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Lüchtenborg M, Huynh J, Armes J, Plugge E, Hunter RM, Visser R, Taylor RM, Davies EA. Cancer incidence, treatment, and survival in the prison population compared with the general population in England: a population-based, matched cohort study. Lancet Oncol 2024; 25:553-562. [PMID: 38697154 DOI: 10.1016/s1470-2045(24)00035-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND The growing and ageing prison population in England makes accurate cancer data of increasing importance for prison health policies. This study aimed to compare cancer incidence, treatment, and survival between patients diagnosed in prison and the general population. METHODS In this population-based, matched cohort study, we used cancer registration data from the National Cancer Registration and Analysis Service in England to identify primary invasive cancers and cervical cancers in situ diagnosed in adults (aged ≥18 years) in the prison and general populations between Jan 1, 1998, and Dec 31, 2017. Ministry of Justice and Office for National Statistics population data for England were used to calculate age-standardised incidence rates (ASIR) per year and age-standardised incidence rate ratios (ASIRR) for the 20-year period. Patients diagnosed with primary invasive cancers (ie, excluding cervical cancers in situ) in prison between Jan 1, 2012, and Dec 31, 2017 were matched to individuals from the general population and linked to hospital and treatment datasets. Matching was done in a 1:5 ratio according to 5-year age group, gender, diagnosis year, cancer site, and disease stage. Our primary objectives were to compare the incidence of cancer (1998-2017); the receipt of treatment with curative intent (2012-17 matched cohort), using logistic regression adjusted for matching variables (excluding cancer site) and route to diagnosis; and overall survival following cancer diagnosis (2012-17 matched cohort), using a Cox proportional hazards model adjusted for matching variables (excluding cancer site) and route to diagnosis, with stratification for the receipt of any treatment with curative intent. FINDINGS We identified 2015 incident cancers among 1964 adults (1556 [77·2%] men and 459 [22·8%] women) in English prisons in the 20-year period up to Dec 31, 2017. The ASIR for cancer for men in prison was initially lower than for men in the general population (in 1998, ASIR 119·33 per 100 000 person-years [95% CI 48·59-219·16] vs 746·97 per 100 000 person-years [742·31-751·66]), but increased to a similar level towards the end of the study period (in 2017, 856·85 per 100 000 person-years [675·12-1060·44] vs 788·59 per 100 000 person-years [784·62-792·57]). For women, the invasive cancer incidence rate was low and so ASIR was not reported for this group. Over the 20-year period, the incidence of invasive cancer for men in prison increased (incidence rate ratio per year, 1·05 [95% CI 1·04-1·06], during 1999-2017 compared with 1998). ASIRRs showed that over the 20-year period, overall cancer incidence was lower in men in prison than in men in the general population (ASIRR 0·76 [95% CI 0·73-0·80]). The difference was not statistically significant for women (ASIRR 0·83 [0·68-1·00]). Between Jan 1, 2012, and Dec 31, 2017, patients diagnosed in prison were less likely to undergo curative treatment than matched patients in the general population (274 [32·3%] of 847 patients vs 1728 [41·5%] of 4165; adjusted odds ratio (OR) 0·72 [95% CI 0·60-0·85]). Being diagnosed in prison was associated with a significantly increased risk of death on adjustment for matching variables (347 deaths during 2021·9 person-years in the prison cohort vs 1626 deaths during 10 944·2 person-years in the general population; adjusted HR 1·16 [95% CI 1·03-1·30]); this association was partly explained by stratification by curative treatment and further adjustment for diagnosis route (adjusted HR 1·05 [0·93-1·18]). INTERPRETATION Cancer incidence increased in people in prisons in England between 1998 and 2017, with patients in prison less likely to receive curative treatments and having lower overall survival than the general population. The association with survival was partly explained by accounting for differences in receipt of curative treatment and adjustment for diagnosis route. Improved routine cancer surveillance is needed to inform prison cancer policies and decrease inequalities for this under-researched population. FUNDING UK National Institute for Health and Care Research, King's College London, and Strategic Priorities Fund 2019/20 of Research England via the University of Surrey.
