AzTrials
AzTrials

Low Anterior Resection SyndromePOLARiSNCT05319054

Pathway of Low Anterior Resection Syndrome Relief After Surgery: a Feasibility Study

A study testing Sacral NeuroModulation, Trans-Anal Irrigation and Optimised Conservative Management in people with Low Anterior Resection Syndrome, run by Cardiff and Vale University Health Board at 4 sites in United Kingdom.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

Currently, no standard exists for the treatment and management of Low Anterior Resection Syndrome (LARS)- a common disorder that affects patients who have had part of their bowel removed due to colorectal cancer. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Low Anterior Resection Syndrome
What is being tested?
Sacral NeuroModulation, Trans-Anal Irrigation and Optimised Conservative Management
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
187 participants
Where
4 sitesUnited Kingdom
Study dates
23 May 2022to 30 Sep 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • For cohort:
  • Diagnosis of rectal or sigmoid cancer
  • Low or high anterior resection (colorectal resection with anastomosis to the rectum)
  • Functioning anastomosis
  • Aged 18 years and older
  • Primary surgery/reversal of ileostomy less than 10 years before recruitment
Show all 13Show fewer
  • Reversal of ileostomy at least 12 weeks prior to recruitment with at least a further 12 weeks of standard care to manage symptoms following reversal
  • Willing and able to provide valid informed consent
  • For randomisation:
  • Recruited to cohort study
  • Willing and able to provide valid informed consent for randomisation
  • Major LARS symptoms (Defined as score of 30+ on LARS scoring tool)
  • Previous unsuccessful conservative treatment determined by treating clinician and patient

Who cannot join

  • For cohort
  • Inability to understand and complete study questionnaires independently. (Due to cognitive or intellectual impairment, Due to insufficient English language skills)
  • For randomised control trial
  • Pregnancy
  • No previous conservative treatment plan for the management of LARS
  • Does not meet any treatment-specific criteria
Show all 19Show fewer
  • For TAI randomisation:
  • Unable to perform TAI
  • History of anastomotic leak with evidence of ongoing leak/sinus
  • Previous use of TAI for LARS
  • Site unable to offer TAI as a treatment
  • Any other contraindications advised by the care team, product manufacturer or distributor
  • For SNM randomisation:
  • <12months since primary cancer surgery
  • Palliative disease
  • Site unable to offer SNM as a treatment
  • Previous SNM
  • Specific contraindications to implantation
  • Any other contraindications advised by the care team, product manufacturer or distributor.

Trial locations and contacts

4 sites in 1 country.

United Kingdom4 sites
  • Julie Cornish

    Cardiff, CF14 4XW

  • Leeds Teaching Hospital NHS Trust

    Leeds, Yorkshire, LS9 7TF

  • Royal Gwent Hospital

    Newport, NP20 2UB

  • University Hospital Southampton NHS Foundation Trust

    Southampton, Hampshire, SO16 6YD

Other trials in United Kingdom

About this study

Official title: A Feasibility, Multicentre Randomised Control Trial Assessing the Treatment Options for Patient With Major Low Anterior Resection Syndrome to Establish a Pathway Of Low Anterior Resection Syndrome Relief After Surgery

Currently, no standard exists for the treatment and management of Low Anterior Resection Syndrome (LARS)- a common disorder that affects patients who have had part of their bowel removed due to colorectal cancer. Decisions about which treatment patients receive is at the discretion of local clinicians, leading to a variation in both clinical practice and the outcomes of these patients. As a result, there is a need for research to assess what treatments are most effective in treating or managing LARS to establish a consensus and develop a treatment pathway in the UK. This study aims to assess the feasibility of undertaking such a trial utilising a novel 'trial within cohorts (TWiCs)' study design, with a view to informing the design of a full-scale trial.

Read the detailed description

Rectal cancer (cancer of the lower part of the bowel) is one of the most prevalent forms of cancer, and affects approximately 14,000 people each year in the UK. The treatment for the majority of these patients is surgical removal of the affected part of the bowel, following which the bowel is joined back together. Some patients may also require chemotherapy and radiotherapy. One consequence of the treatment of bowel cancer is a severe form of bowel dysfunction called major Low Anterior Resection Syndrome (LARS).

