SOCCER

Overview

The Symptoms of Colorectal Cancer Evaluation Research (SOCCER) study was a clinical study using information collected on people who had symptoms that could be caused by bowel cancer and had been referred by their doctor for further tests. SOCCER is closely linked to the SIGGAR study.

Why was this study needed?

When a person visits their doctor with signs or symptoms that could be caused by bowel cancer they might be offered a test that can examine the whole large bowel to look for any cancer or polyp (a small growth that can turn into cancer). This whole bowel examination is most likely to be a colonoscopy.

A study in 2008 had shown that some signs of bowel cancer were more common in people with cancer in the lower part of the large bowel. This suggested that further tests for these patients with a method called flexible sigmoidoscopy was as safe and effective as a colonoscopy (both described below). The study also suggested that other symptoms were more common in people with cancer in parts of the bowel that are out of reach of the flexible sigmoidoscopy.

More evidence was needed though to find out when a flexible sigmoidoscopy was safe and effective for diagnosing bowel cancer, and when it was less effective.

What is flexible sigmoidoscopy?

A flexible sigmoidoscopy is a type of camera examination. It is similar to a colonoscopy in that a doctor passes a camera on the end of a thin tube into a patient’s bottom and up into the bowel to look for any cancer and polyps (which can turn into cancer). A colonoscopy looks at all of the large bowel, while a flexible sigmoidoscopy examines just the lower part of the large bowel.

Flexible sigmoidoscopy has some potential benefits over colonoscopy for patients and for health services. It doesn’t need patients to be sedated, takes less time, has less risk of going wrong and is less expensive than a colonoscopy.

What were the aims of the SOCCER study?

The SOCCER study followed on from the 2008 study on bowel cancer symptoms. We aimed to provide more evidence to show when flexible sigmoidoscopy could be an effective and safe alternative to colonoscopy for diagnosing bowel cancer.

How was the study carried out?

SOCCER was a retrospective, observational analysis, which means we looked at information from patient treatments that had already happened. We also looked again at patient treatment information we had previously collected for an earlier study of ours called SIGGAR.

When and where did the study take place?

Information for the SOCCER study came from patients who had previously registered for our SIGGAR study that took place between 2004 and 2007. These patients had given consent for their health information to be used for other cancer research studies, such as SOCCER.

Who funded the SOCCER study?

This study was funded by the National Institute for Health Research Health Technology Assessment (NIHR-HTA) programme and Cancer Research UK.

What are the results of the study and what impact have they had?

The results of SOCCER confirmed what the earlier 2008 study had suggested. Patients with specific symptoms of bowel cancer could be examined with just a flexible sigmoidoscopy procedure rather than needing a full colonoscopy. These symptoms are either having to poo more often or bleeding from the bottom.

However, some patients with these symptoms should still have a full colonoscopy. This includes patients who:

• Have one or both of these symptoms, combined with anaemia and/or an abdominal mass (lump in tummy).
• Have to poo more often and have any other potential symptom of bowel cancer, for example tummy pain or weight loss.

The SOCCER study findings were published in 2017 in the British Journal of Cancer and the NIHR-HTA Journals Library.

Our findings will help advise doctors on the best tests for their patients for diagnosing bowel cancer based on their symptoms. We hope that evidence from SOCCER will ensure that patients receive the tests that most benefits them as well as reduce unnecessary colonoscopy procedures for health services.