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.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
1R01CA140574-01A1
Application #
7887437
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Dunn, Michelle C
Project Start
2010-02-08
Project End
2014-12-31
Budget Start
2010-02-08
Budget End
2010-12-31
Support Year
1
Fiscal Year
2010
Total Cost
$367,275
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Chu, Jacqueline N; Choi, Jin; Tramontano, Angela et al. (2018) Surgical vs Endoscopic Management of T1 Esophageal Adenocarcinoma: A Modeling Decision Analysis. Clin Gastroenterol Hepatol 16:392-400.e7
Lin, Emery C; Holub, Jennifer; Lieberman, David et al. (2018) Low Prevalence of Suspected Barrett's Esophagus in Patients with Gastroesophageal Reflux Disease Without Alarm Symptoms. Clin Gastroenterol Hepatol :
Tramontano, Angela C; Sheehan, Deirdre F; Yeh, Jennifer M et al. (2017) The Impact of a Prior Diagnosis of Barrett's Esophagus on Esophageal Adenocarcinoma Survival. Am J Gastroenterol 112:1256-1264
Kroep, Sonja; Heberle, Curtis R; Curtius, Kit et al. (2017) Radiofrequency Ablation of Barrett's Esophagus Reduces Esophageal Adenocarcinoma Incidence and Mortality in a Comparative Modeling Analysis. Clin Gastroenterol Hepatol 15:1471-1474
Heberle, Curtis R; Omidvari, Amir-Houshang; Ali, Ayman et al. (2017) Cost Effectiveness of Screening Patients With Gastroesophageal Reflux Disease for Barrett's Esophagus With a Minimally Invasive Cell Sampling Device. Clin Gastroenterol Hepatol 15:1397-1404.e7
Lockwood, Robert; Ozanne, Elissa; Hur, Chin et al. (2017) Patient decision-making and clinical outcomes following endoscopic therapy or esophagectomy for Barrett's neoplasia. Endosc Int Open 5:E1128-E1135
Hur, Chin; Tramontano, Angela C; Dowling, Emily C et al. (2016) Early Pancreatic Ductal Adenocarcinoma Survival Is Dependent on Size: Positive Implications for Future Targeted Screening. Pancreas 45:1062-6
Hur, Chin; Choi, Sung Eun; Kong, Chung Yin et al. (2015) High-resolution microendoscopy for esophageal cancer screening in China: A cost-effectiveness analysis. World J Gastroenterol 21:5513-23
Yachimski, Patrick; Wani, Sachin; Givens, Tonya et al. (2015) Preference of endoscopic ablation over medical prevention of esophageal adenocarcinoma by patients with Barrett's esophagus. Clin Gastroenterol Hepatol 13:84-90
Choi, Sung Eun; Perzan, Katherine E; Tramontano, Angela C et al. (2014) Statins and aspirin for chemoprevention in Barrett's esophagus: results of a cost-effectiveness analysis. Cancer Prev Res (Phila) 7:341-50

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