Table 1

Critical RGs in colorectal cancer

Research areaCritical RGs
Discovery scienceRG1: 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.
RiskRG2: 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.
PreventionRG3: A need for intervention trials of preventive strategies addressing ‘dose’, timing, target group and acceptability, as well as mechanism of action.
RG4: Lack of interdisciplinary collaboration is undermining evaluation of real-life preventative interventions in CRC.
Early diagnosis and screeningRG5: Lack of an optimal strategy for screening for CRC.
RG6: Lack of an effective triage system for symptomatic patients that can determine who will benefit most from invasive investigation.
Pathology: diagnosis – prognosis – predictionRG7: Imprecise pathological assessment of CRC is an unmet challenge.
RG8: Lack of qualified personnel to apply state-of-the-art knowledge in genomics, big data science and digital pathology.
Curative treatmentRG9: Inadequate assessment and communication of risk, benefit and uncertainty of treatment choices where cure is possible.
RG10: A need for novel technologies/interventions that have the potential to improve curative outcomes.
Stage IV diseaseRG11: 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.
RG12: Lack of reliable prognostic and predictive biomarkers to help guide stage IV patient pathways.
Living with and beyond CRCRG13: 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 addressedRG14: 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.
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.