Wang, Emily A.

ImportanceAlthough incarceration is associated with worse cancer outcomes, little is known about quality of cancer care among people with a history of incarceration.ObjectiveTo describe quality of cancer care among those diagnosed with cancer during or immediately after incarceration.Design, Setting, and ParticipantsThis longitudinal cohort study used Connecticut Tumor Registry data linked to Department of Correction rosters from 2005 through 2016. Patients diagnosed with cancer while incarcerated were matched to those diagnosed within 12 months after incarceration and to those with no history of incarceration. Analysis was performed between March 2024 and January 2025.ExposuresIncarceration status at time of cancer diagnosis.Main Outcomes and MeasuresThe main outcomes were treatment initiation within 60 days and receipt of recommended pretreatment and therapeutic care, ascertained from medical records and tumor registries. Logistic regression was used to evaluate odds of treatment initiation by 60 days. The proportion of recommended elements of pretreatment and therapeutic care received was calculated, and group differences were assessed using χ2 tests.ResultsThe sample included 690 individuals (233 diagnosed during incarceration, 221 diagnosed within 12 months after incarceration, and 236 with no incarceration history). The mean (SD) age was 49.7 (12.1) years, and 611 (88.6%) were male. Compared with those with no history of incarceration, those diagnosed with cancer during incarceration were less likely to initiate treatment within 60 days (169 of 209 [80.9%] vs 131 of 189 [69.3%]; OR, 0.49 [95% CI, 0.31-0.79]). Initiation of treatment within 60 days was not statistically different for those diagnosed after incarceration vs those with no history of incarceration (144 of 187 [77.0%]; OR, 0.81 [95% CI, 0.49-1.34]). Those diagnosed with local and regional cancers during incarceration received 49.2% of recommended treatment-related care (31 of 63 measures), while those diagnosed after incarceration received 45.3% (34 of 75 measures), compared with 66.7% (36 of 54 measures) among those with no history of incarceration (P < .001). People diagnosed with local and regional cancers during incarceration received 80.6% of recommended pretreatment evaluation (54 of 67 measures), and those diagnosed after received 96.8% (59 of 68 measures), compared with 78.1% (50 of 64 measures) among those with no history of incarceration (P = .01).Conclusions and RelevanceIn this cohort study of people with a history of incarceration, incarceration was associated with lower likelihood of receiving timely, high-quality cancer treatment. Along with other published literature, this work suggests that gaps in quality of care may contribute to observed disparities in outcomes.

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.