Esophageal Adenocarcinoma Policy Model: Trends, Risk Factors and Screening

食管腺癌政策模型：趋势、危险因素和筛查

• 批准号: 7887437
• 负责人: Chin Hur
• 金额: $ 36.73万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-02-08 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7887437
• 关键词: Address; Affect; American; Area; Arts; Barrett Esophagus; Calibration; Cessation of life; Chemoprevention; Clinical; Clinical Research; Clinical Trials; Clinical Trials Design; Collaborations; Complex; Data; Databases; Development; Diagnosis; Disease model; Early identification; Early treatment; Elements; Esophageal Adenocarcinoma; Factor Analysis; Future; Gastroesophageal reflux disease; Gender; General Population; Goals; Guidelines; Health; Heartburn; Incidence; Individual; Interdisciplinary Study; Intervention; Knowledge; Lead; Literature; Malignant Neoplasms; Medical Societies; Medical Surveillance; Methodology; Modeling; Morbidity - disease rate; Natural History; Obesity; Patients; Policies; Population Projection; Premalignant; Prevalence; Public Health; Publishing; Randomized Controlled Trials; Recording of previous events; Research; Risk; Risk Factors; Screening procedure; Smoke; Source; Surveillance Program; Symptoms; Techniques; Testing; Validation; Work; burden of illness; cancer risk; cohort; cost effectiveness; design; evidence based guidelines; experience; follow-up; high risk; intervention program; models and simulation; mortality; prevent; programs; public health relevance; simulation; surveillance strategy; trend

DESCRIPTION (provided by applicant): The incidence of esophageal adenocarcinoma (EAC) has been rising at an alarming rate over the past three decades. Although the absolute number of EAC cases per year remains too low to screen the general population, targeted screening may be appropriate. Heartburn, the primary symptom of gastroesophageal reflux disease (GERD), affects 60 million Americans and can lead to Barrett's esophagus (BE), a pre-malignant condition associated with the greatest risk (30-125x) of developing EAC. Because of the significant number of individuals affected with GERD and BE, the management of these patients has become a public health issue. However, an accepted screening or surveillance program for EAC has not been proposed. The broad, long-term objectives of the proposal are to identify an effective and affordable targeted screening strategy for EAC with early identification and an intervention program which will diminish the burden of this disease. These research goals will be accomplished developing and analyzing an Esophageal AdenoCarcinoma Policy Model (EACMo). A rich mix of complementary methodologies and state of the art simulation techniques will be necessary to achieve the numerous project objectives. Data from numerous sources including Surveillance Epidemiology and End Results (SEER), clinical trial data and the published literature will be used to develop a simulation model. Calibration methodology will be used to systematically fine tune model parameters to produce targeted endpoints (e.g. cancer incidence). Validation will be achieved by having the model reproduce other published data. The specific aims are: Aim 1: Develop and validate the EACMo. Aim 2: Estimate contributions of pivotal risk factors to the rise in EAC incidence in the U.S. Aim 3: Identify individuals at high risk for EAC: predictors of Barrett's esophagus. Aim 4: Estimate the effectiveness, cost and cost-effectiveness of plausible esophageal adenocarcinoma screening and management programs. The health relatedness of the project will be to use the results to design clinical trials, guide policy decisions and inform evidence-based practice guidelines. The multidisciplinary research team assembled for this project has expertise in all aspects of simulation disease modeling, clinical aspects of EAC, and a proven history of research and collaborations. PUBLIC HEALTH RELEVANCE: Esophageal adenocarcinoma is a concerning public health issue as this cancer is being diagnosed in an increasing number of Americans. The goal of the proposed research is to develop and evaluate a program to identify individuals at risk for this cancer and to intervene early to prevent cancer deaths.

描述（由申请人提供）：在过去的三十年中，食管腺癌（EAC）的发病率一直以惊人的速度上升。尽管每年的EAC案例的绝对数量仍然太低而无法筛查一般人群，但有针对性的筛查可能是合适的。胃灼热是胃食管反流疾病（GERD）的主要症状，影响了6000万美国人，并可能导致Barrett的食管（BE），这是一种与最大的EAC风险（30-125x）相关的恶性疾病。由于受到GERD和BE影响的个人数量很大，因此这些患者的管理已成为一个公共卫生问题。但是，尚未提出针对EAC的公认筛查或监视计划。 该提案的广泛，长期目标是确定具有早期识别和干预计划的有效且负担得起的针对性筛查策略，这将减轻这种疾病的负担。 这些研究目标将实现开发和分析食管腺癌政策模型（EACMO）。为了实现众多项目目标，必须使用丰富的互补方法和最先进的模拟技术。来自众多来源的数据，包括监视流行病学和最终结果（SEER），临床试验数据和已发表的文献将用于开发模拟模型。校准方法将用于系统地微调模型参数，以产生目标终点（例如癌症发生率）。通过使模型重现其他已发布的数据来实现验证。具体目的是：目标1：开发和验证EACMO。 AIM 2：关键风险因素对美国EAC发病率上升的估计贡献3：确定EAC高风险的个体：Barrett食管的预测因素。 AIM 4：估计合理的食管腺癌筛查和管理计划的有效性，成本和成本效益。 该项目的健康相关性将是使用结果设计临床试验，指导政策决策并为基于证据的实践指南提供信息。为该项目组装的多学科研究团队在模拟疾病建模，EAC的临床方面以及可靠的研究与协作历史方面具有专业知识。 公共卫生相关性：食管腺癌与公共卫生问题有关，因为在越来越多的美国人中诊断出这种癌症。拟议的研究的目的是制定和评估一项计划，以识别患有这种癌症风险的人并尽早干预以防止癌症死亡。