Improving Esophageal Adenocarcinoma Prevention, Screening and Treatment

 描述(由申请人提供)：改进食管腺癌的预防、筛查和治疗食管腺癌(EAC)的发病率在过去几十年中在美国和西方世界大部分地区经历了令人震惊的、基本上无法解释的500%的增长。到目前为止，医疗和公共卫生工作主要集中在内窥镜筛查巴雷特食道(BE)，这是一种与EAC发生的最大已知风险相关的前驱病变。然而，目前尚不清楚这些努力是否影响了EAC死亡率，因为尽管大量利用了医疗资源，但病例死亡率仍然很高。这项建议的目标是通过使用疾病模拟模型系统地评估替代食管腺癌预防、筛查和治疗策略在人群层面的影响，以降低食管腺癌(EAC)的发病率和死亡率。结果将为临床指南和公共卫生政策提供信息，以加强资源分配，包括缓解按性别、种族或族裔划分的护理差异。这项拟议的研究具有创新性，因为它建议改变迫切需要改进的临床实践。这项赠款申请是对之前资助的R01奖的竞争性续展，该奖项专注于开发美国人口模拟模型：食管腺癌模型(EACMO)。最初的资金使EACMO得以成功开发，用于执行关键研究，增加了我们对EAC的了解和知情的临床护理。这项拟议的研究将解决以下主要假设：使用食管腺癌模型(EACMO)分析EAC预防、筛查和治疗的具体和关键方面，将允许设计一个全面的EAC控制程序，在降低死亡率的同时优化资源利用。将通过确定当前和未来的预防、筛查和治疗干预措施对EAC发病率和死亡率的影响，包括确定差异及其对生存的影响，来研究这一假说。这项研究将确定EAC护理连续体中替代策略的有效性。这些发现将被纳入一个全面的人口模型，以设计一个包含风险概况的优化的EAC控制程序。到获奖期结束时，研究人员将拥有必要的证据，为临床和公共卫生指南提供信息，以减少EAC的发病率和死亡率，同时优化资源利用。

 DESCRIPTION (provided by applicant): Improving Esophageal Adenocarcinoma Prevention, Screening and Treatment Esophageal adenocarcinoma (EAC) incidence has experienced an alarming and largely unexplained 500% increase over the past few decades in the US and much of the western world. Medical and public health efforts to date have primarily focused on endoscopic screening for Barrett's esophagus (BE), a precursor lesion associated with the greatest known risk of EAC development. However, it is not clear if these efforts have impacted EAC mortality as case fatality rates remain high despite substantial utilization of medical resources. The goal of this proposal is to reduce esophageal adenocarcinoma (EAC) morbidity and mortality by using a disease simulation model to systematically evaluate the population-level impact of alternative EAC prevention, screening and treatment strategies. The results will inform clinical guidelines and public health policy that enhances resource allocation including the mitigation of disparities in care by gender, race or ethnicity. The proposed research is innovative as it proposes to change clinical practice where improvements are urgently needed. This grant application is the competing renewal of a previously funded R01 award which focused on the development of a U.S. population simulation model: Esophageal AdenoCarcinoma Model (EACMo). The initial funding has allowed the successful development of EACMo which was used to perform crucial studies that have increased our understanding of EAC and informed clinical care. The proposed research will address the following overarching hypothesis: analyzing specific and pivotal aspects of EAC prevention, screening and treatment using the esophageal adenocarcinoma model (EACMo) will allow the designing of a comprehensive EAC control program that reduces mortality while also optimizing resource utilization. This hypothesis will be investigated by determining the impact of current and future prevention, screening and treatment interventions on EAC incidence and mortality, including the identification of disparities and their impact on survival. This research will determine the effectiveness of alternative strategies within the EAC care continuum. These findings will be incorporated into a comprehensive population model to design an optimized EAC control program that incorporates risk profiles. By the end of the award period, the investigators will have essential evidence to inform clinical and public health guidelines to diminish EAC incidence and mortality while optimizing resource utilization.