Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. If the spread is not controlled, it can result in about 1 in every 6 deaths worldwide, more than AIDS, tuberculosis, and malaria combined. Today, it is the second-leading cause of death (following cardiovascular diseases) worldwide and in high- and very high Human Development Index (HDI) countries .
According to studies from the International agency for research on cancer (IARC), there will be 17 million new cancer cases in 2018 worldwide, of which six hundred thousand will occur in low HDI countries, 2.8 million in medium HDI countries, 6.4 million in high-HDI countries, and 7.2 million in very high-HDI countries . By 2040, the global burden is expected to grow to 27.5 million new cancer cases and 16.3 million cancer deaths simply due to the growth and ageing of the population .
Diagnosis and treatment should be available, and the early identification of cancer should be prioritized. Detecting cancer at its early stages enables treatment that is generally more effective, less complex and less expensive . Palliative and supportive cares are essential in comprehensive cancer control, and providing access to pain relief is an international legal obligation .
Suicide defined, a serious public health problem, as the act of deliberately killing oneself. The expected risk factors for suicide include chronic psychiatric disorder (depression, and neurological disorders) and chronic medical diseases (cancer and HIV infection). Every year, almost one million people die from suicide, 86% of whom are in low-income countries like our country Ethiopia, and it does not have one single cause and is preventable. World health organization (WHO) estimates for the year 2020, approximately 1.53 million people will die from suicide; and 10 − 20 folds more people will attempt suicide worldwide. These estimates represent on average one death every twenty seconds and one attempt every 1 − 2 seconds .
We can see one or more of these in someone who have been diagnosed cancer especially early and newly diagnosed contemplating suicide. These are the signs that are generally clear and easy to observe: talking about dying or wanting to die, talking about feeling empty, hopeless, or having no way out of problems, mentioning strong feelings of guilt and shame, talking about not having a reason to live or that others would be better off without them, social withdrawal and isolation, giving away personal items and wrapping up loose ends, saying goodbye to friends and family this is all because of the illness condition, and its severity treatment.
Suicidal behaviour refers to talking about or taking actions related to ending one's own life or thoughts or tendencies that put a person at risk for committing suicide. Suicidal behaviour can, therefore, be conceptualized on a phenotypic continuum ranging from suicidal behaviour to suicidal attempt and completed suicide.
A surveillance analyses study done in the United States, Los Angeles, showed that of 467,368 women with gynecologic cancers, there were 309 (0.07%) suicides during the study period; specifically, uterine cancer 88.2%, cervical cancer 78.1%, and ovarian cancer 73.6%; all, P < 0.05) .
According to the study done in Canada revealed that 15.7% of patients with Head and Neck Cancer were suicidal 1 year from diagnosis . Whereas another study done in China indicated that suicidal behaviour was 15.3% in Chinese cancer inpatients .
The study conducted in Korea showed that the suicidal behaviour was present in 10.9% of participants at 1 week and 11.4% at 1 year after breast cancer surgery . According to the report in USA, New York, negative religious coping (AOR = 2.65, 95% CI 1.22 − 5.74, P = 0.01) was associated with an increased risk for suicidal behaviour .
A surveillance analyses study done in United States, Los Angeles, showed that white race (AOR = 3.619 CI: 1.696–7.722), P = 0.001); divorced (AOR = 1.49, CI 1.053–2.112, P = 0.024); Cancer stage IV (AOR = 1.735, CI 1.147–2.624, P = 0.009); cancer type like ovarian cancer (AOR = 1.991, 95% CI 1.461–2.712, P < 0.001) and cervical cancer (AOR = 1.765, 95% CI = 1.290–2.413, P < 0.001) were significant factors for suicide .
A study done in Colorado, Western United States showed the magnitude of suicidal behaviour ranged greatly from 0.7–46.3%. Commonly identified risk factors for suicidal behaviour were included age, sex, and disease/treatment-related characteristics, as well as psychological constructs including depression, anxiety, hopelessness, existential distress, and social support .
Study conducted in China indicated that depression (AOR = 6.41, CI 3.30-12.42, P < 0.001), anxiety (AOR = 6.93, 95% CI 1.57 − 30.66, P = 0.011, moderate to severe pain (AOR = 2.35, 95% CI 1.32 − 4.17, P = 0.004), metastatic cancer (AOR = 2.94, CI 1.26 − 6.98, P = 0.015), poor performance status (AOR = 2.01, 95% CI 1.11 − 3.64, P = 0.021), surgery (AOR = 6.62, 95% CI 2.30 − 19.07, P < 0.001), and palliative care (AOR = 1.90, 95% CI 1.01 − 3.61, P = 0.049) were significantly associated with suicidal behavior .
A study done in Taiwan indicated that the first month of cancer diagnosis was associated behaviour of suicide with in the first month (AOR = 3.47, 95% CI 52.60–4.62) and the sixth month following a cancer diagnosis (AOR = 1.53, 95% CI 51.11–2.12) .
According to a study conducted in Iceland suicidal behaviour was after a cancer diagnosis (AOR = 1.6, 95% CI 1.4–1.9). The risk increase was greatest immediately after diagnosis; during the first year after diagnosis (AOR = 2.5, 95% CI 1.7–3.5) and thereafter diagnosis (AOR = 1.5 95% CI 1.2–1.8) .
A study done in Korea showed that suicidal behaviour was associated with cancer stage, I stage (AOR = 1.97, 95% CI 1.05–3.69, P < 0.05,), living alone (AOR = 3.57, 95% CI 1.05–7.77, P < 0.05) after 1-year diagnosis .
A study was done in South Korea showed that the risk of suicide attempts was significantly higher in participants diagnosed with cancer before 45 years of age compared with those diagnosed at 45–64 years (AOR = 3.81, 95% CI 1.07 − 13.60, P = 0.039), and the higher risk of suicide attempts with borderline significance was found in those for whom more than 10 years had passed since diagnosis compared with those for whom the diagnosis was made only 2–10 years ago (AOR = 3.38, 95% CI 1.98 − 11.70, P = 0.055) .
Cancer patients are at high risk for suicide, particularly when they are informed about the cancer diagnosis or hospitalized for cancer treatment. Therefore, oncology tertiary healthcare settings like Ayder comprehensive specialized hospital may represent an ideal setting to identify and treat suicidality in cancer patients in Mekelle, Ethiopia.