LARS is a constellation of symptoms including incontinence to stool, urgency and frequency of bowel movements and incomplete evacuation; it is diagnosed using the LARS scoring tool. Major LARS can have a huge impact on the persons quality of life resulting in social isolation. Currently there are no guidelines for the management of LARS. The aim of the POLARiS study is to investigate three different treatments for major LARS; optimised conservative management, a combination of diet, medication, bowel retraining and pelvic floor exercises; transanal irrigation, washing out the back passage of stool with warmed water; and sacral nerve stimulation where an electrical impulse delivered to the sacral nerve to help with bowel function. This feasibility study aims to test the study design ahead of a larger fully powered randomised control trial. The study will firstly recruit any consenting adult who has had surgery for rectal cancer (called an anterior resection) and who does not have a stoma, into a cohort and then follow up those patients every 3 months with bowel function and quality of life assessments. Any patient found to have major LARS (LARS score over 30) will be invited into the randomised control trial where the above three treatments will be tested.

Being tested
Sacral NeuroModulation, Trans-Anal Irrigation, Optimised Conservative Management
Keywords
Sacral Neuromodulation, Transanal Irrigation, Trials within cohorts, Colorectal cancer, Quality of Life
Medical subject headings
Low Anterior Resection Syndrome, Colorectal Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Sacral NeuroModulationDevice

    Sacral Neuromodulation group will include up-to 20 patients with major LARS. Medtronic Interstim system will be used, including 2 week trial device.

  • Trans-Anal IrrigationDevice

    Trans-Anal irrigation group will include up-to 20 patients with major LARS. Specific system will be agreed with the patient, depending on eligibility and preference.

  • Optimised Conservative ManagementOther

    Optimised conservative management will include up-to 30 patients with major LARS. They will be provided with a resource booklet which includes dietary and lifestyle advice as well as exercises that can be undertaken independently.

Study groups in NCT05319054
Study groupRoleWhat they receive
CohortNo interventionPatients who have undergone colonic resection for colorectal cancer in the last 10 years. Patient reported outcome measures collected at 3-monthly intervals.
Optimised Conservative ManagementActive comparatorCohort participants who are identified as having 'major LARS' at any point are treated with Optimised Conservative Managements, consisting of medication, dietary advice, lifestyle advice and physiotherapy.
Receives: Other: Optimised Conservative Management
Trans-Anal IrrigationActive comparatorCohort participants who are identified as having 'major LARS' at any point are treated with Trans-anal irrigation, in additional to receiving optimised conservative management. Transanal irrigation system will be decided upon with the participant and procured locally.
Receives: Device: Trans-Anal Irrigation; Other: Optimised Conservative Management
Sacral NeuroModulationActive comparatorCohort participants who are identified as having 'major LARS' at any point are treated with Sacral Neuromodulation system, in addition to receiving optimised conservative management. Medtronic Interstim system will be used.
Receives: Device: Sacral NeuroModulation; Other: Optimised Conservative Management

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Recruitment rate of to cohort arm of study

    The total number of participants enrolled into the study over the recruitment period.

    Measured: 9 months

  2. Assess characteristics of patients recruited to the cohort

    We will record basic demographics, medical history and prevalence of relative symptoms of participants enrolled in the cohort study to describe the characteristics of no- minor- and major- LARS patients

    Measured: 9 months

  3. Prevalence of 'major LARS' in the patient cohort

    The number of participants in the cohort that meet the criteria for 'major low anterior resection syndrome (LARS)', as measured by the LARS scoring tool. LARS scoring tool produces a score from 0 - 42, which represents the severity of symptoms, where 0 is least severe and 42 is most severe. Score =>30 is considered 'major LARS'. LARS score will be measured at 5 times at 3-monthly intervals over 12 months.

    Measured: 12 months

  4. Onset of 'major LARS' symptoms in relation to surgery

    The time (in months) from resection surgery to onset of 'major LARS' symptoms, as reported by the LARS scoring tool.

    Measured: Time from surgery to onset of major LARS, up to 10 years.

  5. Onset of 'major LARS' symptoms in relation to radiotherapy treatment

    The time (in months) from completing radiotherapy treatment to onset of 'major LARS' symptoms, as reported by the LARS scoring tool.

