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

ABSTRACT

OBJECTIVE: Colorectal cancer (CRC) leads to significant morbidity/mortality worldwide. Defining critical research gaps (RG), their prioritisation and resolution, could improve patient outcomes. DESIGN: RG 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. RESULTS: Fifteen 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. CONCLUSION: Prioritising research activity and funding could have a significant impact on reducing CRC disease burden over the next 5 years.