Psychological distress (i.e., a broad range of emotional reactions including worry, fear, helplessness) is commonly experienced by surgical patients in the preoperative period, and is associated with several adverse health-related outcomes including surgical complications, postoperative pain, and mortality, among others. Some research suggests preoperative distress may be particularly elevated among cancer surgery patients. In two studies, this thesis (1) examined adverse healthcare-related correlates associated with preoperative distress (Study 1), further highlighting the need for effective interventions, and (2) evaluated a novel preoperative intervention to mitigate preoperative distress (Study 2). Study 1 analyzed secondary data from the Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION) study – Mental Health Supplement (N = 997; n = 370 with active cancer undergoing cancer surgery), which included the Kessler 6-item Psychological Distress Scale (administered preoperatively on the day of surgery). Regression analyses examined associations between preoperative distress and length of hospital stay and post-discharge institutionalization (e.g., transferred to another facility, new admission to a personal care home, re-hospitalization) among the full mixed surgical sample and among cancer surgery patients specifically. Among both groups, preoperative distress was associated with an increased length of hospital stay, and increased odds of re-hospitalization. In case-series format, Study 2 evaluated the feasibility of and preliminarily piloted a preoperative virtual reality (VR) intervention exposing breast cancer surgery patients to the operating room environment and preoperative process. Participants (N = 7) were assigned to the intervention group (n = 4) or control group (i.e., treatment as usual; n = 3) and completed validated symptom measures of distress and anxiety throughout the perioperative period. Those in the intervention group provided intervention feedback. Despite some recruitment challenges, the intervention was rated favourably and as helpful, with comments describing its realism, impacts on participants’ degree of preparedness/expectations, and relaxing/calming effect. Half of the intervention participants reported reduced distress/anxiety in between trialing the intervention and having surgery. Results underscore the importance of screening for and targeting psychological distress throughout the perioperative period. Findings also inform modifications to the VR intervention and study design of a large scale trial to evaluate the efficacy of the VR intervention.