PURPOSE:Patients with cancer are at risk for anxiety and depression; however, the patterns and predictors of symptoms in an orthopedic oncology population have not been studied.METHODS:We retrospectively reviewed Patient-Reported Outcomes Measurement Information System scores of all adult patients who underwent palliative surgery for metastatic cancer, resection of a sarcoma, or nononcologic total joint arthroplasty at a single institution from 2015 to 2020. Backward stepwise linear regression was used to determine risk factors for perioperative anxiety and depression.RESULTS:Postoperative anxiety and depression were more prevalent in patients with metastatic disease than localized cancer or nononcologic conditions (P <.001 and P <.001, respectively). Worse preoperative pain and function were associated with higher preoperative anxiety (β =.321, P =.001; β = -.236, P =.012, respectively) and depression (β =.245, P =.009; β = -.279, P =.003, respectively). Worse preoperative anxiety, preoperative depression, and postoperative pain were associated with higher postoperative anxiety (β =.204, P =.012; β =.260, P =.001; β =.447, P <.001, respectively). Worse preoperative depression and postoperative pain also predicted higher postoperative depression (β =.542, P <.001; β =.325, P <.001, respectively).CONCLUSION:Anxiety and depression were most prevalent in patients with metastatic disease. Compared with total joint arthroplasty patients, patients with cancer less frequently experienced postoperative improvements in anxiety and depression. Worse preoperative pain and function were independently associated with greater preoperative anxiety and depression. Providers should maintain awareness of the relationship between mental and physical health to optimize outcomes.