Prisoners diagnosed with cancer are more likely than people in the general population to die of the disease, according to research.
A study has calculated that compared with cancer patients in the general population, patients in English prisons are 28% less likely to receive treatment for cancer, particularly surgery to remove tumours, and have a 9% increased risk of death – half of which is due to treatment differences.
It is believed to be the first study of cancer incidence, treatment and survival in an entire national prison population.
Researchers at King’s College London, the University of Surrey and University College London analysed cancer data from the National Disease Registration Service for patients between 2012 and 2017. They compared diagnosis, treatment and survival rates of 847 cancer patients in English prisons with 4,165 similar patients in the general population of the same age, sex, cancer type and stage.
They also interviewed inmates with cancer, prison staff and healthcare professionals.
The study, published as three linked papers by the Lancet Oncology and eClinicalMedicine, found that only 27% of cancer patients in jail were diagnosed following an urgent two-week referral, compared with 37% among the general population cohort. They were also three times less likely to be diagnosed via screening.
Once cancer was confirmed, one- and five-year survival rates were lower for those in prison, largely due to differences in treatment. Compared with cancer patients in the general population, 28% fewer prisoners had surgery, 21% fewer received radiotherapy and 20% fewer received systemic treatments such as chemotherapy or hormonal therapy.
The study identified a number of barriers to both diagnosis and treatment for patients in jail. These included lower health literacy, a complex process to see a GP and being late or missing hospital appointments due to prison staff shortages.
It was also harder for prisoners to follow the advice of their oncologist when managing and reporting any side-effects of treatment, as they could not communicate directly with their consultants from prison, the research found.
The lead researcher, Dr Elizabeth Davies, a clinical reader in cancer and public health at King’s College London, said: “People in prison with cancer have so far been a hidden and under-researched population. They should not be impacted by such health inequalities and should receive the same standard of care as they would in the community.”
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Responding to the findings, Dr Miranda Davies, a senior fellow at the Nuffield Trust, said: “Starting treatment for cancer early is so important, so these findings showing that prisoners are less likely to receive treatments such as tumour removals than cancer patients in the general population are shocking. Unfortunately, these findings only represent part of a broken system where the healthcare needs of prisoners are systematically and regularly not being met. Prisoners should have the same right and access to healthcare services as everyone else, but this basic premise is far from reality.”
A government spokesperson said: “People in prison should receive the same standard and range of healthcare services as they would in the community, including cancer treatment. NHS England has developed a framework to reduce healthcare inequalities at both a national and system level, including for those in contact with the criminal justice system. We will continue to work to improve care pathways for offenders to access healthcare.”
An NHS spokesperson, said: “The NHS is committed to ensuring that anyone in prison diagnosed with cancer receives prompt and effective treatment in line with community provision and we are continuing to work with partner organisations on ways to make it easier for people within secure and detained environments to access cancer and other healthcare services.”