Background: The Australian prison population is growing and ageing. High rates of cancer risk factors and co-morbidities affect cancer prevalence, presentation, compliance and treatment outcomes. In addition, the complex interaction of the health and justice systems further complicates prisoner care.
Methods:
Retrospective review of medical records of all prisoners with cancer treated at SVH from 1/1/2002 - 31/12/2016.
Documentation of: age at cancer diagnosis, cancer type(s), risk factors, co-morbidities, mode of presentation, treatment compliance.
Data analysis in subgroups (entire cohort, 5 year time periods (P1: 1/1/2002 - 31/12/2006, P2: 1/1/2007 - 31/12/2011, P3: 1/1/2012 - 31/12/2016)).
Detailed analysis of adherence to Optimal Cancer Care Pathway (OCCP) recommended treatment timelines for patients in P3 with hepatocellular, skin, lung and colorectal carcinomas.
Results:
211 prisoners identified with 220 separate cancer diagnoses over 15 years.
Increasing number of prisoners with cancer over time (P1 = 39, P2 = 76 P3 = 105).
Median age (range): P1=48 (25 - 74), P2=54 (26 - 85), P3=55 (20 - 93).
High rates of smoking, IVDU and co-morbidity.
Tendency to late presentation (symptomatic vs. screening/incidental): P1=25/39, P2=61/76, P3=81/105.
Exposure-related cancers seen most commonly: skin BCC, hepatocellular carcinoma, lung cancer.
Several recurring obstacles to optimal care identified including information sharing between hospital and prison, appointment booking practices and patient preferences.
Conclusions:
In a 15 year time period we have seen an increasing number of cancer diagnoses in a predominantly male population of prisoners, with a tendency to late presentation and high rates of cancer risk factors and co-morbidities. Additionally we have an improved understanding of the complex barriers to care for these patients, some of which could be addressed through modifications in hospital practice.
Funding Sources:
Western and Central Melbourne Integrated Cancer Service funding program and the St Vincent’s Hospital Research Endowment Fund.