This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Insult to Injury: Cross-Sectional Analysis of Preoperative Psychosocial Vulnerabilities in Adult Patients Undergoing Major Elective Cancer Surgery
by
, , , ,
Kurt S. Schultz
1,2,†
,
Samantha M. Linhares
1,†, 
Emily Y. Park
1,
Elizabeth L. Godfrey
1,
Uday Dhanda
3,
Eliza J. Epstein
1,
Kathryn Bailey Thomson Blake
1,
Yuqing Huang
1,
Haadia Zaheer
4 and
Ira L. Leeds
1,* 1
Division of Colon & Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA
2
Investigative Medicine Ph.D. Program, Yale Graduate School of Arts and Sciences, New Haven, CT 06511, USA
3
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06519, USA
4
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06519, USA
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2025, 17(17), 2859; https://doi.org/10.3390/cancers17172859
Submission received: 5 July 2025
/
Revised: 21 August 2025
/
Accepted: 25 August 2025
/
Published: 30 August 2025
(This article belongs to the Special Issue Preoperative Optimisation in Patients Undergoing Cancer Surgery)
Simple Summary
Psychosocial vulnerabilities are often overlooked in current presurgical optimization programs, despite their growing recognition as a significant factor in outcomes. This study aimed to comprehensively characterize the psychosocial vulnerabilities among patients undergoing major cancer surgery as a critical step toward improving preoperative optimization strategies. This was a cross-sectional analysis of a preoperative psychosocial screener administered to 383 patients across three hospitals, each with three surgical services, within a statewide health system. Across 27 psychosocial domains, more than half of patients with cancer reported at least two psychological vulnerabilities and two social vulnerabilities in the immediate preoperative period. Those residing in more deprived neighborhoods were significantly more likely to report these vulnerabilities, particularly food insecurity and limited health literacy. This preoperative screener provides a model for integrating psychosocial risk assessment into routine surgical care, which could inform targeted preoperative interventions for patients at risk.
Abstract
Background/Objectives: Psychosocial factors are not routinely screened for during the perioperative period, even though they significantly influence overall health. This study aimed to inventory the psychosocial vulnerabilities among patients undergoing cancer surgery. Methods: We conducted a cross-sectional analysis of a researcher-administered psychosocial screener implemented within a statewide health system between July 2023 and August 2025. A 45 min screener was offered to consecutive adult patients within two weeks before their major elective cancer surgery. Residential addresses were geocoded to assign neighborhood deprivation percentiles for the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI). Elevated psychosocial vulnerability was determined based on a model-based clustering approach, and a high deprivation index was defined as ≥75th percentile. Results: A total of 383 patients (37% response rate) completed the screener, including colorectal (40%), thoracic (36%), and surgical oncology (24%) patients, with a median age of 66 years (IQR, 57–73). Over half (52.0%, n = 199) reported ≥2 psychological and ≥2 social vulnerabilities. Younger patients (p = 0.021), non-white patients (p < 0.001), patients identifying as non-heterosexual (p = 0.014), without a partner (p < 0.001) or private insurance (p = 0.040), and those with lower household income (p < 0.001) were more likely to report elevated psychosocial vulnerability. Patients with elevated psychosocial vulnerability were more likely to reside in deprived neighborhoods (ADI: 34.0 vs. 29.0, p = 0.035; SVI: 0.35 vs. 0.27, p = 0.005). Conclusions: Patients undergoing major cancer surgery experience substantial psychosocial vulnerabilities, particularly those from socioeconomically disadvantaged neighborhoods. Future work should identify the psychosocial factors most predictive of poor surgical outcomes to guide targeted preoperative interventions.
