Conclusions

Cancer incidence in English prisons rose between 1998 and 2017 to reach similar levels to those in the general population. However, patients diagnosed in prison have fewer but longer hospital admissions, fewer curative treatments, and a lower survival rate. Following a cancer diagnosis, people in prison have significantly lower planned care costs, but higher emergency care costs and an overall higher care cost due to security escorts. This is alongside evidence of poorer experiences of care reported both in detailed interviews with patients and using an established national survey. Cancer care in prison is complex, not least because people in prison move between a patient and a prison environment. Tensions between control and choice in prison healthcare impacted patients’ experiences of cancer care in terms of the diagnostic process, symptom management, accessing information about their illness, and the involvement of family in their care. The initial policy priorities identified by prison and cancer stakeholders based on these findings are to improve understanding between prison and cancer clinical teams to improve patient care, develop the role of ‘health champions’ in prison, and raise health literacy and awareness of both cancer screening and cancer symptoms in prison.