PROJECT SUMMARY/ABSTRACT
Colorectal cancer (CRC) is an emerging public health problem in South Africa (SA). Preliminary research from
KwaZulu-Natal (KZN), SA shows that 23% of newly diagnosed CRC patients in the public healthcare sector will
fail to engage in oncology care (FEOC). This complicates oncologists’ and oncologic surgeons’ efforts to
effectively manage CRC disease in this setting. There are a variety of resource-intensive interventions for
addressing FEOC. However, implementing these in all newly diagnosed CRC patients would be unfeasible,
given the high patient volumes and existing resource constraints in the SA public healthcare sector. A clinical
prediction rule (CPR) is proposed for identifying newly diagnosed SA CRC patients who are at high risk of
FEOC, thereby enabling more efficient targeting of these specific, high risk patients for interventions which seek
to address FEOC. The CPR will be developed by: 1) Identifying potential predictors of FEOC in CRC populations
through a systematic review of the literature and a survey of 109 patients; 2) Constructing an appropriate
electronic data collection tool that will streamline prospective data collection for these potential predictors and
the study outcome, FEOC, from a cohort of 398 newly diagnosed CRC patients; and 3) Applying machine
learning methods to the data to derive and internally validate the CPR. The CPR will be an important first step
in tackling the high FEOC rates amongst newly diagnosed CRC patients in KZN, SA and will ultimately contribute
toward improving both CRC disease management and patient outcomes in this setting. The proposed K43
research has the potential to be scaled up to the national level, and this will be the basis of a future R01 grant
application. Dr. Moodley (K43 applicant) wants to become an independent gastrointestinal cancer epidemiologist
and a global leader in CPRs, particularly CPRs that seek to address breakdowns in linkage to care and reduce
the burden of disease attributed to gastrointestinal cancers, such as CRC. This award will provide him with
protected time to conduct the proposed research and engage in an intensive career development program while
based at one of the top universities in SA, the University of KwaZulu-Natal. He will be mentored by esteemed
senior researchers from SA (Prof. Thandinkosi Madiba, University of KwaZulu-Natal) and the US (Prof. Ravi
Pokala Kiran, Columbia University) who have a strong track record of mentoring young researchers. A research
advisory committee, comprised of other senior researchers, will provide additional research and career guidance
to Dr. Moodley. This will be coupled with didactic and “hands on” training in the core competencies required to
develop CPRs. It is envisioned that by the end of his K43 training, Dr. Moodley will have developed the proposed
CPR and generated new preliminary data. He will use this new data to successfully apply for an R01 grant, thus
establishing his independence as gastrointestinal cancer epidemiologist and a global leader in CPRs.
