Rehabilitation for Non-Small-Cell Lung Cancer

Medically Reviewed by Minesh Khatri, MD on July 25, 2022
5 min read

Your care for non-small-cell lung cancer (NSCLC) doesn’t end when you finish your medical therapy. Once you’ve gone through your course of treatment – which could involve a combination of surgery, chemotherapy, radiation, targeted therapy, or immunotherapy – your medical team may recommend that you have cancer rehabilitation therapy.

After you’re treated for NSCLC symptoms like shortness of breath, you may tire easily when you do things like walking or running errands. If you get a cold, you may notice that it’s harder to clear your lungs of congestion.

Many lung cancer centers offer pulmonary rehabilitation, where you work with physical, occupational, and respiratory therapists to help you stay active, lessen the side effects of cancer treatment, and help preserve your independence and quality of life.

It’s an educational and exercise program to teach you more awareness about your lungs. It has three main goals:

  • Help you with your shortness of breath, especially during exercise
  • Improve your quality of life
  • Allow you to do daily activities like housework, going to work, or errands

You’ll work with a wide array of health care professionals, including:

  • Physical therapists
  • Occupational therapists
  • Respiratory therapists
  • Psychologists
  • Dietitians

Research shows that pulmonary rehabilitation therapy can help you if you’ve had surgery to remove part of your lung due to lung cancer. Studies show it can:

  • Improve your exercise capacity
  • Improve your shortness of breath
  • Increase your walking speed
  • Strengthen your lower body

One 2021 study in the European Respiratory Journal looked at lung cancer patients who had 8 weeks of pulmonary rehabilitation (PR) just after surgery and compared them to patients who only learned breathing exercises. The patients who did PR showed significant improvements in a 6-minute walking distance, overall physical function, and mental health, while their shortness of breath and anxiety decreased. But the group that did only breathing exercise training noticed only a slight improvement in shortness of breath and in physical function.

There are a few key parts of pulmonary rehabilitation therapy. They include:

Breathing exercises. This is a key piece of PR. Many people with lung cancer have shortness of breath, which makes them reluctant to be physically active. You’ll often be taught two important breathing techniques:

  • Pursed-lipped breathing. In this exercise, you breathe in through your nose and breathe out twice as long through your mouth with pursed lips. This allows more air to flow in and out of your lungs so you can be more active.
  • Belly breathing. This is also referred to as diaphragmic breathing. You’ll breathe in through your nose while you pay attention to how your stomach fills up with air. You’ll then breathe out through your mouth at least twice as long as your inhale. It helps train your diaphragm to work at full capacity, so you take in more oxygen.

Exercise. The stronger your muscles, the better you can use oxygen. This can help improve shortness of breath. Unfortunately, many patients with NSCLC are scared to exercise, since they have trouble breathing. Your therapist will work with you to safely come up with a home-based exercise program. It may start with easier activities, such as chair-based yoga, and work up to riding a stationary bike or running short intervals on a treadmill.

Activity modifications. Your therapists will work with you to teach you ways to prevent your oxygen levels from going too low. To do this, you may make some changes to your daily routine that’ll help you be more efficient with your breathing.

Nutritional counseling. If you are an NSCLC patient, it’s important to stay at a healthy weight. If you weigh too much, you’ll get more shortness of breath, and if you weigh too little, you’ll dampen your immune system. But it can be hard to cook and eat when you get short of breath. You’ll work with a dietitian to learn easy ways to prepare healthy, nutritious food.

Psychological support. It’s normal to feel anxious when you are short of breath, but your distress can just worsen your breathlessness even more. A psychologist or social worker can teach you ways to manage anxiety so you can prevent this vicious cycle.

Your rehabilitation program may also include exercises for you to do at home. It’s very important to do them. This will help you make progress and ensure that your therapy is successful. Your therapists may also create a home program that you’ll follow regularly, even after you’re discharged from pulmonary rehabilitation therapy.

Your medical team can refer you to a rehabilitation therapy program. They are usually done at hospitals or outpatient centers. You can expect to go a few times a week for at least 1 to 3 months. You should ask your doctor about options near your home or office, to make it easier for you to fit in appointments. Some programs will even send therapists to your home.

Medicare and private health insurance often cover pulmonary rehabilitation therapy as part of a treatment plan for NSCLC if you’ve had lung surgery. You’ll need a prescription order from your oncologist or primary care doctor. You’ll need to check your insurance coverage to see if it covers rehabilitation services, and if it does, how many therapy visits you’re allowed. If you don’t have coverage, or your coverage ends, there may be other ways for you to access these services in your community.

Most patients are discharged from their program after weeks or months. But if symptoms such as breathlessness return, make you less active, and make it harder to do your day-to-day activities, talk to your health care provider. You may need to restart treatment.