Correctional Health and Oncologist Perspectives on Strategies to Improve Cancer Care in US Prisons: A Qualitative...

Individuals diagnosed with cancer while incarcerated in US prisons have worse mortality than nonincarcerated individuals. Incarceration poses numerous barriers to care, and optimal strategies to improve cancer screening, diagnosis, and treatment are needed.

To investigate perspectives among correctional health and oncology clinicians on strategies to improve cancer care in US prisons, from screening and diagnosis to treatment and end-of-life care.

This qualitative study conducted interviews across 16 US state and federal prisons systems between September 2023 and April 2024 and a member-checking focus group in February 2025. Semistructured interviews were conducted with prison medical directors, primary care clinicians, and oncologists involved in delivering cancer care for individuals incarcerated in US prisons. Participants were recruited via email invitation sent to attendees of a correctional health conference, purposeful sampling using targeted emails to clinicians in diverse prison systems, and snowball sampling of individuals from research and participant networks. Interview transcripts were analyzed to identify all recommended strategies for improving care across the cancer care continuum. Data were analyzed from September 2023 to February 2025.

To identify recommendations on tools, practices, or policies to improve cancer care (hereafter, strategies) for incarcerated patients with cancer.

A total of 32 participants from 16 prison systems were interviewed (median [range] age, 49 [33 to ≥70] years; 20 female [62.5%]; 6 Asian or Pacific Islander [18.8%], 5 Black [15.6%], and 21 White [65.6%]), including 9 medical directors, 6 primary care physicians, and 15 oncologists. Participants identified strategies to improve care addressing nearly all previously identified barrier themes, including strategies for (1) conducting screening in prisons; (2) bringing cancer treatment into prisons and centralizing care; (3) using telehealth, navigators, and early oncologist involvement to improve care coordination; (4) improving communication and social support; (5) improving symptom management, access to palliative medicine, and end-of-life care; and (6) delivering patient-centered care. Strategies require implementation by prisons, prison clinicians, oncologists, oncology practices, and policymakers. A total of 22 focus group participants reinforced these strategies with additional supportive insights.

In this qualitative study of clinicians delivering cancer care for incarcerated individuals, participants identified pragmatic strategies to improve cancer screening and treatment that address most identified barriers to care in US prisons. Application of these strategies may be associated with mitigation of disparities in cancer survival for incarcerated individuals.