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Grant Details

Grant Number: 5R01CA247790-02 Interpret this number
Primary Investigator: Hur, Chin
Organization: Columbia University Health Sciences
Project Title: A Personalized Approach to Targeted Esophageal Cancer Screening
Fiscal Year: 2021


Abstract

The goal of the project is to diminish the morbidity and mortality associated with esophageal cancer as patients with this cancer continue to suffer from extremely poor survival and high case-fatality rates. Esophageal adenocarcinoma (EAC) is the most common histologic type of esophageal malignancy in the US and has experienced an alarmingly rapid and largely unexplained rise in incidence over the past four decades in much of the western world. Previous attempts to curb the morbidity and mortality associated with EAC in the US have focused on an endoscopic screening, which is invasive and costly. However, innovative new technologies for esophageal cancer screening that are both less invasive and costly have created the opportunity to lower the bar for screening to where it could be a realistic option, particularly for those who are higher risk. While the performance metrics of the device are important, equally critical are identifying and resolving barriers to implementation. We propose to study potential factors for patients, providers and health care systems that could impede screening programs. This R01 proposal will leverage a previously developed and validated natural history simulation model of EAC. The PI has made significant contributions to the fields of esophageal cancer screening, prevention and treatment utilizing the EAC model to assess and analyze critical aspects of EAC cancer control. The prior work and model will provide an exceptionally strong foundation for the current research project. The research team is comprised of experienced investigators who provide the broad and complementary expertise necessary for this project and have a track record of successful collaboration. The overarching premise of our proposal is that novel approaches to esophageal cancer screening have the potential to improve EAC mortality, but that the successful implementation and population impact will depend on: 1) the screening modality characteristics; 2) patient, provider, and health system’s barriers; and 3) the profile of the patients to be screened. We will accomplish these project goals by completing four specific aims. In Aim 1 we will use our validated simulation model of esophageal cancer to test and assess whether a cell sampling device can be cost-effective for population screening. In Aim 2 we will study potential patient, provider and health system barriers to esophageal cancer screening. For Aim 3 we will personalize screening by determining which patient profiles will benefit from screening. Finally, in Aim 4 will assess the population cancer control impact of the potential implementation of the esophageal cancer screening strategy defined by the prior aims. By award period end, we will have developed a personalized approach to targeted EAC screening that is rational and cost-effective.



Publications

Surveillance Cessation for Barrett's Esophagus: A Survey of Gastroenterologists.
Authors: Ozanne E.M. , Silver E.R. , Saini S.D. , Rubenstein J.H. , Lansdorp-Vogelaar I. , Bowers N. , Tan S.X. , Inadomi J.M. , Hur C. .
Source: The American journal of gastroenterology, 2021-08-01; 116(8), p. 1730-1733.
PMID: 34049319
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The Optimal Age to Stop Endoscopic Surveillance of Patients With Barrett's Esophagus Based on Sex and Comorbidity: A Comparative Cost-Effectiveness Analysis.
Authors: Omidvari A.H. , Hazelton W.D. , Lauren B.N. , Naber S.K. , Lee M. , Ali A. , Seguin C. , Kong C.Y. , Richmond E. , Rubenstein J.H. , et al. .
Source: Gastroenterology, 2021 Aug; 161(2), p. 487-494.e4.
EPub date: 2021-05-08.
PMID: 33974935
Related Citations

Utilization of Surveillance Endoscopy for Barrett's Esophagus in Medicare Enrollees.
Authors: Rubenstein J.H. , Noureldin M. , Tavakkoli A. , Hur C. , Omidvari A.H. , Waljee A.K. .
Source: Gastroenterology, 2020 02; 158(3), p. 773-775.e1.
EPub date: 2019-10-31.
PMID: 31676263
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Screening for Upper Gastrointestinal Malignancies in the United States-Which Immigrant Groups Should Be Considered High-Risk?
Authors: Laszkowska M. , Oh A. , Hur C. .
Source: Gastroenterology, 2020 01; 158(1), p. 4-8.
EPub date: 2019-10-12.
PMID: 31614125
Related Citations

Esophageal cancer treatment costs by phase of care and treatment modality, 2000-2013.
Authors: Tramontano A.C. , Chen Y. , Watson T.R. , Eckel A. , Hur C. , Kong C.Y. .
Source: Cancer medicine, 2019 09; 8(11), p. 5158-5172.
EPub date: 2019-07-26.
PMID: 31347306
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