Nearly Half of Hospitalized Cancer Patients Face Anxiety and Depression, Study Finds

When a person with cancer is admitted to a hospital ward, the medical team typically focuses on tumors, blood counts, and treatment schedules. But a new study from Spain suggests that the mind deserves just as urgent attention. Researchers at the Oncology Department of Miguel Servet University Hospital in Zaragoza found that nearly half of hospitalized cancer patients experience clinically significant anxiety, and more than four in ten show symptoms of depression, with the burden persisting even as patients prepare to leave the hospital. The findings, published in the journal Supportive Care in Cancer, offer one of the most detailed snapshots to date of the psychological state of cancer inpatients at two critical moments: the day of admission and the day of discharge.

The research team, led by Paula Morillas-Martínez of the University Hospital Miguel Servet, conducted a single-center, prospective, observational study that enrolled 166 hospitalized cancer patients. Rather than relying on informal impressions or chart reviews, the investigators used validated psychometric instruments to measure emotional distress directly. Patients completed the Hospital Anxiety and Depression Scale, a widely used screening tool known as HADS that was specifically designed to detect mood disorders in medically ill patients without being confounded by physical symptoms of disease. They also filled out the Duke-UNC Functional Social Support Questionnaire, which gauges how much practical and emotional backing patients feel they receive from family and friends, and the Consumer Assessment of Healthcare Providers and Systems survey, which captures how patients perceive the quality of their interactions with clinicians.

The numbers were striking. At admission, 47 percent of patients screened positive for anxiety, with a 95 percent confidence interval of 39 to 55 percent, and 43 percent screened positive for depression, with a confidence interval of 35 to 51 percent. By discharge, the figures had eased only modestly, to 40 percent for anxiety and 39 percent for depression. In other words, a hospital stay, even one that successfully addressed the medical reason for admission, did little to resolve the psychological distress that patients carried through the ward doors. For a substantial fraction of this population, emotional suffering was not a side note to their cancer care but a persistent companion to it.

The study went beyond prevalence figures to identify which clinical and psychosocial factors were associated with worse mental health outcomes, and the pattern of associations is where the research becomes particularly actionable. At baseline, anxiety was significantly linked to prior psychotropic medication use: 29.5 percent of anxious patients were taking anxiolytics before admission compared with 13.6 percent of non-anxious patients, a difference that reached statistical significance at p equals 0.012. Antidepressant use showed a similar relationship, present in 25.6 percent of anxious patients versus 11.4 percent of the rest, with p equal to 0.017. These findings suggest that many patients arrive on the ward with a pre-existing psychiatric vulnerability that hospitalization does not erase.

Depression at admission told a different story, one rooted more in physical illness burden than in psychiatric history. Patients with an Eastern Cooperative Oncology Group performance status of two or higher, meaning they require substantial assistance with daily activities and spend significant portions of the day resting or in bed, were far more likely to be depressed: 64.7 percent versus 42.1 percent of those with better functional status, a difference significant at p equals 0.022. Opioid use was also strongly associated with depression at baseline, present in 62 percent of depressed patients compared with 41.1 percent of non-depressed patients, with p equal to 0.008. Both markers point to advanced or poorly controlled disease as a powerful driver of low mood, a relationship that clinicians who treat advanced cancer will recognize from daily practice.

Perhaps the most provocative findings emerged at discharge, when the researchers examined how the care experience itself shaped emotional outcomes. Patients who reported a poorer relationship with their oncologist were significantly more likely to remain anxious at discharge, with higher anxiety recorded in 26.7 percent of those with strained physician relationships versus 12.1 percent of those with better ones, significant at p equals 0.022. Social support also mattered in a dose-dependent fashion: lower perceived social support correlated with higher anxiety, with a correlation coefficient of negative 0.15 and a p value of 0.01, and even more strongly with higher depression, with a correlation coefficient of negative 0.3 and a p value of 0.001. The message is clear and, in the researchers’ framing, modifiable: the quality of human connection, both inside and outside the hospital, is statistically entwined with a patient’s psychological state.

