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August 18, 2021

Cancer Care in the Incarcerated Population: Barriers to Quality Care and Opportunities for Improvement

Author Affiliations
  • 1Department of Surgery, Tufts School of Medicine, Tufts Medical Center, Boston, Massachusetts
  • 2Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
  • 3Division of Trauma and Critical Care, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
  • 4Deputy Editor, JAMA Surgery
JAMA Surg. 2021;156(10):964-973. doi:10.1001/jamasurg.2021.3754

Importance  Cancer is the leading cause of mortality in incarcerated individuals older than 45 years and the fourth leading cause of mortality overall. Health care professionals face increasing challenges to provide high-quality care under the confines of prison regulations and procedures.

Observations  Adjusted for age, race, sex, and year of diagnosis, the standardized incidence ratio for all cancers is more than 2-fold higher in incarcerated vs general populations. Among deaths occurring in state and federal prison systems, cancer is the overall leading cause of mortality with lung cancer being the leading cause of cancer-related mortality followed by liver, colon, and pancreatic cancers, respectively. Access to high-quality oncological services remains variable; however, cost of care represents about a fifth of overall annual prison expenditures. Given the enormous patient burden, coupled with the rushed discretionary screenings performed by jail and prison nursing staff, early cancer symptoms are often missed altogether or misdiagnosed as a chronic illness or as acute infections. As such, many incarcerated individuals present with more advanced cancer stage. Incarcerated individuals have limited, if any, access to the internet, social media, and other sources of information, which severely limits their ability to research treatment options. Within the prison setting, access to professionals with special skills in assisting with social and spiritual concerns is also generally limited, and less than 4% of prisons have hospice programs. There are no uniform quality-of-care monitoring standards for correctional systems and facilities, nor are there mechanisms for reporting comparable performance data to enforce quality control within correctional health care systems.

Conclusions and Relevance  There is a growing trend in cancer incidence among incarcerated patients, which is multifactorial including barriers in access to care, increased burden of chronic medical conditions, and decreased screening tests. Efforts are needed to ensure quality health care outcomes for incarcerated patients with cancer.

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