# Perioperative mental health intervention for older adults undergoing cancer surgery

> **NIH NIH P50** · WASHINGTON UNIVERSITY · 2024 · $220,784

## Abstract

Abstract/Project Summary – PROJECT 2
Depression and anxiety are under-recognized and undertreated in older adults with cancer. More than a million
older adults will be diagnosed with cancer this year. Each of these individuals are at greater risk for
depression/anxiety than the general older population. The perioperative period is a particularly vulnerable time,
as the patient is concurrently confronted with a life-changing diagnosis as well as functional and physical
changes that accompany a major surgery. Most older adults with both cancer and depression/anxiety do not
receive appropriate mental health treatment, and if they do, it is typically pharmacologic treatment only, further
exacerbating already rampant polypharmacy. In this proposal, we will optimize and test a tailored
pharmacological and behavioral intervention bundle for older patients undergoing surgery for cancer, with
clinically significant depressive and anxiety symptoms. We will institute a perioperative mental healthcare
intervention bundle including: (1) applying a proven behavioral intervention, behavioral activation (BA), with
strategies based on patient preferences and needs; and (2) medication optimization and deprescribing (MOD),
targeting to optimize dosages of anti-depressant medications, and stopping harmful or ineffective medications.
Aim 1 (Adaptation): Informed by a collaborative planning approach, we will adapt, develop and implement an
optimal perioperative mental health intervention bundle for older adults undergoing planned cancer surgery.
Through stakeholder input, we will develop and iteratively adapt a behavioral and medication optimization
intervention bundle for implementation in this population. Following initial protocol development, through
treatment development trials, we will iteratively optimize the intervention through interactive feedback from
patients over the age of 65 undergoing major surgery for cancer, and other stakeholders, noting barriers and
facilitators to program completion. Aim 2 (Testing): Using a hybrid Type 1 randomized controlled trial design,
we will compare the effectiveness of the intervention bundle with usual care in reducing symptoms of
depression and anxiety in older patients with cancer undergoing oncologic surgery. For this aim, 100 patients
with symptoms of depression and anxiety will be randomly assigned to the pharmacological and behavioral
intervention bundle or usual care. Pre-operative depression and anxiety are associated with a host of adverse
outcomes after surgery, including medical complications, falls, delirium, and mortality. Thus, medication
optimization and deprescribing, in an intervention bundle with behavioral activation treatment of depression
and anxiety in older adults with cancer, is expected to improve not only symptoms of depression and anxiety
but also other important post-operative outcomes.

## Key facts

- **NIH application ID:** 10844607
- **Project number:** 5P50MH122351-04
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Tanya M Wildes
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $220,784
- **Award type:** 5
- **Project period:** 2021-06-01 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10844607

## Citation

> US National Institutes of Health, RePORTER application 10844607, Perioperative mental health intervention for older adults undergoing cancer surgery (5P50MH122351-04). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10844607. Licensed CC0.

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