Development of a risk prediction model for Barrett’s oesophagus

1. Development of a risk prediction model for Barrett’s oesophagus Colin Ireland PhD Candidate School of Nursing and Midwifery Division of Health Sciences Supportive Care in Cancer: Advances in Nursing Symposium 22 June 2016

2. Outline Background Overview of PhD study Results What’s next?

3. Background Incidence of adenocarcinoma increased 5 fold in last 25 years 5-year survival rate from adenocarcinoma of the oesophageal is poor – many late diagnosis Australia (2011) 991 Males 404 Females Early diagnosis may result in earlier treatment and better survival rates (Australian Institute of Health and Welfare (AIHW) 2015, Kramer et al. 2012)

4. Barrett’s oesophagus Barrett’s oesophagus – precursor to adenocarcinoma of the oesophagus 30-40 times greater risk of developing adenocarcinoma of the oesophagus Targeted screening could lead to earlier detection and better survival outcomes

5. Barrett’s oesophagus Normal squamous cell epithelium of the oesophagus changes to a columnar like epithelial tissue. Initially protective measure for reflux Estimated prevalence 1.2 – 1.6% general population Generally asymptomatic Increased risk of dysplasia leading to adenocarcinoma (de Jonge et al. 2014, Fitzgerald et al. 2014, Kramer et al. 2012, Thrift et al. 2014, Zimmerman 2014)

6. Prediction tools for Barrett’s oesophagus 5 previous tools developed Area under the Receiver Operating Characteristic (AUC) around 0.70 (70% chance of detection) Based on subsets of population (E.g. White males, 50-79 years) Gerson et al. 2001, Locke, Zinsmeister & Talley 2003, Thrift et al. 2012, Rubenstein et al. 2013, Liu et al. 2014

7. Research Aim To develop and validate a screening tool for Barrett’s oesophagus, that is suitable for use in primary health care

8. Study design

9. Scoping review Follows systematic approach to searching Used to develop questionnaire for case control study Stages: 1: Identify research question 2: Identification of relevant studies 3: Study selection 4: Summarising the data 5: Reporting of the data

10. Scoping review: Results Information used to develop questionnaire that was used in the case-control study Identified factors that were protective or increased risk Demographic Lifestyle Clinical Ireland CJ, Thompson SK, Laws TA, Esterman A. Risk factors for Barrett’s esophagus: a scoping review. Cancer Causes Control. 2016;27:301-23.

11. Case control study: development Method: Population based study Barrett’s oesophagus – identified by using Flinders Medical Centre database Population – identified using electoral roll Data collection: Mailed out invitation letter and questionnaire If not returned within 3 weeks information sent again Completed questionnaires entered into database

12. Results

13. Process

14. Summary of predictors

15. Performance Lowess smoother calibration plot Area under the receiver operator characteristic Hosmer-Lemeshow test: p=0.67

16. Next steps

17. Acknowledgements/ Collaborators Supervisors UniSA Professor Adrian Esterman Dr Andrea Fielder Royal Adelaide Hospital A/Professor Sarah Thompson KeeleUniversity Dr Tom Laws Collaborators Flinders Medical Centre Professor David Watson QIMR Berghofer Medical Research Institute Professor David Whiteman Flinders University Professor Richard Reed

18. Thank you Colin.Ireland@mymail.unisa.edu.au