Improving Esophageal Adenocarcinoma Prevention, Screening and Treatment

 描述（由申请人提供）：改善食管腺癌的预防、筛查和治疗在过去的几十年里，美国和西方世界的大部分地区食管腺癌（EAC）的发病率增长了500%，这是一个令人震惊的数字，而且很大程度上无法解释。迄今为止，医疗和公共卫生工作主要集中在巴雷特食管（BE）的内窥镜筛查上，这是一种与EAC发展的最大已知风险相关的前驱病变。然而，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，但病死率仍然很高。本提案的目标是通过使用疾病模拟模型系统评价替代性EAC预防、筛查和治疗策略的人群水平影响，降低食管腺癌（EAC）的发病率和死亡率。研究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，包括减轻性别，种族或民族的护理差异。拟议的研究是创新的，因为它建议改变临床实践，迫切需要改进。这项资助申请是先前资助的R01奖的竞争性更新，该奖项专注于开发美国人口模拟模型：食管腺癌模型（EACMo）。最初的资金允许EACMo的成功开发，用于进行关键研究，增加了我们对EAC的理解和知情的临床护理。拟议的研究将解决以下总体假设：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控制计划，降低死亡率，同时优化资源利用。将通过确定当前和未来预防、筛查和治疗干预对EAC发病率和死亡率的影响来研究这一假设，包括确定差异及其对生存率的影响。本研究将确定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，以设计一个优化的EAC控制计划，包括风险概况。到奖励期结束时，研究人员将有必要的证据来告知临床和公共卫生指南，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.