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

Abstract

Colorectal cancer (CRC) leads to significant morbidity/mortality worldwide. Defining critical research gaps (RG), their prioritisation and resolution, could improve patient outcomes. 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. Fifteen critical RGs are summarised below: <i>RG1</i>: Lack of realistic models that recapitulate tumour/tumour micro/macroenvironment; <i>RG2</i>: Insufficient evidence on precise contributions of genetic/environmental/lifestyle factors to CRC risk; <i>RG3</i>: Pressing need for prevention trials; <i>RG4</i>: Lack of integration of different prevention approaches; <i>RG5</i>: Lack of optimal strategies for CRC screening; <i>RG6</i>: Lack of effective triage systems for invasive investigations; <i>RG7</i>: Imprecise pathological assessment of CRC; <i>RG8</i>: Lack of qualified personnel in genomics, data sciences and digital pathology; <i>RG9</i>: Inadequate assessment/communication of risk, benefit and uncertainty of treatment choices; <i>RG10</i>: Need for novel technologies/interventions to improve curative outcomes; <i>RG11</i>: Lack of approaches that recognise molecular interplay between metastasising tumours and their microenvironment; <i>RG12</i>: Lack of reliable biomarkers to guide stage IV treatment; <i>RG13</i>: Need to increase understanding of health related quality of life (HRQOL) and promote residual symptom resolution; <i>RG14</i>: Lack of coordination of CRC research/funding; <i>RG15</i>: Lack of effective communication between relevant stakeholders. Prioritising research activity and funding could have a significant impact on reducing CRC disease burden over the next 5 years.