A Comparative Assessment of Depression and Anxiety in English-Speaking and Spanish-Speaking Breast Cancer Patients Undergoing Radiation Therapy

Abstract

Background This study sought to describe the levels of depression and anxiety experienced by English and Spanish-speaking patients undergoing radiation therapy for breast cancer. We aimed to describe the impact of different variables to better understand and quantify potential gaps. Methods Eligibility criteria included English and Spanish-speaking females, ages 18 or older, undergoing radiation therapy treatment for a breast cancer at Boston Medical Center. Surveys were completed before delivery of radiation therapy. Survey included sociodemographic questions along with the standardized PHQ-4 questionnaire, which uses a maximum total score of 12, to assess anxiety and depression. Results were analyzed using a least means square procedure. Results 60 participants completed surveys, with a total distress mean (DM) of 3.32 (SD= 3.55). English-speaking patients comprised 70% (n=42) of the sample and had a DM of 3.40. Spanish-speaking patients comprised 30% (n=18) with a DM of 3.11. Sociodemographic characteristics included: race -- 27% White (n=16), 46% Black (n=28), 27% other (n=16); ethnicity -- 67% non-Hispanic (n=40), 33% Hispanic (n=20); marital status -- 37% never married (n=22), 33% married (n=20), 30% divorced/ separated/widowed (n=18); education level -- 20% < High school (n=12), 60% high school/associate’s (n=36), 20% bachelor’s/master’s/doctorate (n=12); and longest residence -- 60% US (n=36), 40% foreign country (n=24). Additional variables surrounding social determinants of health included housing and food insecurity. Conclusion Our study showed a higher baseline DM among English-speaking patients in comparison to Spanish-speaking patients. Most of our patient population was English-speaking, though approximately one third Spanish-speaking. Participants were also primarily Black, non-Hispanic, never married, had a high school or associate level education, and had their longest residence in the US. Although the majority did not report housing or food insecurity, both had increasing DM with increased insecurity, with statistically significant results. This study provides insight into a patient population that has historically been understudied, particularly Black and Hispanic patients, that comprise ~29% of the US population, but make up less than 10% of participants in cancer clinical trials. In addition, as the number of Spanish-speakers in the US continues to increase, it will be important to understand and address potential differences in cancer care.