A choice or a compromise : suicide issues among cancer sufferers in Hong Kong

Abstract

Evidence supports the association between cancer and elevated suicide risk; however, little is known about the unique characteristics of these suicidal cancer sufferers, and the contributing factors and reasons for this tragic choice. Cancer is the number one killer in Hong Kong. The continuously increasing incidence of cancer due to the aging population leads to growing concern about the well-being of cancer sufferers in the community.

This thesis aims to systematically explore suicide issues among cancer sufferers in Hong Kong by understanding the profiles of cancer sufferers who killed themselves, investigating the risk of fatal suicide and suicidal/self-harm behaviors among Hong Kong cancer sufferers and the clinical risk factors, as well as examining the expressed reasons and motivations for cancer sufferers who have died by suicide.

Using data from the Hong Kong Coroner’s Court records, study one adopted a cross-sectional design to compare the characteristics of suicide cases with and without cancer. The results indicated that cancer sufferers who died by suicide were older, more likely to use violent suicide methods and communicate their suicidal intent before death, less likely to live alone and have histories of physical and psychiatric illnesses compared to non-cancer suicide cases.

Study two utilized electronic medical records from Hong Kong public hospitals to investigate the relationship between clinical profiles and patterns of medical contacts and suicide among cancer sufferers under a retrospective case-control design. The results showed that age, cancer stage, having certain types of cancer, having psychiatric conditions, using painkillers, and different patterns of hospital admissions were associated with the risk of suicide.

Similarly, study three employed a cohort design to examine the risk of suicidal/self-harm behaviors after cancer patients’ first inpatient admission considering the competing risk of death. Overall, 5-year cancer survival rate, history of suicidal/self-harm behaviors and having certain physical conditions were associated with the risk of suicidal/self-harm behaviors. A non-linear association between age and suicidal/self-harm behaviors was identified.

Lastly, study four adopted a mixed-method approach to understand the expressed motivation for cancer sufferers’ suicide using suicide notes. Thematic analysis was performed and suffering from physical conditions and experiencing pain were the main theme identified among note leavers with cancer across all age groups.

Results from this thesis provide a more thorough understanding of cancer sufferers' suicide issues in Hong Kong. The findings highlight that cancer sufferers who killed themselves had a unique profile compared to other suicide cases. Improving the quality of life and managing pain are vital to reduce their suicidal risk. More attention should be paid to cancer sufferers with low survival rates and irregular hospital visits, such as skipping appointments. Suicide prevention should start in the clinical settings and involve different stakeholders including healthcare professionals, caregivers, friends, etc. Follow-up service should be provided after patients’ discharge. Information on suicide detection and prevention should be provided to various stakeholders to allow timely intervention. The results and implications are not only applicable to Hong Kong but may provide insights to other communities with an aging issue.