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Affiliation(s)
- Margreet Lüchtenborg
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King's College London, London, UK; National Disease Registration Service, Data and Analytics, Transformation Directorate, NHS England, UK
| | - Jennie Huynh
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King's College London, London, UK; National Disease Registration Service, Data and Analytics, Transformation Directorate, NHS England, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Emma Plugge
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rachael M Hunter
- Applied Health Research, Institute of Epidemiology and Health, University College London, London, UK
| | - Renske Visser
- Faculty of Education and Psychology, University of Oulu, Oulu, Finland
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Professional Research, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elizabeth A Davies
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King's College London, London, UK.
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Favril L, Rich JD, Hard J, Fazel S. Mental and physical health morbidity among people in prisons: an umbrella review. Lancet Public Health 2024; 9:e250-e260. [PMID: 38553144 DOI: 10.1016/s2468-2667(24)00023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. METHODS In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre-registered with PROSPERO, CRD42023404827. FINDINGS Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9-12·8) for major depression, 9·8% (6·8-13·2) for post-traumatic stress disorder, and 3·7% (3·2-4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0-26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5-46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0-20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small-study effects. INTERPRETATION People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health. FUNDING Research Foundation-Flanders, Wellcome Trust, National Institutes of Health.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Josiah D Rich
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
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Iwai Y, Li J, Isaacs TJ, Ma SJ, Elmore SNC, Kamran SC, Oladeru OT. National Survey of Oncologists' Knowledge, Attitudes, and Practice Behaviors: Caring for Cancer Patients Experiencing Incarceration. JOURNAL OF CORRECTIONAL HEALTH CARE 2024; 30:97-106. [PMID: 38466954 DOI: 10.1089/jchc.23.08.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Cancer is the leading cause of illness-related death in state prisons in the United States. The experiences of physicians providing oncological care to individuals experiencing incarceration are underexplored. The study aims were to evaluate knowledge, attitudes, and practices of oncologists caring for cancer patients who are incarcerated. An online survey was distributed to a random sample of 150 oncologists from the American Society of Clinical Oncology and the American Society for Radiation Oncology from July 2020 to December 2021. Statistical analyses included two proportion Z-test, Fisher's exact test, Kruskal-Wallis test, and Cramer's V to estimate factors associated with attitudes and barriers to care. Of the 55 respondents (36.7% response rate), 21 were medical oncologists and 34 were radiation oncologists. Academic center oncologists were more likely to report caring for incarcerated patients than community or private practice oncologists (p = .04). Most (53%) incorrectly reported "heart disease" as the leading cause of death, as opposed to "cancer" (15% identified correctly). Oncologists practicing at both academic and community centers were more likely to report care coordination barriers than oncologists at academic or community centers (p < .01). We identified potential barriers in caring for incarcerated cancer patients. Future studies should explore ways to improve care coordination between oncology teams and prisons.
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Affiliation(s)
- Yoshiko Iwai
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jian Li
- State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Tamia J Isaacs
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Shekinah N C Elmore
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Richman IB, Soulos PR, Lin HJ, Aminawung JA, Oladeru OT, Puglisi LB, Wang EA, Gross CP. Incarceration and screen-detectable cancer diagnosis among adults in Connecticut. J Natl Cancer Inst 2024; 116:485-489. [PMID: 37991935 PMCID: PMC10919339 DOI: 10.1093/jnci/djad242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
Although incarcerated adults are at elevated risk of dying from cancer, little is known about cancer screening in carceral settings. This study compared stage-specific incidence of screen-detectable cancers among incarcerated and recently released people with the general population, as a reflection of screening practices. We calculated the age- and sex-standardized incidence ratios (SIR) for early- and late-stage cancers for incarcerated and recently released adults compared to the general Connecticut population between 2005 and 2016. Our sample included 143 cancer cases among those incarcerated, 406 among those recently released, and 201 360 in the general population. The SIR for early-stage screen-detectable cancers was lower among incarcerated (SIR = 0.28, 95% CI = 0.17 to 0.43) and recently released (SIR = 0.69, 95% CI = 0.51 to 0.88) individuals than the general population. Incidence of late-stage screen-detectable cancer was lower during incarceration (SIR = 0.51, 95% CI = 0.27 to 0.88) but not after release (SIR = 1.32, 95% CI = 0.93 to 1.82). Findings suggest that underscreening and underdetection of cancer may occur in carceral settings.
