Predictors of Anxiety and Depression Among Older Latino and White Advanced Cancer Patients

Background and Purpose: Cancer is now the leading cause of death for Latinos and the second leading cause of mortality for whites in the US. Parallel to the rising cancer incidence is a significant and escalating mental health burden in these populations. The comorbidity of mental health conditions and advanced cancer is very prevalent and severely impacts a range of outcomes, including quality of life, symptom burden, and healthcare utilization. In the palliative care context, it is estimated that 40–50% of patients experience depression and/or anxiety. Yet little is known about how the combination of cultural, sociodemographic and psychosocial factors predict anxiety/depression in these vulnerable populations.

Methods: Ninety-one older (≥ 65) Latino and white patients with advanced cancer were interviewed cross-sectionally to identify differences/similarities in cultural, sociodemographic and psychosocial domains and predictors of anxiety/depression in these populations. The primary dependent variable (anxiety/depression) was measured using the widely validated and reliable EQ-5D instrument. Bivariate analyses using Chi-square, Wilcoxon rank sum and t-tests were conducted to identify factors associated with anxiety/depression. Independent variables were included in the logistic regression model if p < 0.05 in the bivariate analyses. Data were assessed to determine they met logistic regression assumptions, and all analyses were performed using IBM SPSS Statistics v31.0.

Results: Thirty-four percent of white and 23% of Latino patients reported moderate or extreme anxiety/depression (p = 0.335). The standard logistic regression model contained seven independent variables (sex, health literacy [HL], satisfaction with care, sleep disturbances, cancer worries, quality-of-life contentment and pain). The full model containing all predictors was statistically significant, X²(7, N=91)–45.98, p < .001, correctly classified 82.4% of cases, and explained 57.4% of the variance in anxiety/depression. The strongest predictor of anxiety/depression was health literacy (OR = 16.9, p = .003), meaning those needing any level of help reading written material from their doctor/pharmacy were ≈17 times more likely to report moderate/extreme anxiety/depression. Pain was the second strongest predictor, as those reporting moderate/extreme pain were ≈9 times more likely to report moderate/extreme anxiety/depression (OR = 9.4, p = .002). Finally, patients with sleep disturbances (OR = 2.1, p = .024) and low quality-of-life contentment (OR = 2.0, p = .03) were ≈2 times more likely to report moderate/extreme anxiety/depression.

Conclusion and Implications: These findings underscore that, among older adults with advanced cancer, anxiety and depression are driven less by cultural or demographic characteristics and more by modifiable psychosocial and clinical factors, particularly health literacy, pain, sleep disturbances, and perceived quality of life. Clinically, this suggests a need to prioritize routine mental health screening within palliative care, alongside targeted interventions such as health literacy-informed communication, aggressive pain and symptom management, and behavioral strategies to address sleep disruption. From a policy perspective, integrating psychosocial care into standard oncology and palliative care models may improve both patient well-being and healthcare utilization. Future research should examine these relationships in historically marginalized populations such as older Latino adults and determine how structural and cultural factors may interact with clinical variables to shape mental health outcomes.