Gastric Cancer Prevention: Evaluating U.S. Risk Factor Trends and New Technology

胃癌预防：评估美国危险因素趋势和新技术

• 批准号: 8298248
• 负责人: Jennifer M. Yeh
• 金额: $ 15.17万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8298248
• 关键词: Age; American; Benefits and Risks; Biological Markers; Cancer Control; Cancer Etiology; Cancerous; Cessation of life; Clinical; Clinical Research; Cohort Studies; Costs and Benefits; Cross-Sectional Studies; Data; Data Analyses; Databases; Diagnostic; Disease; Disease Progression; Early Diagnosis; Early treatment; Economics; Effectiveness; Environment; Epidemiologic Methods; Epidemiology; Ethics; Ethnic Origin; Exercise; Future; Gastric Intestinal Type Adenocarcinoma; Goals; Guidelines; Helicobacter pylori; Immigrant; Incidence; Individual; Intervention; Knowledge; Lesion; Life Expectancy; Malignant Neoplasms; Measures; Medical Surveillance; Mentors; Methodology; Methods; Modeling; National Health and Nutrition Examination Survey; Natural History; Outcome; Output; Patients; Pattern; Policies; Population; Premalignant; Prevalence; Prevention; Prevention program; Prevention strategy; Publishing; Race; Recommendation; Relative (related person); Research; Research Design; Research Personnel; Risk Factors; Role; SEER Program; Science; Screening procedure; Serologic tests; Smoking; Societies; Stomach; Subgroup; Surveys; Techniques; Technology; Therapeutic; Time; Training; Validation; base; cancer health disparity; cancer prevention; career; cost effectiveness; disease natural history; effective intervention; epidemiologic data; experience; falls; flexibility; gastric cancer prevention; high risk; improved; insight; malignant stomach neoplasm; mathematical model; models and simulation; modifiable risk; mortality; multidisciplinary; new technology; novel diagnostics; novel therapeutics; population based; prevent; skills; smoking cessation; smoking prevalence; surveillance data; surveillance strategy; tool; treatment strategy; trend

DESCRIPTION (provided by applicant): The goal of the proposed research is to identify effective gastric cancer prevention programs that improve cancer outcomes, reduce disparities, and enhance the cost-effectiveness of gastric cancer prevention in the U.S. This will be accomplished by constructing a flexible decision-analytic simulation model of gastric cancer capable of estimating the contribution of risk factor patterns on gastric cancer trends and assessing the costs, benefits, and cost-effectiveness of primary (smoking cessation) and secondary (surveillance) prevention strategies. As several factors are changing the landscape of gastric cancer control, including a better understanding of the disease natural history, role of risk factors on disease progression, and new noninvasive endoscopic technology to detect and treat precancerous and cancerous lesions, this model will synthesize available clinical, epidemiologic, and economic data to project long-term outcomes and guide clinical study design. Our specific aims are: (1) to develop a natural history model of gastric cancer, including the role of risk factors on disease progression. This model will be empirically calibrated using U.S. epidemiologic data on age-specific prevalence and incidence of precancerous lesions and cancer; (2) to estimate the decline in gastric cancer incidence attributable to declining prevalence of H. pylori, smoking, and other risk factors. Using a population-based model of gastric cancer we will incorporate data on risk factor trends to forecast gastric cancer incidence and mortality; (3) to assess the cost-effectiveness of technology-based surveillance and treatment strategies for patients with precancerous lesions. We will evaluate the effectiveness of endoscopic and serology-based diagnostic and therapeutic technologies for dysplastic and asymptomatic cancerous lesions; (4) to compare the relative effectiveness of alternative gastric cancer control strategies on disparities. We will develop natural history models for specific race/ethnicity, immigrant, and other select subgroups, incorporate demographic trends, and assess the impact of prevention and treatment strategies to improve cancer outcomes and reduce disparities. In summary, this research will synthesize the best available data, improve upon an existing modeling framework, and develop a new set of analytic tools to estimate and project gastric cancer trends; establish management guidelines for patients with gastric precancerous lesions; and provide insight on the relative costs, benefits, and risks associated with different gastric cancer prevention and control strategies. My career goal is to become an independent investigator dedicated to the application of multidisciplinary, decision- analytic methods to improve cancer prevention and control policies. In conjunction with additional training in secondary data analysis, advanced decision-analytic methods, and epidemiology, the execution of this proposed mentored research in a multidisciplinary and highly-collaborative environment will provide the additional experience, knowledge, and skills needed to successfully transition to research independence.

描述（由申请人提供）：拟议的研究的目的是确定有效的胃癌预防计划，以改善癌症结果，减少差异，并提高美国胃癌预防的成本效益，这将通过构建灵活的决策分析模拟模型来实现这一目标，并能够估算胃癌的贡献，并估计胃癌的成本范围，并评估胃癌的贡献，并估计胃癌的贡献， （戒烟）和次要（监视）预防策略。由于有几个因素正在改变胃癌控制的局势，包括更好地了解疾病自然病史，危险因素对疾病进展的作用以及新的非侵入性内窥镜技术检测和治疗癌症和癌性病变，因此该模型将使可用的临床学，流行病学，流行病学数据以及长期的长期临床研究和指导性研究。我们的具体目的是：（1）开发胃癌的自然历史模型，包括危险因素在疾病进展中的作用。该模型将使用美国的流行病学数据进行经验校准，以了解年龄特异性的患病率和癌前病变和癌症的发生率； （2）估计胃癌发病率下降，这是由于幽门螺杆菌，吸烟和其他危险因素的患病率下降。使用基于人群的胃癌模型，我们将结合有关危险因素趋势的数据，以预测胃癌的发病率和死亡率； （3）评估针对癌前病变患者的基于技术的监视和治疗策略的成本效益。我们将评估基于内窥镜和血清学的诊断和治疗技术对发育不良和无症状癌性病变的有效性； （4）比较替代性胃癌控制策略对差异的相对有效性。我们将开发自然历史模型，以用于特定种族/民族，移民和其他精选亚组，并结合人口趋势，并评估预防和治疗策略的影响，以改善癌症结果并减少差异。总而言之，这项研究将综合最佳的可用数据，改进现有的建模框架，并开发一套新的分析工具来估计和项目胃癌趋势；为胃癌病变患者建立管理指南；并提供有关与不同胃癌预防和控制策略相关的相对成本，收益和风险的见解。我的职业目标是成为一名独立研究者，致力于应用多学科的决策方法来改善癌症预防和控制政策。结合二级数据分析中的其他培训，先进的决策方法和流行病学，在多学科和高度学业的环境中，这项拟议的指导研究的执行将提供成功过渡到独立性的过渡所需的其他经验，知识和技能。