Cancer Screening, Diagnosis, and Treatment for Vulnerable Patients Incarcerated in US Prisons.

Abstract

Purpose: Cancer is the leading cause of death in US prisons, where incarcerated patients have substantially worse survival than nonincarcerated patients. Yet, cancer care delivery in US prisons has not been well described. This study describes cancer care delivery across the cancer continuum for individuals incarcerated in US prisons.

Methods: Semistructured interviews were conducted with 32 prison medical directors, primary care clinicians (PCPs), and oncologists caring for patients with cancer incarcerated in 16 US state and federal prison systems between September 2023 and April 2024. A member-checking focus group of 22 prison medical directors and clinicians was held in February 2025.

Results: Interview participants included nine prison medical directors, six PCPs, one gynecologist, 15 oncologists, and one palliative care clinician. Themes identified distinct logistics related to screening, diagnosis, treatment, symptom management, survivorship, and end-of-life care, and several cross-cutting topics including communication, scheduling, community transitions, and payment models. Participants reported that screening is widely available for some but not all cancers in prison. Prison clinicians and staff manage most screening and diagnostic evaluations, which require lengthy, sequential approval processes. Radiographic imaging, procedures, surgery, and treatment usually occur outside of prisons. Prison primary care teams manage many tasks usually overseen by oncology teams, including scheduling, care coordination, and management of symptoms from cancer and treatment. Policies limit clinician communication and family involvement, with important care ramifications. Security requirements and staff shortages complicate care coordination and scheduling. The focus group reinforced these themes and did not identify new themes.

Conclusion: The unique and complicated logistics of cancer care for patients incarcerated in US prisons differ from care provided to nonincarcerated patients and may negatively affect their cancer outcomes.