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.

A high-throughput serum Raman spectroscopy platform and methodology for colorectal cancer diagnostics

“…In this study the development of HT platforms for serum RS for the triage of colorectal referrals has been presented which has been previously presented as a critical research gap in colorectal cancer. 32 Aluminium foil proved to be a cheap and effective substrate for drying serum samples and collecting spectra, when coupled to fresh serum samples the aluminium substrate proved the most diagnostically effective with a sensitivity and specificity for colorectal cancer of 83% and 83%. Furthermore, in terms of analysis time the HT platform takes just 10 mins per sample excluding drying time.…”

Plasma miRNA‐based signatures in CRC screening programs

“…These results constitute a first attempt to refine the CRC screening workflow and could help bridge the still critical research gap in CRC related to unnecessary colonoscopies. 31 They do suggest that an intermediate step based on circulating miRNA signatures could be introduced into the CRC screening procedure, after a positive finding in the FIT test and before colonoscopy, to identify which patients could benefit most from colonoscopy. The test, on blood, is minimally invasive and could help increase compliance in screening programs.…”

Ayuno postquirúrgico en cirugía mayor abdominal electiva con bases en medicina basada en evidencias

“…Posteriormente en el 2001 se publica su tercera versión, misma que reposa en la web de la Agency for Healthcare Research and Quality (www.ahrq.gov/clinic/uspstfix.htm) (21), donde se analiza la calidad de la evidencia de una forma más elaborada y no considerando únicamente la variante de diseño de los trabajos, relacionando los mismos con un aspecto novedoso hasta entonces, la valoración coste-efectividad. (22)(23)(24) Por sus siglas (SIGN), la Scottish Intercollegiate Guidelines Network, propuso en ese mismo período otra escala para evaluar la evidencia científica. (Tablas I y II) (25)(26)(27).…”