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Affiliation(s)
- Ilana B Richman
- Cancer Outcomes, Public Policy, and Effectiveness Research, Yale School of Medicine, New Haven, CT, USA
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy, and Effectiveness Research, Yale School of Medicine, New Haven, CT, USA
| | - Hsiu-ju Lin
- School of Social Work, University of Connecticut, Storrs, CT, USA
- Connecticut Department of Mental Health and Addiction Services, Hartford, CT, USA
| | - Jenerius A Aminawung
- Cancer Outcomes, Public Policy, and Effectiveness Research, Yale School of Medicine, New Haven, CT, USA
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
| | | | - Lisa B Puglisi
- School of Social Work, University of Connecticut, Storrs, CT, USA
| | - Emily A Wang
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research, Yale School of Medicine, New Haven, CT, USA
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Vetrani C, Verde L, Ambretti A, Muscogiuri G, Pagano AM, Lucania L, Colao A, Barrea L. Nutritional interventions in prison settings: a scoping review. Nutr Rev 2024:nuae011. [PMID: 38366579 DOI: 10.1093/nutrit/nuae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Mounting evidence has shown that incarceration can affect the health and well-being of individuals and increase the risk of noncommunicable diseases (NCDs). Diet quality is known to be one of the main determinants of risk of NCDs, and dietary changes are the first approach used in primary care to reduce the incidence of NCDs. OBJECTIVE This scoping review aimed to summarize the evidence for (1) the diet quality of inmates, and (2) the effect of nutritional intervention in prison systems. In addition, we aimed to describe limitations in the current literature and to suggest potential future research areas. METHOD A systematic search was performed in 2 databases (PubMed and Web of Science) using predefined search terms and covering the period May 2023 to June 2023. Additionally, reference lists from the retrieved studies were hand-searched to identify any additional relevant publications. The identified literature was screened based on defined search strategies, criteria, and research questions defined using the PICo (population or problem, interest, and context) framework. The review was conducted referring to the PRISMA-ScR and the PICo framework. RESULTS A total of 19 studies out of 63 initially identified records were included in this review (11 cross-sectional evaluations and 9 intervention-based studies). In almost all studies, assessment of the diet quality of menus showed the menus to be nutritionally adequate, except for having a higher-than-recommended intake of total energy, saturated fatty acids, sodium, cholesterol, and sugar. In addition, some studies reported a lower-than-recommended intake of fiber, magnesium, potassium, vitamins D, E, and A, and omega-3 fatty acids. Nutritional interventions were mainly planned in the form of workshops, seminars, and written material to deliver information on healthy dietary choices. Although no significant changes in inmates' dietary choices were observed in any of the studies, a high participation rate was detected. CONCLUSION Inmates might require additional prevention intervention to reduce their susceptibility to cardiometabolic diseases by virtue of their isolation from community facilities. Interventions should be tailored to the characteristics of prison settings and inmates to increase adherence to nutritional recommendations.
