City academics part of team undertaking a £3m NIHR project to investigate how to deliver bowel cancer care more effectively.

By Mr Shamim Quadir (Senior Communications Officer), Published (Updated )

Academics at the School of Health Sciences at City, University of London are collaborating with colleagues at The Royal Marsden NHS Foundation Trust and Institute of Cancer Research (ICR) on a new £3 million, eight-year long study, funded by the National Institute for Health Research (NIHR).

The City academics will work on the health economics aspect of the study, to investigate how cost-effective a new diagnostic blood test for residual, microscopic bowel cancer may be.

New blood test

Launched in January, and led by Professor David Cunningham, Director of the NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research, the study will evaluate the use of a new blood test to precisely guide who should be offered chemotherapy after surgery for bowel cancer.

Bowel cancer is the third most common cancer in both men and women in the UK, with more than 40,000 people diagnosed each year. While most patients have an operation to remove the cancerous tumour, unfortunately, in around half of these patients the cancer returns and chemotherapy is generally offered to reduce the chance of this happening. Chemotherapy works by killing off microscopic sized cancer cells left behind after surgery.

Untreated, this microscopic disease causes the cancer to return, often within three years. Understandably, many patients choose to receive chemotherapy hoping to improve their chances of a cure.

However, around half of these patients do not have microscopic disease and are successfully treated by surgery alone, and receiving chemotherapy also produces side-effects. The more serious side-effects can include damage to the patient’s nerves in their hands and feet, life threatening infections, cardiac chest pain, and blood clots.

Detecting microscopic cancer

A test has now been developed for the detection and measurement of microscopic cancer through analysis of blood samples, measuring the DNA shed from microscopic size cancer cells into a patient’s bloodstream.

Several small studies have already suggested that a positive DNA blood test after surgery accurately predicts those patients in whom the cancer has returned. The research team have an established network of UK hospitals which has already recruited patients undergoing surgery for bowel cancer to this larger, national study, and will continue to recruit to the study in the future. If the national study is successful, the next step would be to use each patient's DNA blood test to precisely guide recommendations for their chemotherapy treatment after surgery.

Health economics

Dr Kyriaki Giorgakoudi, Senior Research Fellow, Division of Health Services Research Management, School of Health Sciences, is leading the health economic work on the study, with Dr Charitini Stavropoulou, Co-director of the Centre for Healthcare Innovation Research (CHIR) at City, completing the health economics team.

Reflecting on the launch of the new grant, Dr Giorgakoudi said:

"If our study shows this new blood test to be effective, then policy makers will be deciding on whether to introduce it in the NHS. The cost-effectiveness analysis, which is part of the work we will be doing here at City, will provide them with important health economic evidence. Such evidence is crucial, as it indicates which health interventions will give the most health benefits. It therefore supports decision makers in making difficult decisions on how to allocate limited funds in a fair way."

Further information

Find out more about the study on the Royal Marsden’s news page.

Read the trial information on the National Institute for Health Research website.

About the academic

Dr Kyriaki Giorgakoudi joined City, University of London as Senior Research Fellow in Economic Evaluation in October 2019. She also holds an honorary contract with The Royal Marsden NHS Foundation Trust and is a Fellow of the Higher Education Academy.

Dr Giorgakoudi has overlapping research interests in mathematical modelling, health economics, biomathematics, cancer and infectious diseases and has experience working in highly interdisciplinary environments.


This project (NIHR 128529) is funded by the Efficacy and Mechanism Evaluation (EME) Programme, an MRC and NIHR partnership. The views expressed in this publication are those of the author(s) and not necessarily those of the MRC, NIHR or the Department of Health and Social Care.

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