Prisoners are among the most marginalised groups in society. The Victorian prison population is increasing, and although prisoners overall are mostly young men, there is a growing group of older prisoners with a unique set of health problems.
Risk factors such as higher rates of smoking, illicit drug and alcohol use mean there is an increased need for the provision of cancer care among this disadvantaged and vulnerable group.
Oncologist Dr Genni Newnham provides specialist care for all cancer patients in Victorian prisons and says they are often difficult to treat for a number of reasons
‘They have poorer outcomes than other groups and often don’t receive optimal care,’ Dr Newnham says. ‘These patients frequently refuse to come to appointments, and as a clinician I never really understood why.’
Dr Newnham is conducting research analysing prison patients with a cancer diagnosis treated at St Vincent’s over the past 15 years. This research has been made possible due to funding from St Vincent’s Inclusive Health Innovation Fund, which supports St Vincent’s clinicians passionate about improving outcomes for the poor and vulnerable.
‘What we are learning is that there are priorities for these patients that are perceived by them to be more important than their healthcare. Concerns for their own safety, or the consequences of leaving prison (such as losing their cell or job), even for an outpatient appointment, lead some to refuse medical appointments or treatment.’
In addition, a more detailed analysis of prisoners with cancer in the last six years is being undertaken to determine if optimal care pathways have been followed for these patients. The research will explore potential changes in hospital practice to improve prisoner compliance and outcomes.
Dr Newnham wants to know more about the risk factor profile of prison patients, better understand the types and stage of cancers occurring in these patients, the mode of presentation, and the types of treatment.
Finding these patients for continuing care once they have been released from prison is a major issue. Many patients are lost to follow up once they are released. In many cases it is not until they reoffend that these patients re-enter the healthcare system, often in much poorer condition.
‘Our ultimate goal is to develop a prison oncology program together with supportive programs for post discharge follow up, to ensure equitable access and health outcomes.’
‘We are hoping that once we analyse all the data, we can identify two or three main trends which contribute to poorer outcomes and come up with some strategies for improvement. ’
Changes already introduced include an increase in the use of telehealth consultations in cases where a patient doesn’t need intravenous treatment.