There were 17 million new cases of cancer worldwide(1). The four most common cancers occurring worldwide are lung, female breast, bowel and prostate cancer. Lung, liver, stomach, and bowel are the most common causes of cancer death worldwide, accounting for more than four in ten of all cancer deaths(1).
A person’s risk of developing cancer depends on many factors, including age, genetics, and exposure to risk factors (including some potentially avoidable lifestyle factors). Cancer risk factors are overall similar worldwide. Smoking, insufficient physical activity, alcohol, diet, overweight and obesity, and infections account for a high proportion of cancers worldwide(2, 3).
Cancer is a life-threatening and feared diagnosis, and is a source of great distress in patients. One in three people with cancer will experience a mental health problem such as depression or anxiety disorders before, during or after treatment(4).
A cancer diagnosis, its associated symptoms and treatment can have a significant emotional impact on people and their families, with fear, isolation, loss of self-esteem and loss of independence having an impact(5).
Everyone knows it is better to catch cancer earlier, at stage one instead of later at stage four(6). The same is true for mental health conditions. Unfortunately, many people with cancer are never told about the chance they will develop a mental health condition like depression nor will they receive treatment for it(7).
It is estimated that up to one-third of people treated for cancer in hospitals have a common mental health condition(8). Rates of major depressive disorder are thought to be up to three times higher than in the general population(9). Anywhere from 8–24% of people with cancer are also livings with depression(10). Youth and young adults are at greater risk for depression and other conditions compared to adults with cancer(11).
However mental health problems that arise as a result of cancer are too often sidelined, and there are several reasons why a person with cancer may not get help for their mental health condition: Cancer, depression and anxiety have shared symptoms like fatigue, lack of sleep, and decreased appetite which can make recognizing mental health conditions difficult(12–14). This is a group that regularly faces threats to life and figuring out what is a regular reaction to cancer diagnosis and treatment versus signs one has a mental health condition can be hard.
Cancer care teams often lack specific skills to recognize mental health conditions. Some in the community do not agree on what depression is and looks like. With so much time and money spent on cancer treatment, many are forced to see their mental health as less important and do not seek help(14). For example, they may be less likely to exercise, more likely to drink too much alcohol or miss therapy appointments.
Depression affects quality of life (QOL) and compromises patient outcomes, with depression resulting in higher rates of mortality in cancer(15). A meta‑analysis revealed that minor or major depression increases mortality rates by 39%(16).
People, who get treatment, often see improvement in their overall medical condition, are more likely to follow through with medical care and have a better quality of life. Study found that those who got treatment and had fewer symptoms of depression had longer average survival times than those who had more symptoms(17).
The prevalence of depression in cancer patients is thought to be up to three times higher than in the general population(18). Studies have identified a variety of prevalence ranging from 2.0-43.5%(19, 20), whilst palliative care wards have documented rates of depression as high as 49.0%(21). The wide range of reported prevalence may be due to differences in assessment tools, variation in the types of patients interviewed, and varying age groups, varying gender proportions, inpatient status and other factors. Knowledge of having cancer and stage of the disease were also significantly associated with occurrence of depression(22).
Despite the fact that multiple studies have been performed and showed that cancer patients have extensive variations in the prevalence and associated factors of depression across different communities of sub-Saharan Africa, there is no pooled evidence regarding the overall prevalence and potential associated factors of depression among cancer patients. The objective of the current review is to present an overview on the magnitude and associated factors of depression among cancer patients in sub-Saharan Africa. Knowledge on pooled magnitude of depression and detecting its determinants would assist policy-makers and program implementers in deciding evidence-driven prevention and promotion and treatment activities in this area. So, this systematic review and meta-analysis study is intended to review the existing pieces of evidences on prevalence of depression and its risk factors and pooling them to have a synergized effect in cancer patients in sub-Saharan Africa.