Grant Number:	5U01CA199336-05 Interpret this number
Primary Investigator:	Hur, Chin
Organization:	Columbia University Health Sciences
Project Title:	Controlling Esophageal Cancer: a Collaborative Modeling Approach
Fiscal Year:	2019

 DESCRIPTION (provided by applicant): Controlling Esophageal Cancer: A Collaborative Modeling Approach. The ultimate goal of the proposed research project is to advance our understanding of esophageal cancer and the impact of cancer control interventions to diminish the burden of this disease. This will be accomplished through a collaborative and comparative modeling project. There are two main histologic types of esophageal cancer: adenocarcinoma (EAC) and Squamous Cell Carcinoma (ESCC). Although ESCC is more common globally, in the US and much of the western world, EAC is more common and of greater concern. Esophageal AdenoCarcinoma (EAC) has experienced a remarkable (more than 6-fold) increase in incidence over the past few decades, which is largely unexplained. To date, primary screening and prevention efforts have targeted patients with symptoms of gastroesophageal reflux disease (GERD) using endoscopy and biopsy to identify patients with Barrett's esophagus (BE), with BE patients targeted for endoscopic surveillance. There is no firm evidence indicating that this screening/surveillance strategy is effective, which is underscored by persistently poor survival rates while a large proportion of cancers continue to be diagnosed at late and invasive stages. With an estimated 40-60 million Americans with GERD and 3-12 million with BE, the management of patients who are at significantly increased risk of EAC has become an important public health issue. In addition to uncertain long-term benefits, current unproven strategies may subject patients to overtesting and overdiagnosis, negatively impacting patient quality of life while expending considerable medical resources. The research team's prior work includes comparative modeling of the natural history of EAC by three independent models providing a strong foundation upon which to perform analyses that assess and improve screening and prevention strategies: specifically, the evaluation of cutting-edge enhancements such as new screening technologies, prevention, genomic and other biomarkers, and clinical prediction tools. Precision risk stratification is the aim, with the broader goal to identify a caner control strategy that is effective while limiting overtesting and overtreatment, thereby reducing patient burden and improving healthcare efficiency. These modeling efforts will provide the personalized patient data necessary to construct a decision aid, which will minimize patient screening burden by aligning management choices with personal preferences for screening. Finally, although the initial focus of the project will be on EAC, ESCC is more common and widespread globally, particularly in parts of Asia such as China. The models will be extended to include an ESCC natural history component and assess ESCC screening in the US and China. The proposal will address the overarching goals of increasing our understanding of the natural history of esophageal cancer and determining the impact and of potential cancer control interventions with the ultimate goal of ameliorating cancer morbidity.




Endoscopic Screening Program for Control of Esophageal Adenocarcinoma in Varied Populations: A Comparative Cost-Effectiveness Analysis.
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Patients with Adenocarcinoma of the Esophagus or Esophagogastric Junction Frequently Have Potential Screening Opportunities.
Authors: Rubenstein J.H. , Evans R.R. , Burns J.A. , Arasim M.E. , Zhu J. , Waljee A.K. , Harnessing Opportunities to Screen for Esophageal Adenocarcinoma Group , Macdonald P.W. , Adams M.A. , Chang J.W. , et al. .
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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. .
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Comparative Cost Effectiveness of Reflux-Based and Reflux-Independent Strategies for Barrett's Esophagus Screening.
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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. .
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Long-Term Quality of Life Following Endoscopic Therapy Compared to Esophagectomy for Neoplastic Barrett's Esophagus.
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Optimal Timing for Cancer Screening and Adaptive Surveillance Using Mathematical Modeling.
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Utility and Cost-Effectiveness of a Nonendoscopic Approach to Barrett's Esophagus Surveillance After Endoscopic Therapy.
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Impact of assumptions on future costs, disutility and mortality in cost-effectiveness analysis; a model exploration.
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Computational modelling suggests that Barrett's oesophagus may be the precursor of all oesophageal adenocarcinomas.
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Optimizing Management of Patients With Barrett's Esophagus and Low-Grade or No Dysplasia Based on Comparative Modeling.
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The Impact of the Policy-Practice Gap on Costs and Benefits of Barrett's Esophagus Management.
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Family History of Colorectal or Esophageal Cancer in Barrett's Esophagus and Potentially Explanatory Genetic Variants.
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Editorial: moving towards the appropriate use of proton pump inhibitors.
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Epigenetic aging: more than just a clock when it comes to cancer.
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Diabetes in relation to Barrett's esophagus and adenocarcinomas of the esophagus: A pooled study from the International Barrett's and Esophageal Adenocarcinoma Consortium.
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Esophageal cancer treatment costs by phase of care and treatment modality, 2000-2013.
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Lorenz Curves and Gini Coefficient Analyses Indicate Inefficiencies in Esophageal Adenocarcinoma Screening.
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