Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer

Abstract

ObjectiveColorectal cancer (CRC) leads to significant morbidity/mortality worldwide. Defining critical research gaps (RG), their prioritisation and resolution, could improve patient outcomes.DesignRG analysis was conducted by a multidisciplinary panel of patients, clinicians and researchers (n=71). Eight working groups (WG) were constituted: discovery science; risk; prevention; early diagnosis and screening; pathology; curative treatment; stage IV disease; and living with and beyond CRC. A series of discussions led to development of draft papers by each WG, which were evaluated by a 20-strong patient panel. A final list of RGs and research recommendations (RR) was endorsed by all participants.ResultsFifteen critical RGs are summarised below:RG1: Lack of realistic models that recapitulate tumour/tumour micro/macroenvironment;RG2: Insufficient evidence on precise contributions of genetic/environmental/lifestyle factors to CRC risk;RG3: Pressing need for prevention trials;RG4: Lack of integration of different prevention approaches;RG5: Lack of optimal strategies for CRC screening;RG6: Lack of effective triage systems for invasive investigations;RG7: Imprecise pathological assessment of CRC;RG8: Lack of qualified personnel in genomics, data sciences and digital pathology;RG9: Inadequate assessment/communication of risk, benefit and uncertainty of treatment choices;RG10: Need for novel technologies/interventions to improve curative outcomes;RG11: Lack of approaches that recognise molecular interplay between metastasising tumours and their microenvironment;RG12: Lack of reliable biomarkers to guide stage IV treatment;RG13: Need to increase understanding of health related quality of life (HRQOL) and promote residual symptom resolution;RG14: Lack of coordination of CRC research/funding;RG15: Lack of effective communication between relevant stakeholders.ConclusionPrioritising research activity and funding could have a significant impact on reducing CRC disease burden over the next 5 years.