Cancer stage at presentation for incarcerated patients at a single urban tertiary care center

Abstract

Patients who are incarcerated are a vulnerable patient population and may suffer from less access to routine cancer screenings compared to their non-incarcerated counterparts. Therefore, a thorough evaluation of potential differences in cancer diagnosis staging is needed. We sought to examine whether there are differences in cancer stage at initial diagnosis between non-incarcerated and incarcerated patients by pursuing a retrospective chart review from 2010-2017 for all patients who were newly diagnosed with cancer at an urban safety net hospital. Incarceration status was determined by insurance status. Our primary outcome was incarceration status at time of initial cancer diagnosis. Overall, patients who were incarcerated presented at a later cancer stage for all cancer types compared to the non-incarcerated (+.14 T stage, p = .033; +.23 N stage, p < .001). Incarcerated patients were diagnosed at later stages for colorectal (+0.93 T stage, p < .001; +.48 N stage, p < .001), oropharyngeal (+0.37 N stage, p = .003), lung (+0.60 N stage, p = .018), skin (+0.59 N stage, p = 0.014), and screenable cancers (colorectal, prostate, lung) as a whole (+0.23 T stage, p = 0.002; +0.17 N stage, p = 0.008). Incarcerated patients may benefit from more structured screening protocols in order to improve the stage at presentation for certain malignancies.

Incarceration status and cancer mortality: A population-based study

“…Almost two-thirds of patients diagnosed with cancer while incarcerated and more than half of those diagnosed following release were found to have regional spread or metastasized cancer, including for screenable cancers such as colorectal cancer. These data support the previously reported trend of late-stage cancer diagnosis in the incarcerated population [13]. Past research has indicated that incarcerated individuals are less likely to receive age-appropriate screening and this disparity warrants immediate health system intervention [27].…”

“…While prior studies have identified the association between incarceration and cancer survival time [13], our study illuminates the immediate post release period as a particularly highrisk time period. People diagnosed shortly following release from correctional settings are more likely to die earlier from cancer compared with counterparts diagnosed during incarceration, likely reflecting the significant barriers following release for obtaining timely cancer care.…”

“…On the other hand, people who are incarcerated may face barriers to cancer screening or evaluation of symptoms-either prior to or during incarcerationand therefore present at a later stage. Indeed, recent evidence from a single urban tertiary care center shows that cancer is diagnosed at more advanced stages among incarcerated people [13]. After release from correctional facilities, access to community healthcare could be impaired due to barriers in obtaining public insurance, housing, and employment compounded by the lasting impact of a criminal record, leading to low rates of screening and barriers to cancer treatment [14].…”

Cancer Care in the Incarcerated Population

“…There is also a high positivity rate of infections such as human papillomavirus, HIV, and hepatitis C that increase the risk of cancer development including lung, liver, and anorectal cancers. 3,10,11 In general, the US population is aging and the incarcerated population is no exception. With the gradual rise in mean age of incarcerated individuals throughout the last several years, 12 the correctional system has steadily seen an increase in prevalence of chronic medical conditions including cancer, a condition now recognized as the leading cause of mortality in the incarcerated population older than 45 years (Figure 1).…”

“…According to the 2016 US Bureau of Justice Statistics report, incarcerated individuals 55 years or older roughly tripled from 2001 to 2016 (4% to 12%, respectively), an increase of more than 200%. [10][11][12] Furthermore, according to the American Civil Liberties Union, by 2030, more than one-third of individuals in prison in the US will be older than 55 years. 13 The 2020 US Bureau of Justice Statistic report noted that individuals older than 55 years had the highest mortality rate of all incarcerated individuals (more than 3 times as high as any other age group).…”