Behavioral Activation and Medication Optimization For Improving Perioperative Mental Health In Older Adults Undergoing Oncologic Surgery

Using a Hybrid Type 1 Effectiveness-Implementation randomized control trial (RCT) design, the investigators will test the effectiveness of a bundled behavioral activation and medication optimization in reducing symptoms of depression and anxiety in older adults undergoing oncologic surgery (compared with usual care), while examining implementation outcomes.

Inclusion Criteria:Pre-screening:To be considered for participation, patients will be screened using PHQ-4 questionnaire. Scores >3 will indicate positive pre-screen (i.e. can be considered for participation and formal screening). Scores < 3 will indicate negative screen (i.e. patient not considered for formal screening due to low risk for anxiety or depression).Screening:Adults age ≥60 yearsScheduled major thoracic or abdominal surgery for suspected or confirmed malignancyPHQ-ADS (Patient Health Questionnaire Anxiety and Depression Scale) ≥10 indicating clinically significant depression or anxiety symptoms.Exclusion Criteria:Barrier to communication (Unable to read, speak, and understand English)Severe cognitive impairment screened by the SBT (Short Blessed Test) >10Acutely suicidalConsidered ineligible per the discretion of the oncologic surgeon or study PIPrevious participation in this study or another CPMH study of the intervention bundle or its feasibility.