A multicenter study of 167 lung cancer patients found that persistent emotional distress across neoadjuvant therapy and surgery was independently associated with worse overall and progression-free survival. The analysis links a longitudinal patient-reported construct to oncologic outcomes rather than treating distress as a short-term side effect. For clinicians and trial designers, the result supports integrating patient mental health measures alongside traditional biomarkers and staging. It also raises the need to test whether targeted interventions can modify distress trajectories without compromising adherence to cancer therapy.