Physical symptoms left their own imprint. Fatigue at discharge was associated with both increased anxiety, seen in 36.7 percent of fatigued patients versus 18.7 percent of those without fatigue at p equals 0.013, and increased depression, seen in 35.6 percent versus 19.6 percent at p equals 0.028. Pre-admission anxiolytic use predicted greater anxiety at discharge, at 28.3 percent versus 14.3 percent with p equal to 0.034, and showed a trend toward greater depression as well. Pre-admission antidepressant use was strongly linked to depression at discharge, present in 30.5 percent of users versus 9.8 percent of non-users, with p equal to 0.001, and opioid use was again associated with depression, at 57.6 percent versus 39.1 percent with p equal to 0.026. Taken together, these associations sketch a profile of the patient most at risk: someone with advanced functional impairment, heavy symptom burden, and a history of psychiatric medication, whose recovery is further shaped by the warmth of their medical relationships and the strength of their social network.

The scientific context gives these findings real weight. Prior meta-analyses, including a systematic review of more than 282,000 breast cancer patients, have linked depression and anxiety not only to reduced quality of life but also to worse oncological outcomes, including higher recurrence and mortality rates. Clinical practice guidelines from the European Society for Medical Oncology now recommend routine screening for psychological distress in adult cancer patients, yet screening in busy inpatient wards remains inconsistent across health systems. The HADS instrument used in the Spanish study has been validated specifically for cancer patients in acute care settings, with cutoff scores calibrated to distinguish true mood disorder from the understandable sadness and worry that accompany a cancer diagnosis, which lends credibility to the prevalence estimates reported here.

What makes this study resonate beyond its statistical tables is the implication that some of the strongest predictors of psychological distress are things hospitals can actually change. A physician’s communication style is not a fixed personality trait; experimental studies have shown that patient-centered communication during cancer diagnosis delivery measurably reduces anxiety, negative affect, and distrust, and that physician trust can buffer the impact of uncertainty on cancer-related worry. Similarly, social support, while partly outside the hospital’s walls, can be reinforced through family involvement, psycho-oncology referrals, and peer support programs. The association between fatigue and distress, meanwhile, suggests that symptom management teams, exercise interventions, and energy conservation strategies may carry psychological benefits alongside their physical ones.

The authors are careful to note the study’s design and its limits. It was a single-center investigation at one Spanish hospital, and as an observational study it identifies associations rather than proving causation; it cannot determine, for example, whether a poor doctor-patient relationship causes anxiety or whether anxious patients perceive their physicians more negatively. The modest sample of 166 patients, while adequate for the prevalence estimates and the reported comparisons, warrants replication in larger and more diverse populations. Still, the direction of the evidence aligns with a growing international literature, and the practical takeaway is hard to ignore. With roughly four in ten patients still distressed at the moment they leave the hospital, discharge planning that ignores mental health may be missing a critical window. Routine HADS screening at admission, targeted psycho-oncology consultation for high-risk patients, deliberate attention to the therapeutic relationship, and systematic assessment of social support could transform the emotional trajectory of cancer hospitalization. As the researchers conclude, hospitalized cancer patients carry a heavy psychological burden, and the factors that lighten it, good relationships, strong support networks, and relief from fatigue, are within reach of every oncology ward willing to look beyond the chart.

Subject of Research: Prevalence and predictors of anxiety and depression among hospitalized cancer patients

Article Title: Psychological impact of hospital admission in cancer patients

Article References: Morillas-Martínez, P., Gallart-Caballero, L., Pascual-delaFuente, N. P., Ruffini-Egea, S. E., Mocha-Campillo, F., Trincado-Cobos, P., Monreal-Cepero, M. L., Campos-Ramírez, S. E., Gómez-Mugarza, P., Barriendos-Sanz, S., Felices-Lobera, M. P., Casas-Deza, D., & Gascón-Ruiz, M. (2026). Psychological impact of hospital admission in cancer patients. Supportive Care in Cancer, 34(10), Article 1014. https://doi.org/10.1007/s00520-026-11252-2

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11252-2

Keywords: anxiety, depression, psycho-oncology, cancer inpatients, hospital admission, HADS, social support, doctor-patient relationship, fatigue, opioids, quality of care, supportive care