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Grant Details

Grant Number: 5R01CA140574-09 Interpret this number
Primary Investigator: Hur, Chin
Organization: Massachusetts General Hospital
Project Title: Improving Esophageal Adenocarcinoma Prevention, Screening and Treatment
Fiscal Year: 2018
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Abstract

 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.

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Publications

Low Prevalence of Suspected Barrett's Esophagus in Patients With Gastroesophageal Reflux Disease Without Alarm Symptoms.
Authors: Lin E.C. , Holub J. , Lieberman D. , Hur C. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2019 04; 17(5), p. 857-863.
EPub date: 2018-09-07.
PMID: 30196157
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Lorenz Curves and Gini Coefficient Analyses Indicate Inefficiencies in Esophageal Adenocarcinoma Screening.
Authors: Hur C. , Zhan T. , Thrift A.P. , Vaughan T.L. , Feuer E.J. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2019 02; 17(3), p. 560-562.e2.
EPub date: 2018-05-09.
PMID: 29753084
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Surgical vs Endoscopic Management of T1 Esophageal Adenocarcinoma: A Modeling Decision Analysis.
Authors: Chu J.N. , Choi J. , Tramontano A. , Morse C. , Forcione D. , Nishioka N.S. , Abrams J.A. , Rubenstein J.H. , Kong C.Y. , Inadomi J.M. , et al. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2018 03; 16(3), p. 392-400.e7.
EPub date: 2017-11-24.
PMID: 29079222
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Patient decision-making and clinical outcomes following endoscopic therapy or esophagectomy for Barrett's neoplasia.
Authors: Lockwood R. , Ozanne E. , Hur C. , Yachimski P. .
Source: Endoscopy international open, 2017 Nov; 5(11), p. E1128-E1135.
EPub date: 2017-11-08.
PMID: 29124122
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Cost Effectiveness of Screening Patients With Gastroesophageal Reflux Disease for Barrett's Esophagus With a Minimally Invasive Cell Sampling Device.
Authors: Heberle C.R. , Omidvari A.H. , Ali A. , Kroep S. , Kong C.Y. , Inadomi J.M. , Rubenstein J.H. , Tramontano A.C. , Dowling E.C. , Hazelton W.D. , et al. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2017 Sep; 15(9), p. 1397-1404.e7.
EPub date: 2017-02-24.
PMID: 28238953
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Radiofrequency Ablation of Barrett's Esophagus Reduces Esophageal Adenocarcinoma Incidence and Mortality in a Comparative Modeling Analysis.
Authors: Kroep S. , Heberle C.R. , Curtius K. , Kong C.Y. , Lansdorp-Vogelaar I. , Ali A. , Wolf W.A. , Shaheen N.J. , Spechler S.J. , Rubenstein J.H. , et al. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2017 09; 15(9), p. 1471-1474.
EPub date: 2017-01-12.
PMID: 28089850
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The Impact of a Prior Diagnosis of Barrett's Esophagus on Esophageal Adenocarcinoma Survival.
Authors: Tramontano A.C. , Sheehan D.F. , Yeh J.M. , Kong C.Y. , Dowling E.C. , Rubenstein J.H. , Abrams J.A. , Inadomi J.M. , Schrag D. , Hur C. .
Source: The American journal of gastroenterology, 2017 Aug; 112(8), p. 1256-1264.
EPub date: 2017-04-04.
PMID: 28374815
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Early Pancreatic Ductal Adenocarcinoma Survival Is Dependent on Size: Positive Implications for Future Targeted Screening.
Authors: Hur C. , Tramontano A.C. , Dowling E.C. , Brooks G.A. , Jeon A. , Brugge W.R. , Gazelle G.S. , Kong C.Y. , Pandharipande P.V. .
Source: Pancreas, 2016 08; 45(7), p. 1062-6.
PMID: 26692444
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High-resolution microendoscopy for esophageal cancer screening in China: A cost-effectiveness analysis.
Authors: Hur C. , Choi S.E. , Kong C.Y. , Wang G.Q. , Xu H. , Polydorides A.D. , Xue L.Y. , Perzan K.E. , Tramontano A.C. , Richards-Kortum R.R. , et al. .
Source: World journal of gastroenterology, 2015-05-14; 21(18), p. 5513-23.
PMID: 25987774
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Preference of endoscopic ablation over medical prevention of esophageal adenocarcinoma by patients with Barrett's esophagus.
Authors: Yachimski P. , Wani S. , Givens T. , Howard E. , Higginbotham T. , Price A. , Berman K. , Hosford L. , Katcher P.M. , Ozanne E. , et al. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2015 Jan; 13(1), p. 84-90.
EPub date: 2014-03-26.
PMID: 24681073
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Incidence and predictors of adenocarcinoma following endoscopic ablation of Barrett's esophagus.
Authors: Yasuda K. , Choi S.E. , Nishioka N.S. , Rattner D.W. , Puricelli W.P. , Tramontano A.C. , Kitano S. , Hur C. .
Source: Digestive diseases and sciences, 2014 Jul; 59(7), p. 1560-6.
EPub date: 2014-01-07.
PMID: 24395382
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Statins and aspirin for chemoprevention in Barrett's esophagus: results of a cost-effectiveness analysis.
Authors: Choi S.E. , Perzan K.E. , Tramontano A.C. , Kong C.Y. , Hur C. .
Source: Cancer prevention research (Philadelphia, Pa.), 2014 Mar; 7(3), p. 341-50.
EPub date: 2013-12-31.
PMID: 24380852
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Trends in esophageal adenocarcinoma incidence and mortality.
Authors: Hur C. , Miller M. , Kong C.Y. , Dowling E.C. , Nattinger K.J. , Dunn M. , Feuer E.J. .
Source: Cancer, 2013-03-15; 119(6), p. 1149-58.
EPub date: 2012-12-11.
PMID: 23303625
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The cost effectiveness of radiofrequency ablation for Barrett's esophagus.
Authors: Hur C. , Choi S.E. , Rubenstein J.H. , Kong C.Y. , Nishioka N.S. , Provenzale D.T. , Inadomi J.M. .
Source: Gastroenterology, 2012 Sep; 143(3), p. 567-575.
EPub date: 2012-05-21.
PMID: 22626608
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Screening and surveillance for Barrett's esophagus: current issues and future directions.
Authors: Choi S.E. , Hur C. .
Source: Current opinion in gastroenterology, 2012 Jul; 28(4), p. 377-81.
PMID: 22508325
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Aspirin protects against Barrett's esophagus in a multivariate logistic regression analysis.
Authors: Omer Z.B. , Ananthakrishnan A.N. , Nattinger K.J. , Cole E.B. , Lin J.J. , Kong C.Y. , Hur C. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2012 Jul; 10(7), p. 722-7.
EPub date: 2012-03-15.
PMID: 22426086
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The impact of obesity on the rise in esophageal adenocarcinoma incidence: estimates from a disease simulation model.
Authors: Kong C.Y. , Nattinger K.J. , Hayeck T.J. , Omer Z.B. , Wang Y.C. , Spechler S.J. , McMahon P.M. , Gazelle G.S. , Hur C. .
Source: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2011 Nov; 20(11), p. 2450-6.
EPub date: 2011-09-19.
PMID: 21930957
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The prevalence of Barrett's esophagus in the US: estimates from a simulation model confirmed by SEER data.
Authors: Hayeck T.J. , Kong C.Y. , Spechler S.J. , Gazelle G.S. , Hur C. .
Source: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 2010 Aug; 23(6), p. 451-7.
EPub date: 2010-03-26.
PMID: 20353441
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