Compassionate release for incarcerated patients with cancer: A nationwide policy review.

Abstract

e24040 Background: Cancer is the leading cause of death among incarcerated individuals in the United States, who experience higher cancer incidence and mortality than the general population. Compassionate release allows incarcerated individuals with severe medical illness, including terminal cancer, to be released from prison; however, it remains underutilized. Understanding policy-level barriers to compassionate release is critical to improving end-of-life care for incarcerated patients with cancer. Methods: We reviewed compassionate release policies in all 50 U.S. states and the District of Columbia as they pertain to incarcerated individuals with terminal cancer. Laws were evaluated based on application initiation, eligibility criteria, prognosis requirements, treatment considerations, release planning requirements, and the availability of appeals. Results: One state, Iowa, did not have a compassionate release law. Among the remaining 49 states and Washington, DC, 15 required compassionate release applications to be initiated by the department of corrections, while 32 permitted initiation by attorneys, family members, or incarcerated individuals; three states did not specify an initiating party. Prognostic eligibility varied widely: 12 states required a prognosis of less than six months, 13 required a prognosis less than one year, and seven states required a prognosis less than two years, while 18 states did not specify an explicit prognosis timeline. Limited functional status was a common eligibility criterion, and the ability to receive improved medical care outside the correctional system was considered in 20 states. Cancer and hospice care were infrequently referenced, with cancer explicitly mentioned in six states and hospice in 20. Eight states allowed appeals of denied applications; 13 did not allow appeals, 16 did not specify an appeals process, and 13 allowed reapplication if clinical circumstances changed. Conclusions: Compassionate release policies for incarcerated individuals with terminal cancer vary substantially across states and frequently include unclear or restrictive eligibility criteria. Future policy reform should focus on expanding who may initiate applications, clarifying and broadening eligibility criteria, and increasing awareness among clinicians and incarcerated individuals. Such efforts may facilitate timely, medically appropriate end-of-life care for incarcerated patients with cancer.