Table 1

Critical RGs in colorectal cancer

Research area	Critical RGs
Discovery science	RG1: A need for realistic in silico, in vitro and in vivo models that more precisely recapitulate the tumour and its micro/macroenvironment, to enable comprehensive dissection of the relevant mechanisms governing the transition from normal colorectum to the different malignant stages of the disease.
Risk	RG2: Insufficient evidence on the precise contributions of genetic, environmental and lifestyle factors, and in particular how they interact together, to influence the risk of developing CRC.
Prevention	RG3: A need for intervention trials of preventive strategies addressing ‘dose’, timing, target group and acceptability, as well as mechanism of action.
Prevention	RG4: Lack of interdisciplinary collaboration is undermining evaluation of real-life preventative interventions in CRC.
Early diagnosis and screening	RG5: Lack of an optimal strategy for screening for CRC.
Early diagnosis and screening	RG6: Lack of an effective triage system for symptomatic patients that can determine who will benefit most from invasive investigation.
Pathology: diagnosis – prognosis – prediction	RG7: Imprecise pathological assessment of CRC is an unmet challenge.
Pathology: diagnosis – prognosis – prediction	RG8: Lack of qualified personnel to apply state-of-the-art knowledge in genomics, big data science and digital pathology.
Curative treatment	RG9: Inadequate assessment and communication of risk, benefit and uncertainty of treatment choices where cure is possible.
Curative treatment	RG10: A need for novel technologies/interventions that have the potential to improve curative outcomes.
Stage IV disease	RG11: Lack of approaches that take cognisance of the molecular interplay between the metastasising tumour and its microenvironment and help guide evolution of innovative treatments that deliver improved health outcomes for the stage IV patient.
Stage IV disease	RG12: Lack of reliable prognostic and predictive biomarkers to help guide stage IV patient pathways.
Living with and beyond CRC	RG13: The need to increase understanding of health-related quality of life (HRQOL) issues and resolve residual symptoms as part of a research effort to enhance survivorship for those living with and beyond CRC.
Overarching RGs that need to be addressed	RG14: Lack of coordination of CRC research and its funding, leading to fragmented efforts to elucidate the biology of the disease and translate this knowledge into new preventative agents, screening tools, diagnostics and therapeutics.
Overarching RGs that need to be addressed	RG15: Lack of effective communication strategies between healthcare professionals, patients with CRC/survivors, those at elevated risk of developing CRC, and the general public and varying levels of awareness of key risk factors, prevention options and benefits/risks associated with different treatment options.

CRC, colorectal cancer; RG, research gap.