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.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.