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Affiliation(s)
- Claudia Vetrani
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale Isola F2, Naples, Italy
| | - Ludovica Verde
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antinea Ambretti
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale Isola F2, Naples, Italy
| | - Giovanna Muscogiuri
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University of Naples "Federico II", Naples, Italy
- UNESCO Chair "Education for Health and Sustainable Development", University of Naples "Federico II", Naples, Italy
| | - Antonio Maria Pagano
- President S.I.M.S.Pe. Società Italiana di Medicina e Sanità Penitenziaria (Italian Society of Penitentiary Medicine and Healthcare), Viale Bruno Buozzi, ROMA, Italy
- Dipartimento delle Attività Territoriali, Direttore U.O. Tutela Salute Adulti e Minori, Area Penale, ASL SALERNO, Salerno, Italy
| | - Luciano Lucania
- Director S.I.M.S.Pe. Società Italiana di Medicina e Sanità Penitenziaria (Italian Society of Penitentiary Medicine and Healthcare), Viale Bruno Buozzi, ROMA, Italy
- Specialista Ambulatoriale in Chirurgia, Responsabile Istituto Penitenziario di Reggio Calabria Giuseppe Panzera, Street Carcere Nuovo, 15, Reggio Calabria, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University of Naples "Federico II", Naples, Italy
- UNESCO Chair "Education for Health and Sustainable Development", University of Naples "Federico II", Naples, Italy
| | - Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale Isola F2, Naples, Italy
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Tosetti I, Kuper H. Do people with disabilities experience disparities in cancer care? A systematic review. PLoS One 2023; 18:e0285146. [PMID: 38091337 PMCID: PMC10718463 DOI: 10.1371/journal.pone.0285146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. METHODS A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. RESULTS Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. DISCUSSION Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.
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Affiliation(s)
- Irene Tosetti
- M.Sc. Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Ramaswamy M, Manz C, Kouyoumdjian F, Vest N, Puglisi L, Wang E, Salyer C, Osei B, Zaller N, Rebbeck TR. Cancer equity for those impacted by mass incarceration. J Natl Cancer Inst 2023; 115:1128-1131. [PMID: 37219371 PMCID: PMC10560595 DOI: 10.1093/jnci/djad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Abstract
The cancer disparities between people with incarceration histories compared with those who do not have those histories are vast. Opportunities for bolstering cancer equity among those impacted by mass incarceration exist in criminal legal system policy; carceral, community, and public health linkages; better cancer prevention, screening, and treatment services in carceral settings; expansion of health insurance; education of professionals; and use of carceral sites for health promotion and transition to community care. Clinicians, researchers, persons with a history of incarceration, carceral administrators, policy makers, and community advocates could play a cancer equity role in each of these areas. Raising awareness and setting a cancer equity plan of action are critical to reducing cancer disparities among those affected by mass incarceration.
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Affiliation(s)
- Megha Ramaswamy
- Population Health, Obstetrics and Gynecology, University of Kansas Medical Center/University of Kansas Cancer Center, Kansas City, KS, USA
| | - Christopher Manz
- Medical Oncology, Population Sciences, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | | | - Noel Vest
- Community Health Sciences, School of Public Health, Boston University, Boston, MA, USA
| | - Lisa Puglisi
- Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Emily Wang
- Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Chelsea Salyer
- Population Health, Obstetrics and Gynecology, University of Kansas Medical Center/University of Kansas Cancer Center, Kansas City, KS, USA
| | - Beverly Osei
- Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Nick Zaller
- Health Behavior and Health Education, College of Public Health, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Timothy R Rebbeck
- Medical Oncology, Population Sciences, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
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Bradley CJ, Zhao J, Shih YCT, Yabroff KR. Mass incarceration and cancer health disparities in the United States: reimagining models of care delivery. J Natl Cancer Inst 2023; 115:1121-1124. [PMID: 37550255 DOI: 10.1093/jnci/djad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Cathy J Bradley
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Ya-Chen Tina Shih
- Department of Radiation Oncology, School of Medicine, University of California Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
