How is cancer care best provided to patients in English prisons? Assessing the disease burden in the prison population, experiences of diagnosis, treatment and support, and of receiving and providing cancer care

Background

There are approximately 85,000 people in prison in England and Wales. This is an ageing population so it is anticipated there will be an increase in people diagnosed with cancer. Reports have highlighted the lack of care systems and planning for the management of non-infectious diseases. An initial evidence review identified no studies that had examined the experiences of people with cancer in prison. This study will determine the incidence and survival rates for people diagnosed with cancer in the English prisons, patients’ experiences of cancer care and how professionals caring for people in prison with cancer view their role in the patient’s cancer journey.

Methods

We will conduct a sequential explanatory multiple methods study consisting of:

1. Analysing national cancer registry and Hospital Episode Data for prison postcodes to examine comparative national trends (1997-2016) for cancer incidence in those aged over 16 serving a prison sentence compared with the English general population. We will report on treatment received, days spent in hospital, survival rates and cause of death alongside estimating the comparative cost of cancer care for those in prison.
2. Qualitative interviews describing experiences of diagnosis, treatment and care from the perspectives of patients and professionals. We will also analyse 2010-2016 National Cancer Patient Experience Survey data for patients in prison compared with those reported for all English cancer patients.
3. Workshops to consider the implications of our findings from which we will identify priorities and recommendations for national prison policy, commissioning and cancer practice. As a result we will create a policy briefing and a short film that illustrates the findings

Outcomes/practical implications

We anticipate the findings will impact on the provision of cancer care in prisons, by highlighting gaps in care and examples of best practice, and provide new information to policy makers, commissioners and providers of cancer care. This will help them to develop more appropriate and effective cancer services that will positively impact the care experience of people with cancer in prison.

We aim to assess the incidence and potential cost of cancer in English prisons, equity of access to cancer care, experiences of care and develop recommendations to inform and improve local services and English prison cancer care policy. 

Objectives:

1. To investigate the incidence of cancer, access to treatment and survival in the English adult prison population compared with the general population and calculate the cost of cancer to the prison and health services in England.
2. To explore experiences of diagnosis, treatment, care and support from the perspectives of patients in prison and prison staff and clinicians.
3. To develop priorities and recommendations to improve the quality of cancer care in prisons, care of prison patients in hospital and the policy underpinning the commissioning of services.