April is bowel cancer awareness month, aimed at raising awareness of this condition. Throughout this blog we discuss bowel cancer, screening methods, early diagnosis, treatment options, innovation, the impact of the COVID-19 pandemic and the important role Real World Evidence has in improving outcomes for patients.

What is bowel cancer?

Bowel cancer (or colorectal cancer) focuses on a group of malignancies that are found in the colon and rectum. In the UK, Bowel cancer is the fourth most common cancer and the second biggest cancer killer with over 42,000 people diagnosed each year. Around 268,000 people are living with a bowel cancer diagnosis in the UK.

More than nine out of ten of new cases of bowel cancer are diagnosed in those over 50. However recent studies point to the increasing incidence of bowel cancer in those aged between 20 – 49 years of age, with more than 2,500 new cases being diagnosed each year in people under the age of 50. Initiatives such as the ‘Never Too Young’ are campaigning to raise awareness of bowel cancer in younger people.

Whilst significant progress has been made, there remains some unanswered questions around the causes of the disease, but we do know old age is the main risk factor. Cancer Research UK have shown that eating too little fibre causes 28% of bowel cancer cases, 13% caused from eating processed meat and 11% from obesity. Other risk factors include - family history, smoking status, alcohol consumption, inactivity, digestive disorders, and genetic conditions.

The importance of primary care data in early diagnosis in bowel cancer

Data collected in the primary care setting can help us understand how things such as age, weight and other lifestyle factors may affect a patient’s risk of developing bowel cancer. IQVIA Medical Research Data (IMRD) (incorporating data from The Health Improvement Network (THIN), a Cegedim Database) captures a rich source of primary care data - including coded demographic, administrative data, clinical events, prescriptions, with secondary care and death information. Medical Research Data covers approximately 4.5% of the UK population and provides a valuable source of nationally representative and generalisable data that can be used for robust scientific retrospective cohort studies.

Diagnosing bowel cancer at the earliest stage

Cancer screening is a key tool in the fight against bowel cancer. Early diagnosis from screening ensures that treatment is given early when it is most effective. Early diagnosis can also mean that the tumour is caught before it has had the chance to spread to other parts of the body, which greatly improves treatment outcomes.

The COVID-19 pandemic has impacted screening. Insights from IQVIA’s Impact of COVID-19 on the treatment of cancer and the Cancer Won’t Wait report highlight the repercussions of the pandemic on screening services both in the UK and beyond.

Screening for bowel cancer

The most common methods of bowel cancer screening in the UK is the Faecal Immunochemical Test (FIT) which is taken at home and then mailed to the hospital to looks for tiny traces of blood, with those with abnormal results invited for a type of endoscopy called a colonoscopy. Bowel cancer is diagnosed in 12-15% of men and 8% of women who have colonoscopy or other investigation following an abnormal bowel cancer screening result in England and Scotland. COVID-19 is also having a significant impact on the amount of people attending gastrointestinal endoscopies – current predictions suggest it will take a year to eliminate the pandemic-related backlog. The Cancer won’t Wait report discusses how delays caused in patients accessing diagnostic services are affecting cancer treatment and survival, and how these delays are likely to have an impact for many years to come.

The importance of innovation in bowel cancer

Improved screening methods and treatments mean that bowel cancer survival in the UK has more than doubled in the last 40 years, but we still have a long way to go. In March 2021 the NHS announced it would roll out capsule cameras to test for bowel cancer. This imaging technology is cased within a capsule no bigger than a pill, can provide a diagnosis within hours and can be done from the person’s home. Innovative technologies mean that more cancers will be diagnosed at an earlier stage – when the chances of survival are highest. Generally cancers are grouped into those discovered at an ‘early stage’ or those that are found at a ‘late stage’, when the cancer has become advanced. Both the treatment plan and prognosis for patients diagnosed at the different stages vary, although many factors are considered when a patient’s treatment plan is being developed.

With 54% of bowel cancer cases being preventable, increased awareness is crucial, along with early diagnosis given that an estimated 9 in 10 people will survive bowel cancer if diagnosed at the earliest stage. Further understanding of the microbiome and its impact in bowel cancer along with innovative targeted therapies (such as immunotherapy) and personalised medicine, will also help us to improve outcomes and quality of life for those living with bowel cancer.

Another important innovation in the diagnosis and treatment of bowel cancer, is our increased understanding of the role of our genome. The UK government have set out the Genome UK: the future of healthcare strategy to ensure patients are offered the best possible predictive, preventive, and personalised care by leveraging the potential of advanced genome sequencing.

IQVIA and Genomics England have collaborated to create a platform for clinical and observational research that is able to provide genomic testing to patients in parallel or as part of their clinical programs. This innovative platform can help to advance precision medicine and patients’ access to novel therapies, with the goal of delivering the right drugs to the right patients at the right time.

The treatment of bowel cancer

Treatment in bowel cancer is dependent on many different factors and tumour characteristics. The main factors include where the cancer is detected and how far the cancer has spread. The way oncologists treat patients has changed over the years as medicine and diagnostic technology advance – important criteria now include the patient’s own genetic makeup.

Typically surgery is the main treatment method with 63% - 66% of patients having surgery to remove their tumour. Curative or palliative chemotherapy is given to 31% - 42% of patients and curative or palliative radiotherapy is given to 3% - 41% of patients. The COVID-19 pandemic has meant that temporary changes have been made to how bowel cancer is treated. Changes such as the use of immunotherapies instead of chemotherapies, to reduce the chances of patients developing neutropenia, which makes them much more susceptible to infection have been implemented.

A significant development in bowel cancer is that of the approval of targeted therapies. Targeted therapies, such as immunotherapy, are designed to find and attack cancer cells, proteins, or nucleic acids specifically. These targeted therapies offer those with specific subsets of the disease a real ‘step change’ in the treatment of their cancer.

IQVIA’s Oncology Insights Simulator offers researchers the potential to look at many different aspects of bowel cancer treatment, by leveraging synthetic data from one of the most detailed cancer databases in the world – the National Cancer Registration database. An example of this data source being used to making a difference is in the modification of systemic anti-cancer therapies and weight loss study.

Looking to the future to improve treatment options for all bowel cancer patients will include many different approaches. IQVIA’s collaboration with DATA-CAN, the Health Data Research Hub for cancer, has the ambition to use Real World Evidence to drive improvements in quality of care and to increase treatment options for all cancer patients. IQVIA’s Cancer Data Network, developed as part of DATA-CAN, helps trust to leverage real time data on cancer services and the use of treatments to support operational decisions. In addition, organisations will benefit from a trial matching solution which supports study design, feasibility, and recruitment. Researchers are also be able to access this Real World Data to run protocolised and non-protocolised research studies to further contribute to efforts to improve patient experiences and outcomes in cancer care. The COVID-19 pandemic has really shown the important of near real time data to support the national response to the pandemic – the Cancer Data Network will enable key insights into treatment patterns, and how events (such as the pandemic) may impact on patient outcomes.

The benefit of Real World Evidence in advancing treatments and improving outcomes in bowel cancer is clear

This insight generated from Real World Data is already making a difference in clinical care and policy decisions. Health technology assessments bodies such as the UK National Institute for Health and Care Excellence (NICE) recognises the benefit for guidance development, the US Food and Drug Administration (FDA) in health care decisions and influential industry voices in modernising oncology approvals.

Selecting the right Real World Data is key to supporting your research – use this guide to help you. To get more information on how Real World Evidence can help you get closer to improving outcomes for cancer patients, get in touch: stephen.benson@iqvia.com.