology in good standing	Letters of attestation
xii.	Promotes bladder cancer public awareness, early diagnosis, and prevention	Documentation
xiii.	Actively participates in a nationwide network of bladder or genitourinary cancer Centres of Expertise and in patient groups	Documentation
xiv.	The centre manages greater than the annual minimum case load in the following:	Case logs or equivalent over past 3 years
	a. Radical cystectomy: 25
	b. Continent urinary diversion: 5
	c. Radiation-based definitive treatment: 5
B. Clinical Centre of Expertise
Criteria		Method of evaluation
B. A Level 2 Centre of Expertise in bladder cancer in Canada is defined as a healthcare institution that provides comprehensive clinical care for patients diagnosed with all stages of bladder cancer, with the following:
i.	Availability of a team of health professionals dedicated to urologic oncology (defined as postgraduate training, majority of practice, or academic focus), including one or more of each of the following:	CV
	a. Urologic oncologist
	b. Radiation oncologist
	c. Medical oncologist
	d. Genitourinary pathologist
	e. Nurse practitioner, navigator, or pivot nurse
	With availability of the following professional services
	f. Colorectal, vascular, gynecologic, plastic surgeons with expertise in reconstruction	Letters of attestation
	g. Intensive/critical care
	h. Interventional radiology
	i. Advanced imaging (MRI, PET)
	j. Stoma therapy
	k. Clinical psychology/sexology
	l. Social work
	m. Supportive and palliative care
ii.	Provides care in an interdisciplinary fashion	Letters of attestation, clinic schedules, minutes of interdisciplinary team meetings
iii.	Adheres to evidence-based standards of practice and guidelines	Guidelines
iv.	Conducts regular multidisciplinary tumour boards or conferences with the presence of urologist(s), medical oncologist(s), radiation oncologist(s), radiologist, and pathologist	Minutes, schedules
v.	Measures and reports several indicators of clinical performance, including outcomes, compliance to guidelines, etc.	Quality of care audits with benchmarks over past 2 years
vi.	Provides education to trainees, nurses, and continued medical education	Documentation
vii.	Promotes bladder cancer public awareness, early diagnosis, and prevention	Documentation
viii.	Actively participates in a nationwide network of bladder or genitourinary cancer Centres of Expertise and in patient groups	Documentation
ix.	The centre manages greater than the annual minimum case load in the following:	Case logs or equivalent over past 3 years
	a. Radical cystectomy: 25
	b. Continent urinary diversion: 5
	c. Radiation-based definitive treatment: 5