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Burkett WC, Iwai Y, Gehrig PA, Knittel AK. Fractured and delayed: A qualitative analysis of disruptions in care for gynecologic malignancies during incarceration. Gynecol Oncol 2023; 176:1-9. [PMID: 37393632 PMCID: PMC10528285 DOI: 10.1016/j.ygyno.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Women are experiencing growing rates of incarceration at twice the pace of that for men. Additionally, one-third will be older than 55 years of age by the end of the decade. Women who are incarcerated experience a higher prevalence of gynecologic malignancies and present with higher stage disease, which may be contributing to the greater mortality from cancer than the age-adjusted US population. Limited access to guideline-recommended screening and prevention and resource limitations across correctional facilities may result in gynecologic cancer disparities. Reasons for delayed gynecologic cancer care in prisons remain underexplored. Therefore, we sought to identify contributors to delayed gynecologic cancer care among women experiencing incarceration. METHODS Women at a single tertiary center in the Southeastern U.S. who were incarcerated and were diagnosed with a gynecologic cancer during 2014-2021 were identified in the electronic medical record. Note text was extracted and contributors to delay were identified and categorized using the RADaR method. Descriptive statistics were used to assess quantitative data. RESULTS 14 patients were identified with a total of 14,879 text excerpts. Data reduction was performed to identify excerpts that were relevant to the central research question resulting in 175 relevant note excerpts. Delays prior to the tertiary care visit included patient and institutional contributors. Delays during transition from the tertiary center to prison included discharge planning and loss to follow-up during/after incarceration. Transportation, authorization, and restraints were concrete contributors. Abstract contributors included communication, and the patient's emotional experience. CONCLUSIONS We identify myriad contributors to delayed or fractured gynecologic cancer care in women experiencing incarceration. The impact of these issues warrants further study and intervention to improve care.
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Affiliation(s)
- Wesley C Burkett
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Yoshiko Iwai
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America.
| | - Paola A Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America.
| | - Andrea K Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
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Aminawung JA, Soulos PR, Oladeru OT, Lin H, Gonsalves L, Puglisi LB, Hassan S, Richman IB, Wang EA, Gross CP. Cancer incidence among incarcerated and formerly incarcerated individuals: A statewide retrospective cohort study. Cancer Med 2023; 12:15447-15454. [PMID: 37248772 PMCID: PMC10417084 DOI: 10.1002/cam4.6162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Cancer incidence among individuals with incarceration exposure has been rarely studied due to the absence of linked datasets. This study examined cancer incidence during incarceration and postincarceration compared to the general population using a statewide linked cohort. METHODS We constructed a retrospective cohort from a linkage of state tumor registry and correctional system data for Connecticut residents from 2005 to 2016, and identified cancers diagnosed during and within 12 months postincarceration. We estimated incidence rates (including for screen-detectable cancers) and calculated the standardized incidence ratios (SIR) for the incarcerated and recently released populations, relative to the general population. We also examined cancer incidence by race and ethnicity within each group. RESULTS Cancer incidence was lower in incarcerated individuals (SIR = 0.64, 95% CI 0.56-0.72), but higher in recently released individuals (SIR = 1.34, 95% CI 1.23-1.47) compared with the general population, and across all race and ethnic strata. Similarly, nonscreen-detectable cancer incidence was lower in incarcerated and higher in recently released populations compared to the general population. However, non-Hispanic Black individuals had elevated incidence of screen-detectable cancers compared with non-Hispanic White individuals across all three populations (incarcerated, SIR = 1.66, 95% CI 1.03-2.53; recently released, SIR = 1.83, 95% CI 1.32-2.47; and general population, SIR = 1.18, 95% CI 1.16-1.21). CONCLUSION Compared with the general population, incarcerated persons have a lower cancer incidence, whereas recently released persons have a higher cancer incidence. Irrespective of incarceration status, non-Hispanic Black individuals have a higher incidence of screen-detectable cancers compared with non-Hispanic White individuals. Supplemental studies examining cancer screening and diagnoses during incarceration are needed to discern the reasons for observed disparities in incidence.
