Patients Who Speak Spanish, Identify as Hispanic or Experience Food & Housing Insecurity at Increased Risk for Depression, Anxiety During Radiation Treatment

Depression and anxiety among people living with a cancer diagnosis is a growing clinical and research priority. However, the prevalence of mood disorders in those living with cancer varies due to a multitude of variables such as stage and type of cancer, treatment, age, race and ethnicity.

A new study  has found that Spanish-speaking patients undergoing radiotherapy for breast cancer experienced higher distress levels at baseline compared to English-speakers and that this distress increased over the course of treatment in contrast to English-speakers’ distress, which decreased over time. Additionally, those who identified their race as “other” and ethnicity as Hispanic similarly reported an increase in distress throughout treatment.

“Given that breast cancer remains the most common type of cancer worldwide, its impact on mental health continues to be highly researched as it can hinder treatment, recovery and quality of life. However, Black and Hispanic patients which comprise about 29% of the U.S. population, have been historically understudied in cancer research,” said corresponding author Corina Beiner, a fourth-year medical student at the school.

To better understand the changes in levels of depression and anxiety, the researchers surveyed English and Spanish-speaking females, age 18 or older, before and after they underwent radiation therapy treatment for breast cancer. Sociodemographic characteristics including race, ethnicity, marital status, education level, longest residency location, religion, housing and food insecurity were also collected. The survey ended with a standardized questionnaire to assess for depression and anxiety and the score was used as a marker of psychological distress.

Prior to treatment, Spanish-speakers had a baseline distress level higher than English-speakers. Overall, participants showed a decreased level of distress post-treatment, however, when analyzed by language, English-speakers had decreased distress while Spanish-speakers reported an increased level of distress. Once sociodemographic factors were adjusted by language, Spanish-speakers reported a significantly higher level of housing and food insecurity, which may explain their higher levels of distress. “For this reason, we believe it would be beneficial to screen all Spanish-speaking patients for risk factors that may increase their distress throughout treatment,” added Beiner.

According to the researchers, exploring the varying levels of depression and anxiety faced by these patients is warranted, particularly given that a diagnosis of mood disorders is linked to poorer survival outcomes. Prior knowledge that certain groups at a baseline may be experiencing more distress, can help guide initial changes to mediate these differences.

“Additionally, regarding radiation therapy, knowing that a portion of our patients are at an increased risk of developing higher distress levels throughout a course of treatment can drive interventions to combat this,” said senior author Ariel E. Hirsch, MD, professor of radiation oncology.

While further investigation is necessary to elucidate other reasons for this increase in distress throughout treatment, the researchers believe these results indicate an area for clinical need. “Patients at risk for increased depression or anxiety or increased distress throughout treatment may benefit from interventions prior to and throughout radiation therapy, such as preferred language education sessions or informational calls throughout treatment,” added Hirsch.

These findings appear online in the International Journal of Radiation Oncology, Biology and Physics.