    Measured: Time from ending radiotherapy treatment to onset of major LARS, up to 10 years.

  6. Recruitment rate to randomised trial part of the study

    The total number of cohort participants that are enrolled into the randomised trial part of the study, over the recruitment period.

    Measured: 9 months

  7. Proportion of randomised participants that are allocated to each trial arm

    The proportion of randomised participants that meet the criteria for, and are allocated to, each of the three trial arms (transanal irrigation; sacral neuromodulation; optimised conservative management).

    Measured: 9 months

  8. Describe variation in clinical practice across UK sites

    Where possible, we will record patient's previous treatments and interactions with health services in relation to their bowel dysfunction symptoms. This will be used to describe the variation in UK clinical practice in terms of diagnosis, management and treatment pathways.

    Measured: Up to 10 years prior to recruitment

  9. Compliance of participants to the study programme

    The proportion of participants that complete and return follow-up questionnaires (four questionnaires at 3-month intervals).

    Measured: 12 months

  10. Adherence of participants to the treatment programme

    The proportion of patients that continue to receive the treatment assigned to them at the end of the follow-up period.

    Measured: 12 months

Secondary outcomes (7)
  1. Change in LARS score

    LARS score will be measured at 5 time points (at 3-monthly intervals from baseline to 12 months) to assess severity of bowel dysfunction. Self-reported by participants using the LARS scoring tool (min 0, max 42) where higher score denotes greater severity of symptoms.

    Measured: 12 months.

  2. Change in EuroQuol 5-Dimension Health-related Quality of Life instrument (5-level) (EQ-5D-5L)

    Patient-reported quality of life will be measured using the EuroQuol 5-Dimension Health-related Quality of Life instrument (5-level) (EQ-5D-5L) at 5 time-points (3-monthly intervals from baseline to 12 months). Quality of life total score will be calculated (min 5; max 25), where reduction in total score represents improvement in quality of life.

    Measured: 12 months

  3. Change in European Organisation for Research and Treatment of Cancer Colorectal Quality of Life Questionnaire

    Quality of life will be self-reported by participants using the European Organisation for Research and Treatment of Cancer Colorectal Quality of Life Questionnaire (EORTC QLQ-CR29) at 5 time-points (3-monthly intervals, from baseline to 12 months). Quality of life total score will be calculated (min 26; max 104) where reduction in total score represents improvement in quality of life.

    Measured: 12 months

  4. Change in European Organisation for Research and Treatment of Cancer Cancer Quality of Life Questionnaire

    Quality of life will be self-reported by participants using the European Organisation for Research and Treatment of Cancer Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This will be recorded at 5 time-points (3-monthly intervals, from baseline to 12 months). Total score will be calculated (min 30; max 128), where reduction in total score represents improvement in quality of life.

    Measured: 12 months

  5. Change in medical outcome profile score

    Measure Yourself Medical Outcome Profile (MYMOP) 2 will be used to record patient-reported medical outcome profile at 5 time-points (3-montly intervals from baseline to 12 months). Change in patient-reported severity (min 0; max 5) will be measured, where change ≥ 1.0 is considered clinically significant.

    Measured: 12 months

  6. Patient-reported adverse events

    We will record any adverse events reported by randomised patients in relation to each of the treatments they receive, which impairs their adherence to the study protocol, treatment programme or safety.

    Measured: 12 months

  7. LARS treatment history

    Treatments offered to manage individual patient's LARS symptoms will be recorded, along with duration of treatment and reasons for stopping. This will be used to support the description of standard care variation and patient characteristics.

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Apr 2022
  2. Study start23 May 2022
  3. Primary completion30 Sep 2023 (estimated)
  4. Study completion30 Sep 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Trials within Cohorts
Masking
None (open label)
Enrolment
187 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05319054
Sponsor's protocol ID
8238
Other IDs
307764
Acronym
POLARiS
Status last verified
Nov 2022
First submitted
1 Apr 2022
Last updated
20 Jul 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Sacral NeuroModulation, Trans-Anal Irrigation and Optimised Conservative Management in people with Low Anterior Resection Syndrome, run by Cardiff and Vale University Health Board at 4 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 19 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 20 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Recruitment rate of to cohort arm of study (time frame: 9 months). The study lists 10 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Jul 2023.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in