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Affiliation(s)
- Jenerius A. Aminawung
- Department of Internal Medicine, SEICHE Center for Health and JusticeYale School of MedicineNew HavenConnecticutUSA
- Department of Internal Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
| | - Pamela R. Soulos
- Department of Internal Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
| | | | - Hsiu‐Ju Lin
- School of Social WorkUniversity of ConnecticutHartfordConnecticutUSA
- Research DivisionConnecticut Department of Mental Health and Addiction ServicesHartfordConnecticutUSA
| | - Lou Gonsalves
- Connecticut Tumor Registry, Connecticut Department of Public HealthHartfordConnecticutUSA
| | - Lisa B. Puglisi
- Department of Internal Medicine, SEICHE Center for Health and JusticeYale School of MedicineNew HavenConnecticutUSA
| | - Sirad Hassan
- Department of Internal Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
| | - Ilana B. Richman
- Department of Internal Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
| | - Emily A. Wang
- Department of Internal Medicine, SEICHE Center for Health and JusticeYale School of MedicineNew HavenConnecticutUSA
| | - Cary P. Gross
- Department of Internal Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
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11
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Wurcel AG, Kraus C, Johnson O, Zaller ND, Ray B, Spaulding AC, Flynn T, Quinn C, Day R, Akiyama MJ, Del Pozo B, Meyer F, Glenn JE. Stakeholder-engaged research is necessary across the criminal-legal spectrum. J Clin Transl Sci 2022; 7:e5. [PMID: 36755540 PMCID: PMC9879908 DOI: 10.1017/cts.2022.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
People with lived experience of incarceration have higher rates of morbidity and mortality compared to people without history of incarceration. Research conducted unethically in prisons and jails led to increased scrutiny of research to ensure the needs of those studied are protected. One consequence of increased restrictions on research with criminal-legal involved populations is reluctance to engage in research evaluations of healthcare for people who are incarcerated and people who have lived experience of incarceration. Ethical research can be done in partnership with people with lived experience of incarceration and other key stakeholders and should be encouraged. In this article, we describe how stakeholder engagement can be accomplished in this setting, and further, how such engagement leads to impactful research that can be disseminated and implemented across disciplines and communities. The goal is to build trust across the spectrum of people who work, live in, or are impacted by the criminal-legal system, with the purpose of moving toward health equity.
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Affiliation(s)
- Alysse G. Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Christina Kraus
- Tufts University Medical Student, JCOIN LEAP Scholar, Boston, MA, USA
| | - O’Dell Johnson
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Bradley Ray
- RTI International, Division for Applied Justice Research, 3040 Cornwallis Road, Research Triangle Park, NC27709, USA
| | - Anne C. Spaulding
- Associate Professor of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tara Flynn
- Assistant Deputy Superintendent Health Services, Norfolk County Sheriff’s Office, Dedham, MA, USA
| | | | - Ronald Day
- The Fortune Society, Vice President of Programs and Research, Long Island City, New York, USA
| | - Matthew J. Akiyama
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Fred Meyer
- Deputy Chief (Retired), Las Vegas Metropolitan Police Department, Las Vegas, NV, USA
| | - Jason E. Glenn
- Department of History and Philosophy of Medicine, University of Kansas Medical Center, Kansas, USA
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12
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Oladeru OT, Aminawung JA, Lin HJ, Gonsalves L, Puglisi L, Mun S, Gallagher C, Soulos P, Gross CP, Wang EA. Incarceration status and cancer mortality: A population-based study. PLoS One 2022; 17:e0274703. [PMID: 36112653 PMCID: PMC9481043 DOI: 10.1371/journal.pone.0274703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background The complex relationship between incarceration and cancer survival has not been thoroughly evaluated. We assessed whether cancer diagnosis during incarceration or the immediate post-release period is associated with higher rates of mortality compared with those never incarcerated. Methods We conducted a population-based study using a statewide linkage of tumor registry and correctional system movement data for Connecticut adult residents diagnosed with invasive cancer from 2005 through 2016. The independent variable was place of cancer diagnosis: during incarceration, within 12 months post-release, and never incarcerated. The dependent variables were five-year cancer-related and overall survival rates. Results Of the 216,540 adults diagnosed with invasive cancer during the study period, 239 (0.11%) people were diagnosed during incarceration, 479 (0.22%) within 12 months following release, and the remaining were never incarcerated. After accounting for demographics and cancer characteristics, including stage of diagnosis, the risk for cancer-related death at five years was significantly higher among those diagnosed while incarcerated (AHR = 1.39, 95% CI = 1.12–1.73) and those recently released (AHR = 1.82, 95% CI = 1.57–2.10) compared to the never-incarcerated group. The risk for all-cause mortality was also higher for those diagnosed with cancer while incarcerated (AHR = 1.92, 95% CI = 1.63–2.26) and those recently released (AHR = 2.18, 95% CI = 1.94–2.45). Conclusions and relevance There is a higher risk of cancer mortality among individuals diagnosed with cancer during incarceration and in the first-year post-release, which is not fully explained by stage of diagnosis. Cancer prevention and treatment efforts should target people who experience incarceration and identify why incarceration is associated with worse outcomes.
