{"id":8127,"date":"2023-06-26T12:05:26","date_gmt":"2023-06-26T10:05:26","guid":{"rendered":"https:\/\/institutrobertbadinter.fr\/fr\/?post_type=publications&p=8127"},"modified":"2026-04-27T11:43:14","modified_gmt":"2026-04-27T09:43:14","slug":"capri-le-cancer-en-prison-vecu-et-prise-en-charge-de-la-maladie-en-unite-hospitaliere-securisee-interregionale","status":"publish","type":"publications","link":"https:\/\/institutrobertbadinter.fr\/fr\/publications\/capri-le-cancer-en-prison-vecu-et-prise-en-charge-de-la-maladie-en-unite-hospitaliere-securisee-interregionale\/","title":{"rendered":"Le cancer en prison : V\u00e9cu et prise en charge de la maladie en unit\u00e9 hospitali\u00e8re s\u00e9curis\u00e9e interr\u00e9gionale (CaPri)"},"content":{"rendered":"\n

Cette recherche s\u2019inscrit dans une triple perspective : m\u00e9dicale, \u00e9pid\u00e9miologique et sociologique. Elle mobilise des donn\u00e9es statistiques nationales et repose sur un terrain d\u2019investigation qualitative constitu\u00e9 par deux des huit Unit\u00e9s hospitali\u00e8res s\u00e9curis\u00e9es interr\u00e9gionales (UHSI) fran\u00e7aises. Les UHSI, qui prennent en charge les hospitalisations de plus de 48 heures des personnes d\u00e9tenues, repr\u00e9sentent des lieux centraux pour le soin et le suivi des cancers.<\/p>\n\n\n\n

Le panorama statistique s\u2019appuie sur les donn\u00e9es du Syst\u00e8me national des donn\u00e9es de sant\u00e9 (SNDS) \u00e0 partir desquelles a \u00e9t\u00e9 distingu\u00e9e l\u2019activit\u00e9 des UHSI. De 2011 \u00e0 2020, 2 082 patients atteints de cancer ont s\u00e9journ\u00e9 en UHSI (m\u00e9diane : 186\/an). La tendance est stable, avec un taux d\u2019incidence de 0,24% de la population carc\u00e9rale. Les caract\u00e9ristiques socio-sanitaires des personnes d\u00e9tenues sont marqu\u00e9es par des comportements addictifs et de fortes comorbidit\u00e9s (notamment diab\u00e8te, hypertension et d\u00e9pression) qui constituent autant de facteurs de risque. Parmi les diff\u00e9rentes formes de cancer, celui du poumon pr\u00e9sente le plus grand nombre de cas (N = 332 ; soit 16%). Arrivent ensuite : ORL (9%), prostate (7%), colorectal (6%) et vessie (6%). Compar\u00e9 aux donn\u00e9es nationales, le cancer du poumon est largement surrepr\u00e9sent\u00e9 (16% contre 6%).<\/p>\n\n\n\n

Les entretiens avec les patients-d\u00e9tenus ont \u00e9clair\u00e9 tant la situation qu\u2019ils avaient connue au sein des \u00e9tablissements p\u00e9nitentiaires que ce qu\u2019ils vivent au sein de l\u2019UHSI o\u00f9 ils ont \u00e9t\u00e9 rencontr\u00e9s. Le concept de \u00ab trajectoire de maladie \u00bb (Anselm Strauss) trouve, avec l\u2019exp\u00e9rience du cancer en prison, un terrain embl\u00e9matique. Nous avons d\u00e9nomm\u00e9 \u00ab trajectoire ascendante \u00bb les situations o\u00f9, pour les patients incarc\u00e9r\u00e9s atteints de cancer, la prison constitue, nous ont dit certains d\u2019entre eux, une \u00ab chance \u00bb, parce que cette pathologie, singuli\u00e8rement lourde, n\u2019avait pas \u00e9t\u00e9 d\u00e9tect\u00e9e avant l\u2019incarc\u00e9ration. Nous avons d\u00e9nomm\u00e9 \u00ab trajectoire descendante \u00bb les situations o\u00f9 l\u2019incarc\u00e9ration a contribu\u00e9, \u00e0 l\u2019inverse, \u00e0 ce que le diagnostic et la prise en charge soit particuli\u00e8rement longs.<\/p>\n\n\n\n

