Patterns of Care for Incarcerated Head and Neck Cancer Patient Receiving Radiation: A Single-Center Retrospective Descriptive Cohort Study.

Purpose/objective(s) United States (US) have the highest incarceration rate in the world. In the context of the US justice system, many inmates are older than 55 years of age and as such are at an increased risk of cancer development. Additionally, largely due to mass incarcerations, correctional control is associated with significant racial disparities, further layering the complexity of the prison population's health. The purpose of this study was to describe patterns of care in incarcerated head and neck (H&N) cancer patients who received radiation treatment (RT) as a part of the management of their malignancy. Materials/methods Following IRB approval, a total of 44 charts of patients who were imprisoned for at least a part of their radiation treatment were manually reviewed. The variables extracted included demographic data (age, race, gender), vital status, tumor site, stage, social history, cancer history, RT purpose, RT plan details (start, end, duration, dose, fractionation, completion as prescribed, concurrent systemic treatment), weight loss, surveillance (loss to follow-up) and oncologic outcomes (tumor recurrence.) Data was summarized using descriptive statistics. Results A total of 41/44 inmates were males (93%), 13/44 (29.5%) were African American. Median age at diagnosis was 49.5 years (range 27-68). A total of 21/44 tumors (47%) were oropharyngeal tumors, followed by 9 laryngeal tumors (20%). A total of 41 patients (93%) had a previous smoking history (median 20 pack years), and 30 (68%) had documented history of alcohol abuse. Most common treatment purpose was post-operative (47%) followed by definitive (40%). The most common tumor histology reported was squamous (77%), and the most common stage at diagnosis was stage IV, reported in a total of 32 (72%) of patients. Median time between surgery date and RT start date was 65 days (9.28 weeks), median time from radiation oncology consult to radiation treatment start was 29.5 days. Overall, a total of 7 patients (15%) did not complete treatment as prescribed. A total of 11 (25%) of patients progressed. The median progression-free survival for those who progressed was 409 days (range 102 - 2310). The time interval between the detection/confirmation of progression and an intervention was 89.4 days on average (range 0 - 252 days). The frequency of loss to follow-up was 77%. A total of 12 patients (27%) died. Conclusion Incarcerated patients represent a vulnerable population, yet very little is known about patterns of care for those who require RT as a part of the management of their H&N cancer. Oropharyngeal cancers were predominant in our cohort, while oral tongue is the most common anatomic site of H&N cancer in the US. We noted the median time between surgery and RT of almost ten weeks (NCCN recommends initiating radiotherapy within 6 weeks), and the average time of almost 90 days from confirmation of disease progression and intervention. These data suggest that there may be venues for quality improvement in oncologic care for incarnated patients.