Challenges to Treating Cancer in Prison
Few to no prison nurses are oncology specialists by training. Thus, by the time incarcerated patients arrive at their initial oncology visit outside the prison, many are presenting with advanced stages of cancer and a history of prolonged signs and/or symptoms indicating serious illness. For nurses outside the prison setting, this delay in treatment can cause feelings of confusion and anxiety. Nurses have reported a sense of conflict regarding their obligation to report potential patient neglect and malpractice. Reporting such incidences may impede the relationship with prison medical personnel and negatively affect patient treatment and pain management upon return to the prison. Likewise, they are hesitant to suggest the patient consider legal counsel as they fear it might exacerbate the patient’s emotional distress.7,14
Another impediment to off-site oncology visits is transportation. An outpatient visit to a doctor can be long and arduous ordeal for an inmate with cancer. Many prisons are located in rural areas. Inmates are transported in large groups, often very early in the morning. As a result, inmate patients may miss the morning distribution of their pain medications. They are transported in shackles and unable to move around freely. For a patient suffering from tumors in the anal or spinal region, a long bumpy ride on a hard bench without medication may be particularly painful. At the facility, inmates are confined to a holding cell when not being treated and must wait until every patient is seen before the bus returns to the prison.7
Another set of unique challenges are waiting for patients and their care providers when they are returned to the prison. Drugs prescribed during the outpatient visit may in fact not be given when the patient returns to the prison for several reasons.7 Many inmates struggle with drug addiction, making distribution of pain medications particularly difficult to navigate. In some cases, on-site nurses cannot give an inmate pain medication without first obtaining permission from the residing physician. Almost three-quarters of prison nurses report feeling that their training in pain management was poor.15 One study revealed that few prison nurses had treated more than 40 patients with cancer during the previous year.15 Overall, poor training and stringent restrictions can lead to undertreating pain among inmates with cancer.
The problem is not limited to medication distribution. Other forms of prescribed accommodations, such as treatment-specific diets, may also be difficult to follow once the inmate has returned to prison.7 In one report, an inmate at a state prison who had prostate cancer had to plead with prison officials to reinstate his doctor-mandated diet.16“I’m 76 years old. Please renew my wasting diet as soon as possible,” he wrote to prison officials. The diet was eventually reinstated, but his request for prostate treatment was not granted for another month.16
This article originally appeared on ONA