CoSMIC-Q
Research type
Research Study
Full title
Colorectal cancer with Synchronous liver-limited Metastases: an Inception Cohort study of standardised care pathways – a Qualitative study of patient, care giver and clinician perspectives and experiences (CoSMIC-Q)
IRAS ID
213506
Contact name
Ajith Siriwardena
Contact email
Sponsor organisation
Central Manchester University Hospitals NHS Foundation Trust
Duration of Study in the UK
0 years, 6 months, 1 days
Research summary
Bowel cancer is the fourth most common cancer in the UK. In 20% of patients, bowel cancer has already spread when it is diagnosed. The disease is ‘synchronous’ when found in several places at first diagnosis. If the cancer has spread beyond the liver, only 6% of patients live more than 5 years following their diagnosis, but for patients with metastatic disease limited to the liver, surgery can improve 5-year survival to 25-40%.
The approach to surgery for patients with synchronous disease is complex. In conventional surgery, the bowel cancer is removed first, followed by chemotherapy and then surgery to remove the liver metastasis. With advances in Surgery, two other options have become possible. Synchronous surgery removes the bowel cancer and liver metastasis together in one major operation. Liver-first surgery removes the liver metastasis first as this is thought to be the source of cancer that spreads, and then the bowel cancer.
Currently, there is little evidence showing which approach is better. Thus, there is no established treatment protocol or pathway. The care of each patient is discussed amongst specialist doctors at multidisciplinary team meetings. Treatment options offered depend on a multitude of factors: aspects of the cancer, patient health and wishes, and clinical experience.
In this typically complex care plan it may be difficult for the patients’ voice to be heard and given due consideration. The focus on patient experience is important. For example, the NHS outcomes framework emphasises the importance of a positive experience of care. This experience may vary substantially according to the treatment pathway and thus the aim of the CoSMIC-Q study is to undertake a qualitative study of the patient experience in individuals with colorectal cancer with synchronous liver metastases who have had either synchronous surgery or staged treatment pathways.
REC name
South Central - Oxford C Research Ethics Committee
REC reference
16/SC/0610
Date of REC Opinion
11 Nov 2016
REC opinion
Favourable Opinion