M\u00eame si des diff\u00e9rences entre les UHSI investigu\u00e9es ont pu \u00eatre not\u00e9es, la dimension de ce type d\u2019unit\u00e9 est propice \u00e0 favoriser la communication entre services, et, par l\u00e0 m\u00eame, \u00e0 prodiguer une attention particuli\u00e8re \u00e0 des personnes doublement vuln\u00e9rables car soumises, d\u2019une part, \u00e0 une incarc\u00e9ration, d\u2019autre part \u00e0 une pathologie lourde.<\/p>\n\n\n\n

S\u00e9journer en UHSI pour un cancer implique de nouvelles formes de socialisation. Outre le fait d\u2019\u00eatre soign\u00e9 pour une pathologie qui dans certains cas \u00e9tait inconnue du patient, celui-ci doit \u00e9galement apprendre les codes et les normes de ce nouvel espace relationnel.<\/p>\n\n\n\n

Une des recommandations pourrait \u00eatre de r\u00e9fl\u00e9chir \u00e0 des dispositifs pour accompagner les justiciables incarc\u00e9r\u00e9s malades, et d\u2019insister, outre les aspects m\u00e9dicaux, sur les formes de sociabilit\u00e9s n\u00e9cessaires pour vivre le moins mal possible le cancer en prison.<\/p>\n\n\n\n

18.32_synth\u00e8se<\/a><\/div>\n\n\n\n
18.32_rapport<\/a><\/div>\n\n\n\n
English version below \/ R\u00e9sum\u00e9 en anglais <\/summary>\n

This research is situated within a threefold perspective: medical, epidemiological, and sociological. It draws on national statistical data and is based on qualitative fieldwork conducted in two of the eight French Interregional Secure Hospital Units (UHSIs). These units, which provide care for hospitalizations exceeding 48 hours for incarcerated individuals, are central locations for the treatment and monitoring of cancer.<\/em><\/p>\n\n\n\n

The statistical overview relies on data from the French National Health Data System (SNDS), from which UHSI activity was specifically identified. Between 2011 and 2020, 2,082 cancer patients were admitted to UHSIs (median: 186 per year). The trend remains stable, with an incidence rate of 0.24% of the prison population. The socio-health profile of incarcerated individuals is marked by addictive behaviors and high levels of comorbidities (notably diabetes, hypertension, and depression), all of which constitute risk factors. Among the various types of cancer, lung cancer accounts for the highest number of cases (N = 332; 16%). It is followed by ENT cancers (9%), prostate cancer (7%), colorectal cancer (6%), and bladder cancer (6%). Compared with national data, lung cancer is significantly overrepresented (16% versus 6%).<\/em><\/p>\n\n\n\n

Interviews with incarcerated patients shed light both on their experiences within correctional facilities and on what they undergo within UHSIs, where they were interviewed. The concept of \u201cillness trajectory\u201d (Anselm Strauss) finds a particularly illustrative application in the experience of cancer in prison. We identified \u201cascending trajectories\u201d as situations in which incarceration, according to some patients, constituted a \u201cchance,\u201d insofar as this particularly serious condition had not been diagnosed prior to imprisonment. Conversely, we identified \u201cdescending trajectories\u201d as situations in which incarceration contributed to significantly delayed diagnosis and treatment.<\/em><\/p>\n\n\n\n

Although differences were observed between the UHSIs studied, the structure of these units tends to facilitate communication between services and, consequently, to provide particular attention to individuals who are doubly vulnerable\u2014both due to incarceration and to serious illness.<\/em><\/p>\n\n\n\n

Being hospitalized in a UHSI for cancer also entails new forms of socialization. In addition to receiving treatment for a condition that may, in some cases, have been previously unknown to them, patients must also learn the codes and norms of this new relational environment.<\/em><\/p>\n\n\n\n

One recommendation would be to develop support mechanisms for incarcerated individuals with serious illnesses, placing emphasis not only on medical care but also on the forms of social interaction necessary to cope as effectively as possible with cancer in prison.<\/em><\/p>\n<\/details>\n\n\n\n

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