Inmate cancer patient – Highlighting the importance of a holistic approach to oncological care

Maria Tolia¹*, Emmanouil K Symvoulakis²*, Konstantinos Kamposioras³, Davide Mauri⁴, Angeliki Skoutari⁵, Panagiotis Volkos⁶, Dimitrios Schizas⁷, Athanasios Spanos⁸, Ioannis Kokakis⁹, Nikolaos Tsoukalas¹⁰, Nikolaos Charalampakis¹¹, Francesco Cuccia¹², Filippo Alongi¹², Ramon Andrade de Mello¹³, Katerina M Antoniou¹⁴, Thomas Hyphantis¹⁵, Ioanna Nixon¹⁶, Dimitris Matthaios¹⁷, Michail Nikolaou¹⁸, Francesco de Lorenzo¹⁹, Kathi Apostolidis¹⁹

¹Department of Radiotherapy, School of Medicine, University of Crete, Heraklion, Crete, Greece;

²Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece;

³Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom;

⁴Medical Oncology, University of Ioannina, Ioannina, Greece;

⁵Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41500, Larisa, Greece;

⁶4th Local Health Team – Academic Unit of Heraklion, Crete, Greece;

⁷First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece;

⁸University-level Institution of Officers’ School – Hellenic Police Academy, 13679, Athens, Greece;

⁹School of Theology, National and Kapodistrian University of Athens, 157 84, Athens, Greece;

¹⁰Oncology Clinic 401 General Military Hospital, Athens, Greece;

¹¹Oncology Clinic, Metaxa Hospital, Mpotasi 51, 18537 Piraeus, Greece;

¹²Advanced Radiation Oncology Department, IRCCS SacroCuore Don Calabria, Hospital, Negrar, Verona, Italy;

¹³Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil / Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal;

¹⁴Laboratory of Molecular & Cellular Pneumonology, Department of Respiratory Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece;

¹⁵Department of Psychiatry, University of Ioannina, 45110, Ioannina, Greece;

¹⁶The Beatson West of Scotland Cancer Center, 1053 Great Western Road, G12 OXP, Glasgow, United Kingdom;

¹⁷Oncology Department, General Hospital of Rhodes, Rhodes, Greece;

¹⁸1st Oncology Department, “Saint Savvas” Anticancer-Oncology Hospital, 11522 Athens, Greece;

¹⁹European Cancer Patient Coalition, Brussels, Belgium.

*These authors contributed equally to this work.

Summary

Purpose: Inmate oncologic patients’ rates increased drastically worldwide. Elderly, limited exercise, unhealthy diet, hepatitis, HIV + status, tobacco and alcohol use, constitute the main cancer risk factors. We present an outline of practical oncological management and ethical thinking, in the specific environment of a detention facility.

Methods: PubMed, Cochrane Database of Controlled Trials, SCOPUS and grey literature were extensively searched up to October 2021. Ιncarcerated oncologic patients experience various everyday challenges:their confinement in high security facilities, the lack of access to critical care and related ethical dilemmas inherent to the context of a correctional facility.

Results: The detention facilities may be inadequate in providing early cancer diagnosis and appropriate care mainly due to a lack of specialized personnel, b) in-house or in external specialized cancer hospitals, care variability (e.g. admissions in small local or regional hospitals), c) delays in providing access and d) gatekeeper systems. There is a paucity of administration of a)systemic therapy (chemotherapy, targeted drug therapy etc),b)radiotherapy, c) palliative care, and d)enrollment in clinical trials.

Conclusions: Correctional facilities must encourage teamwork between healthcare and correctional professionals in order to improve the provided anticancer care.

Key words: Inmate, cancer, patient, holistic, anticancer, approach.

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