“De-Shackling” Biases in Oncology Care for Incarcerated Populations

Some patients who are incarcerated may end up undergoing stigmatizing care following a cancer diagnosis. Cary P. Gross, MD, professor of General Medicine and Epidemiology, as well as the founder and director of the Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center at the Yale School of Medicine, believes that the way to ensure these patients receive care concordant with guidelines is to confront one’s own biases when treating them.

In an interview with CancerNetwork®, Gross discussed how oncology practices might overcome influences to experience of care, such as distrust, stigmatization, poor physician-patient communication, and subsequently low health literacy when treating this patient population. This discussion was contextualized by a study he coauthored and published in JAMA Network Open, which explored the disparities in the quality of care between the general population and currently or recently incarcerated individuals undergoing treatment for their cancers.

He began by suggesting that an evaluation of one’s own biases when tasked with treating patients with cancer and a history of incarceration may be a key consideration, disclosing that patients may be “shackled” when undergoing treatment for cancers despite posing no real threat. Additionally, Gross emphasized that, to the practicing oncologist, these individuals are patients, not prisoners, and that considering support for their disease and humanity may help reduce stigmatization in practice.

Regarding challenges to health literacy, Gross encouraged clinicians to consider tailoring communication to be more patient-centric, focusing on clarity and employing family members to help ensure the retention of information. He concluded by emphasizing that a cancer diagnosis can be emotionally burdensome for patients, but that getting families and loved ones involved may help enhance the quality of care for these patients.

Transcript:

First, 1 key consideration is to think about what our own biases are when it comes to how patients are being treated when they come into the healthcare system. Are they being shackled? We have heard—not from our study—anecdotes of people who are receiving chemotherapy or getting palliative radiotherapy at the end of life, who have a poor functional status and are being shackled to their bed when they are clearly not a threat. Some of these people are suffering and cannot even stand up.

Regardless of their functional status, we must ask, “Do we have to make people feel stigmatized at each and every step of the way within our healthcare system?” As clinicians, we can ask ourselves the tough questions about how our patients––not prisoners––who are under our care are being treated. How can we ensure that they are feeling supported and [we are] supporting their humanity, particularly when confronting a serious diagnosis, such as cancer.

There are challenges regarding the health literacy of a broader population, certainly amongst people exposed to incarceration. Trying to think through, “How can we better communicate in a clear and understandable way? What are the treatments people are getting? What are the risks and benefits?…. Is it possible to bring in family members?” Everybody forgets what you are told in the doctor’s office. We often say that on your first visit after a cancer diagnosis, you hear the word cancer and then everything else is shut out. Understand this is a human nature thing. You are blown away by this diagnosis, and it is hard to remember anything.

For everyone, including people who are incarcerated, [it’s about] figuring out, “Is there a way to engage family members or loved ones to help them to navigate the system?”, asking questions, remembering what the next steps are, and supporting the patient in a caregiving and emotionally supportive way.

Reference

Oladeru OT, Richman IB, Aminawung JA, et al. Incarceration and quality of cancer care. JAMA Netw Open. 2025;8(10):e2537400. doi:10.1001/jamanetworkopen.2025.37400