A full-cycle integrated management model for esophageal cancer in county health systems: effects on care processes, clinical outcomes, quality of life, and cost-utility.

Authors

Jianjia Xiao, Limei Ye, Jinduan Zhou, Mingmei Li, Yuchao Sang, Dongqin Huang, Qiaoqin Lin, Weihong Chen

Published in

Frontiers in oncology. Volume 16. Pages 1821733. Epub Jul 27, 2026.

Abstract

Esophageal cancer (EC) remains a major public health challenge in high-incidence, resource-limited county settings, where fragmented services often lead to delayed diagnosis, suboptimal multidisciplinary care, and poor continuity of follow-up. We developed a county-adapted, integrated "prevention-screening-treatment" model with full-cycle closed-loop management and evaluated its effectiveness.
We conducted a controlled pilot study in Anxi County, Fujian Province, China. The intervention was delivered through a county-township-village three-tier service network supported by a digital management platform and standardized quality-of-life (QoL) assessment. Two hundred adults with pathologically confirmed EC were enrolled and assigned (non-randomly, based on enrollment in the program pathway at first presentation) to the intervention group receiving the integrated full-cycle management model (n=100) or to a control group receiving usual county-level care (n=100). Primary outcomes included diagnostic delay, multidisciplinary team (MDT) participation, standardized follow-up, and survival outcomes. Secondary outcomes included treatment adherence, complications, QoL (EORTC QLQ-C30 and QLQ-OES18), and cost-utility (cost per quality-adjusted life year, QALY). Between-group comparisons used χ² tests and t tests; longitudinal QoL used repeated-measures analysis; and survival used Cox regression.
Compared with controls, the intervention group had shorter diagnostic delay (46.8 ± 13.2 vs 88.5 ± 17.6 days; p < 0.001), higher MDT participation (91.0% vs 34.0%; p < 0.001), higher standardized follow-up (86.0% vs 32.0%; p < 0.001), and lower loss to follow-up (4.0% vs 17.0%; p = 0.001). One-, two-, and three-year overall survival was higher in the intervention group (88.0%, 75.0%, and 67.0%) than in controls (71.0%, 57.0%, and 55.0%). QoL improved more over time in the intervention group, with significant group-by-time interactions for key functional and symptom domains (all p < 0.001). Direct medical and indirect costs were lower, while QALYs were higher (0.696 ± 0.127 vs 0.602 ± 0.119; p < 0.001), resulting in a lower cost per QALY.
A county-adapted, integrated full-cycle EC management model supported by a three-tier service network, digital tools, and standardized QoL measurement improved care processes, outcomes, and cost-utility. This approach appears feasible and potentially scalable to similar high-incidence county settings.

PMID:
42577252
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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