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

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 years * Scheduled major thoracic, breast, or abdominal surgery for suspected or confirmed malignancy * PHQ-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) \>10 * Acutely suicidal * Considered ineligible per the discretion of the oncologic surgeon or study PI * Previous participation in this study or another CPMH study of the intervention bundle or its feasibility.