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

Research output: Contribution to journalArticle


  • Mark Lawler
  • Deborah Alsina
  • Richard A. Adams
  • Annie S. Anderson
  • Gina Brown
  • Nicola S. Fearnhead
  • Stephen W. Fenwick
  • Stephen P. Halloran
  • Daniel Hochhauser
  • Mark A. Hull
  • Viktor H. Koelzer
  • Angus G. K. McNair
  • Kevin J. Monahan
  • Inke Näthke
  • Christina Norton
  • Marco R. Novelli
  • Robert J. C. Steele
  • Anne L. Thomas
  • Lisa M. Wilde
  • Richard H. Wilson
  • Ian Tomlinson
  • Bowel Cancer UK Critical Research Gaps in Colorectal Cancer Initiative

Colleges, School and Institutes


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.


Original languageEnglish
Pages (from-to)179-193
Issue number1
Early online date12 Dec 2017
Publication statusPublished - Jan 2018