Side Effects of Lung Cancer Surgery and How to Manage Them

Pain is expected after a lobectomy because the surgeon makes incisions and works between the ribs to remove part of the lung, says Nabil Rizk, MD, chief of thoracic surgery at Hackensack University Medical Center in New Jersey.

Some people feel pain around the ribs that spreads to their back, chest, or upper abdomen on the side of the surgery, says Rachit Shah, MD, chief of thoracic and foregut surgery at VCU Massey Comprehensive Cancer Center and VCU Health in Virginia. This nerve-related pain can feel like aching, burning, or pressure in the chest, he says.

Pain is often strongest in the first five to seven days after surgery, then gradually improves over two to four weeks, adds Dr. Shah, though mild stiffness or soreness can linger for a few months.

Tips for Managing Pain

• Stay ahead of the pain. Your surgery team will prescribe various pain medications during early recovery, says Shah. Take them as directed and avoid waiting until the pain becomes severe, when it might be more challenging to control.
• Use a pillow for support. “Hold a pillow firmly against your chest when you cough, sneeze, or get up from a seated or lying position,” Rizk says. This supports the incision and helps reduce pain.
• Move your body. To reduce stiffness, improve circulation, and help your body heal, walk a little each day, says Rizk, though it may be uncomfortable at first.
• Avoid heavy lifting. Ask your surgeon how much weight you can lift. You may be told to avoid lifting anything heavier than a gallon of milk for at least two to four weeks.

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Because people who have undergone a lobectomy have reduced lung capacity (the amount of air your lungs can hold) after surgery, it’s natural to feel short of breath easily, says Kiran Lagisetty, MD, a thoracic surgeon at the University of Michigan Health System. You might also find yourself taking shallow breaths due to pain, which can make you feel even more winded, he notes.

Shortness of breath often gets better as pain improves and the remaining lung adapts, says Michael Marsh, MD, a pulmonologist specializing in diagnosing and treating chest and lung conditions at Jupiter Medical Center in Florida. Many people return close to their usual breathing within about six to eight weeks, though recovery varies depending on their overall health and lung function before surgery, says Rizk.

Tips for Managing Shortness of Breath

• Keep expanding your lungs. You will likely use an incentive spirometer (a handheld device that exercises your lungs to prevent complications) during recovery in the hospital.

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   Continue using it at home as directed, Dr. Marsh says.
• Try pursed-lip breathing. To feel more in control when you’re short of breath, Rizk recommends inhaling slowly through your nose for two counts, then exhaling through pursed lips like you’re about to whistle for four counts.
• Continue moving your body. In addition to managing pain, short daily walks and gentle movement also help your lungs recover, Marsh says.
• Quit smoking. If you are a smoker and haven’t already quit, this is the perfect time to do so to help speed up your recovery.

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The effects of anesthesia, reduced lung capacity, pain medications, and even the emotional stress of the diagnosis can contribute to fatigue, says Rizk. Not only is fatigue common after a lobectomy but it can also be one of the longer-lasting side effects, sometimes lingering for a month or longer, he says.

Tips for Managing Fatigue

• Pace yourself. Try not to do too much too soon. Alternate light activity with rest instead of staying in bed most of the day, Marsh says. Take a short walk each day, gradually increasing in length to help rebuild stamina.

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• Make life a little easier at home. “Keep frequently used items within easy reach,” Rizk says. “Sit down for tasks like getting dressed or preparing food. Ask for and accept help from family and friends with chores and errands.”
• Eat to support healing. A diet rich in protein and complex carbohydrates can help your body repair tissue and stay energized, Rizk says. If you don’t have much of an appetite, which is a normal part of recovery, try smaller, more frequent meals throughout the day.

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These symptoms can develop in the first few weeks and usually improve as pain lessens and you become more active, Rizk says. While you might want to stop coughing immediately, Lagisetty notes that doctors often avoid prescribing cough suppressants right after surgery because it’s important to be able to cough effectively to clear your lungs and prevent pneumonia. “For a longer-term persistent cough, patients can use cough suppressants,” he says.

Congestion that lingers, worsens, or comes with thick or colored mucus can be a sign of infection, so let your surgeon know if that happens, says Shah. A severe or debilitating cough that lasts more than two or three weeks also warrants a call to your care team.

Tips for Managing a Persistent Cough and Chest Congestion

• Keep up with your breathing exercises. Using the incentive spirometer and continuing breathing exercises help keep your lungs expanded and prevent mucus from settling in.

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• Try huff coughing. “This is a technique we teach to help clear mucus without strenuous coughing,” Rizk says. “Take a slow, deep breath, hold it for a moment, and then force the air out in short huffs, as if you were trying to fog up a mirror.”
• Stay hydrated. Keep mucus thin and easier to clear by drinking plenty of water, says Rizk. If your throat feels dry or scratchy, drinking warm liquids, like tea with honey, can be helpful.

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• Use a humidifier. Add a little moisture to the air with a humidifier, especially at night.

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• Avoid irritants. Rizk suggests staying away from strong perfumes, smoke, and harsh cleaning chemicals that might trigger a coughing fit.

• Pain and fatigue are common after lung cancer surgery. Take medications as prescribed, do your breathing exercises, and walk a little each day to manage the discomfort and help your lungs recover.
• Shortness of breath, a nagging cough, and chest congestion are also common and often improve with time. Keeping hydrated, staying active, and continuing with your breathing exercises can help manage these symptoms.
• Contact your healthcare team if you develop worsening shortness of breath, fever, chest pain, palpitations, significant bleeding when coughing, or if symptoms aren’t improving as expected.