{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:01:47Z","timestamp":1785132107236,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"\n Background<\/jats:title>\n 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 \u201cprevention\u2013screening\u2013treatment\u201d model with full-cycle closed-loop management and evaluated its effectiveness.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a controlled pilot study in Anxi County, Fujian Province, China. The intervention was delivered through a county\u2013township\u2013village 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 \u03c7\u00b2 tests and t tests; longitudinal QoL used repeated-measures analysis; and survival used Cox regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Compared with controls, the intervention group had shorter diagnostic delay (46.8 \u00b1 13.2 vs 88.5 \u00b1 17.6 days; p &lt; 0.001), higher MDT participation (91.0% vs 34.0%; p &lt; 0.001), higher standardized follow-up (86.0% vs 32.0%; p &lt; 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 &lt; 0.001). Direct medical and indirect costs were lower, while QALYs were higher (0.696 \u00b1 0.127 vs 0.602 \u00b1 0.119; p &lt; 0.001), resulting in a lower cost per QALY.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fonc.2026.1821733","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:40:47Z","timestamp":1785130847000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"16","author":[{"given":"Jianjia","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Tumor Prevention and Control Center, Anxi County Hospital","place":["Quanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limei","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Tumor Prevention and Control Center, Anxi County Hospital","place":["Quanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinduan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Anxi County Hospital","place":["Quanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingmei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Medical Research Center, Anxi County Hospital","place":["Quanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchao","family":"Sang","sequence":"additional","affiliation":[{"name":"Department of Clinical Medical Research Center, Anxi County Hospital","place":["Quanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongqin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Tumor Prevention and Control Center, Anxi County Hospital","place":["Quanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoqin","family":"Lin","sequence":"additional","affiliation":[{"name":"Anxi County Guanqiao Hospital","place":["Quanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medical Research Center, Anxi County Hospital","place":["Quanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"765","DOI":"10.3390\/cancers15030765","article-title":"Current status and future 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