A Personalized Approach to Targeted Esophageal Cancer Screening

针对性食管癌筛查的个性化方法

• 批准号: 10413908
• 负责人: Chin Hur
• 金额: $ 48.92万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-08 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10413908
• 关键词: Award; Biopsy; Cancer Control; Case Fatality Rates; Cells; Characteristics; Clinical Research; Collaborations; Colorectal Cancer; Cost Analysis; Data; Devices; Effectiveness; Endoscopy; Esophageal Adenocarcinoma; Esophagus; Financial cost; Foundations; Funding; Goals; Health system; Healthcare Systems; Histologic; Incidence; Individual; Life Expectancy; Logistics; Malignant Neoplasms; Malignant neoplasm of esophagus; Mass Screening; Methods; Modality; Modeling; Morbidity - disease rate; Natural History; Patients; Performance; Population; Prevention; Primary Health Care; Procedures; Provider; Regimen; Research; Research Personnel; Research Project Grants; Risk; Sampling; Screening for cancer; Technology; Testing; Western World; Work; base; burden of illness; cost; cost effective; cost effectiveness; cost estimate; experience; future implementation; high risk; implementation barriers; improved; individual patient; innovation; insight; member; models and simulation; mortality; new technology; novel; novel strategies; personalized approach; personalized screening; primary care setting; profiles in patients; screening; screening program

The goal of the project is to diminish the morbidity and mortality associated with esophageal cancer as patients with this cancer continue to suffer from extremely poor survival and high case-fatality rates. Esophageal adenocarcinoma (EAC) is the most common histologic type of esophageal malignancy in the US and has experienced an alarmingly rapid and largely unexplained rise in incidence over the past four decades in much of the western world. Previous attempts to curb the morbidity and mortality associated with EAC in the US have focused on an endoscopic screening, which is invasive and costly. However, innovative new technologies for esophageal cancer screening that are both less invasive and costly have created the opportunity to lower the bar for screening to where it could be a realistic option, particularly for those who are higher risk. While the performance metrics of the device are important, equally critical are identifying and resolving barriers to implementation. We propose to study potential factors for patients, providers and health care systems that could impede screening programs. This R01 proposal will leverage a previously developed and validated natural history simulation model of EAC. The PI has made significant contributions to the fields of esophageal cancer screening, prevention and treatment utilizing the EAC model to assess and analyze critical aspects of EAC cancer control. The prior work and model will provide an exceptionally strong foundation for the current research project. The research team is comprised of experienced investigators who provide the broad and complementary expertise necessary for this project and have a track record of successful collaboration. The overarching premise of our proposal is that novel approaches to esophageal cancer screening have the potential to improve EAC mortality, but that the successful implementation and population impact will depend on: 1) the screening modality characteristics; 2) patient, provider, and health system’s barriers; and 3) the profile of the patients to be screened. We will accomplish these project goals by completing four specific aims. In Aim 1 we will use our validated simulation model of esophageal cancer to test and assess whether a cell sampling device can be cost-effective for population screening. In Aim 2 we will study potential patient, provider and health system barriers to esophageal cancer screening. For Aim 3 we will personalize screening by determining which patient profiles will benefit from screening. Finally, in Aim 4 will assess the population cancer control impact of the potential implementation of the esophageal cancer screening strategy defined by the prior aims. By award period end, we will have developed a personalized approach to targeted EAC screening that is rational and cost-effective.

该项目的目标是降低食管癌患者的发病率和死亡率 患有这种癌症的人仍然面临着极低的生存率和高病死率。食管 腺癌（EAC）是美国最常见的食管恶性肿瘤组织学类型， 在过去的四十年里，许多地方的发病率都经历了惊人的快速且基本上无法解释的上升 西方世界的。美国此前曾尝试遏制 EAC 相关的发病率和死亡率 重点关注内窥镜筛查，这是一种侵入性且昂贵的方法。然而，创新的新技术 食管癌筛查的侵入性较小且成本较高，这为降低 筛查的门槛是否可能是一个现实的选择，特别是对于那些风险较高的人来说。 虽然设备的性能指标很重要，但识别和解决障碍也同样重要 到实施。我们建议研究患者、提供者和医疗保健系统的潜在因素 可能会妨碍筛查计划。 该 R01 提案将利用先前开发和验证的 EAC 自然历史模拟模型。 PI在食管癌筛查、预防和治疗领域做出了重大贡献 利用 EAC 模型评估和分析 EAC 癌症控制的关键方面。前期工作及模型 将为当前的研究项目提供异常坚实的基础。研究团队组成 经验丰富的研究人员为该项目提供了必要的广泛和补充的专业知识，并且 拥有成功合作的记录。 我们提案的首要前提是食管癌筛查的新方法具有 降低 EAC 死亡率的潜力，但成功实施和人口影响将取决于 关于： 1) 筛查方式特征； 2) 患者、提供者和卫生系统的障碍； 3） 待筛查患者的概况。我们将通过完成四个具体目标来实现这些项目目标。 在目标 1 中，我们将使用经过验证的食管癌模拟模型来测试和评估细胞是否 采样装置对于人群筛查来说具有成本效益。在目标 2 中，我们将研究潜在患者， 食管癌筛查的提供者和卫生系统障碍。对于目标 3，我们将进行个性化筛查 通过确定哪些患者资料将受益于筛查。最后，目标 4 将评估人口 食管癌筛查策略的潜在实施对癌症控制的影响 先前的目标。 到奖励期结束时，我们将开发出一种个性化的有针对性的 EAC 筛查方法，即 合理且具有成本效益。