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Affiliation(s)
- Oluwadamilola T. Oladeru
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Jenerius A. Aminawung
- Department of Internal Medicine, SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut, United States of America
| | - Hsiu-Ju Lin
- School of Social Work, University of Connecticut, Storrs, Connecticut, United States of America
- Research Division, Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut, United States of America
| | - Lou Gonsalves
- Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, Connecticut, United States of America
| | - Lisa Puglisi
- Department of Internal Medicine, SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Sophia Mun
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States of America
| | - Colleen Gallagher
- Connecticut Department of Correction, Wethersfield, Connecticut, United States of America
| | - Pamela Soulos
- Department of Internal Medicine, Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut, United States of America
| | - Cary P. Gross
- Department of Internal Medicine, Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut, United States of America
| | - Emily A. Wang
- Department of Internal Medicine, SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, United States of America
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13
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Manz CR, Odayar VS, Schrag D. Disparities in cancer prevalence, incidence, and mortality for incarcerated and formerly incarcerated patients: A scoping review. Cancer Med 2021; 10:7277-7288. [PMID: 34477309 PMCID: PMC8525139 DOI: 10.1002/cam4.4251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Racial and ethnic minority status, structural racism, low educational attainment, and poverty are consistently associated with cancer disparities and with higher rates of incarceration. The objective of this scoping review is to conduct a qualitative synthesis of the literature on cancer prevalence, incidence, mortality, and disparities in these outcomes for incarcerated and formerly incarcerated patients, as this literature is fragmented and heterogenous. METHODS This scoping review included Bureau of Justice Statistics reports and searched PubMed in May 2021 for all English language studies published between 1990 and 30 April 2021, that reported on cancer prevalence, incidence, or mortality for incarcerated or formerly incarcerated individuals in the United States. RESULTS Twenty studies were selected. Data on cancer prevalence and incidence were scarce but suggested that incarcerated and formerly incarcerated patients have a similar overall risk of cancer diagnosis as the general population, but elevated risk of certain cancers such as cervical, lung, colorectal, and hepatocellular carcinoma for which effective prevention and screening interventions exist. Cancer mortality data in state and local jails as well as prisons were robust and suggests that both incarcerated and formerly incarcerated patients have higher cancer mortality than the general population. CONCLUSIONS Incarcerated and formerly incarcerated patients likely have a higher risk of dying from cancer than the general population, but important gaps in our knowledge about the extent and drivers of disparities for this population remain. Additional research is needed to guide interventions to reduce cancer disparities for patients experiencing incarceration.
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Affiliation(s)
- Christopher R. Manz
- Division of Population SciencesDepartment of Medical OncologyDana‐Farber Cancer InstituteBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | | | - Deborah Schrag
- Division of Population SciencesDepartment of Medical OncologyDana‐Farber Cancer InstituteBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
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