Cancer in Victorian prisoners: a description of cancer diagnoses, demographics, risk factors and barriers to optimal care

• Published in: Internal medicine journal Vol. 54; no. 2; pp. 295 - 300
• Main Authors: Newnham, Genni M., Munton, Karen, Shaw, Mark, McLachlan, Sue A.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-02-2024; Wiley Subscription Services, Inc
• Subjects: Aging; Cancer; carcinoma; Cigarette smoking; Comorbidity; Demography; health care delivery; health equity; Hepatoma; Lung cancer; Malignancy; Mental disorders; Prisoners; Risk factors; Skin cancer; Statistical analysis; vulnerable population; health equity; prisoners; health care delivery; carcinoma; vulnerable population
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.16182

Background
The Victorian prison population is growing and ageing. Little has been documented about this group's cancer incidence, presentation or treatment.
Aims
To conduct a retrospective review of Victorian prisoners with cancer, including assessment of change over 15 years and adequacy of treatment delivery.
Methods
Detailed demographic, cancer and treatment data were collected for all prisoners with malignancy treated at St Vincent's Hospital Melbourne from 2002 to 2017. Detailed analysis of adherence to Optimal Care Guidelines was undertaken for a subset. Descriptive statistics were used.
Results
We identified 200 cancers in 191 prisoners. The population was predominantly male (185 of 191, 93%), with a median age of 54 years. Rates of cigarette smoking (118 of 191, 59%), mental illness (92 of 191, 46%) and intravenous drug use (59 of 191, 29.5%) were high. Exposure‐related cancers predominated (nonmelanoma skin cancer, lung cancer and hepatoma). Most were symptomatic (154 of 191, 77%) and almost one‐third had incurable disease at diagnosis (64 of 191, 32%). The number of prisoners with cancer increased over time (2002–2006 [T1], n = 31 vs 2012–2016 [T3], n = 101), as did the median age (45 years in T1 vs 55 years in T3) and rates of mental illness (10 of 31 [32%] in T1 vs 55 of 101 [54%] in T3). Delayed treatment initiation occurred in eight of 12 (66%) assessable patients, largely because of nonattendance.
Conclusions
Victorian prisoners with cancer are at risk of poor outcomes because of late presentation, delayed treatment initiation and medical comorbidities. Tailored interventions are urgently required to improve the provision of timely, comprehensive cancer care to this vulnerable and growing population.