Importance Cancer is the leading cause of mortality in incarcerated individuals older than 45 years and the fourth leading cause of mortality overall. Health care professionals face increasing challenges to provide high-quality care under the confines of prison regulations and procedures.

Observations Adjusted for age, race, sex, and year of diagnosis, the standardized incidence ratio for all cancers is more than 2-fold higher in incarcerated vs general populations. Among deaths occurring in state and federal prison systems, cancer is the overall leading cause of mortality with lung cancer being the leading cause of cancer-related mortality followed by liver, colon, and pancreatic cancers, respectively. Access to high-quality oncological services remains variable; however, cost of care represents about a fifth of overall annual prison expenditures. Given the enormous patient burden, coupled with the rushed discretionary screenings performed by jail and prison nursing staff, early cancer symptoms are often missed altogether or misdiagnosed as a chronic illness or as acute infections. As such, many incarcerated individuals present with more advanced cancer stage. Incarcerated individuals have limited, if any, access to the internet, social media, and other sources of information, which severely limits their ability to research treatment options. Within the prison setting, access to professionals with special skills in assisting with social and spiritual concerns is also generally limited, and less than 4% of prisons have hospice programs. There are no uniform quality-of-care monitoring standards for correctional systems and facilities, nor are there mechanisms for reporting comparable performance data to enforce quality control within correctional health care systems.

Conclusions and Relevance There is a growing trend in cancer incidence among incarcerated patients, which is multifactorial including barriers in access to care, increased burden of chronic medical conditions, and decreased screening tests. Efforts are needed to ensure quality health care outcomes for incarcerated patients with cancer.

重要性 癌症是 45 岁以上被监禁人员死亡的主要原因，也是总体死亡的第四大原因。在监狱法规和程序的限制下，医疗保健专业人员在提供高质量护理方面面临越来越大的挑战。

观察 根据年龄、种族、性别和诊断年份调整后，所有癌症的标准化发病率在监禁人群中比一般人群高出 2 倍以上。在州和联邦监狱系统发生的死亡中，癌症是导致死亡的总体主要原因，肺癌是癌症相关死亡的主要原因，其次是肝癌、结肠癌和胰腺癌。获得高质量肿瘤学服务的机会仍然多变；然而，护理费用约占监狱年度总支出的五分之一。鉴于巨大的患者负担，再加上监狱和监狱护理人员进行的仓促酌情筛查，早期癌症症状经常被完全遗漏或误诊为慢性疾病或急性感染。像这样，许多被监禁的人呈现出更晚期的癌症阶段。被监禁的个人对互联网、社交媒体和其他信息来源的访问受到限制（如果有的话），这严重限制了他们研究治疗方案的能力。在监狱环境中，在协助解决社会和精神问题方面具有特殊技能的专业人员通常也受到限制，只有不到 4% 的监狱有临终关怀项目。惩教系统和设施没有统一的医疗质量监测标准，也没有报告可比绩效数据以在惩教医疗系统内实施质量控制的机制。这严重限制了他们研究治疗方案的能力。在监狱环境中，在协助解决社会和精神问题方面具有特殊技能的专业人员通常也受到限制，只有不到 4% 的监狱有临终关怀项目。惩教系统和设施没有统一的医疗质量监测标准，也没有报告可比绩效数据以在惩教医疗系统内实施质量控制的机制。这严重限制了他们研究治疗方案的能力。在监狱环境中，在协助解决社会和精神问题方面具有特殊技能的专业人员通常也受到限制，只有不到 4% 的监狱有临终关怀项目。惩教系统和设施没有统一的医疗质量监测标准，也没有报告可比绩效数据以在惩教医疗系统内实施质量控制的机制。

结论和相关性 被监禁患者的癌症发病率呈增长趋势，这是多方面的因素，包括获得护理的障碍、慢性疾病负担的增加和筛查测试的减少。需要努力确保为被监禁的癌症患者提供高质量的医疗保健结果。