OBJECTIVES: Cancer diagnosis often triggers depression among patients, and depression is associated with poor health behavior as well as poorer overall prognosis. The purpose of this study was to examine gender, racial, and geographical differences in depression among patients with metastatic tumor. METHODS: We analyzed 133,552 hospital records from the 2012 Nationwide Inpatient Sample for patients with a procedure code for metastatic tumor, per the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Depression was defined using ICD-9-CM for major depressive disorder. Weighted multivariable logistic regression model was used to examine gender, racial, and geographical variations in depression among patients with metastatic tumor. RESULTS: The prevalence of major depressive disorder in patients with metastatic tumor in our study sample was 10.7%. There were gender and racial disparities observed in the prevalence of depression. Compared to men, women were significantly more likely to be depressed (aOR=1.76, 95% CI: 1.68 – 1.84).  Conversely, Black (aOR=0.46, 95% CI: 0.43 – 0.50), Hispanic (aOR=0.67, 95% CI: 0.62 – 0.73), and Asian patients (aOR=0.36, 95% CI: 0.30 – 0.42) were significantly less likely to be depressed as compared to Caucasians. Geographical variation was also observed. In comparison to patients admitted to hospitals in the South, the rates of depression were higher in the Northeast (aOR=1.11, 95% CI = 1.05 – 1.16), Midwest (aOR=1.19. 95% CI = 1.13– 1.25), and West (aOR=0.94, 95% CI: 0.89 – 0.99). CONCLUSIONS: Based on these findings, healthcare providers should regularly screen patients with metastatic cancer for depression, particularly those in higher risk categories. Providers can then work collaboratively with patients on evidence-based psychological support and-pharmacological treatments.