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.
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.
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.
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.
Western and Central Melbourne Integrated Cancer Service funding program and the St Vincent’s Hospital Research Endowment Fund.