Why Is Lung Health Key to Survivorship After Cancer Treatment?

In an interview with CURE, Dr. Joshua Sabari, a thoracic medical oncologist at NYU Langone Health’s Perlmutter Cancer Center and editor-in-chief of CURE magazine, emphasized that lung health remains an essential part of survivorship for patients with cancer, even after treatment ends.

He explained that therapies such as surgery, chemotherapy, radiation and immunotherapy can have lasting effects on lung function. Removing part of the lung reduces breathing capacity, radiation may cause scarring and some systemic treatments can affect how oxygen moves into the bloodstream. Because lung tissue does not regrow, protecting remaining function is important.

Sabari recommends regular activity, such as walking 30 minutes a day several times a week, to help maintain lung strength. Survivors should promptly report new shortness of breath, cough or chest pain. Follow-up care may include CT scans and pulmonary function testing to monitor recovery.

CURE: Why is lung health such an important part of survivorship for patients with cancer, even after treatment ends?

Sabari: We know that a lot of treatments can affect both the heart and the lung, particularly systemic chemotherapies, for example, as well as immunotherapies, and it's important to continue to upkeep both your cardiac and pulmonary lung health. So how do you do that? By exercising routinely, 30 minutes a day at minimum, three to four times a week. And if you can exercise, just walking, getting out, walking for 30 minutes a day, keeping your lung function sort of up, keeping your lungs expanded, is really, really important for your lung health.

How can cancer treatments like surgery, radiation or systemic therapy affect the lungs long term?

Surgery on the lungs, particularly a lobectomy, removal of an entire lobe, or a segmentectomy, removal of a segment of the lung, removes part of that lung, and the lungs function by taking in air or oxygen from the outside, transmitting that oxygen to the blood vessels. Then it gets pumped to the whole body. And if you're missing a part of your lung, that ability to take in oxygen and to have that capacity is going to be diminished. So it's very important.

Lungs do not regenerate or regrow. So very important that we continue to work or exercise the other parts of the lung to help, and keep the lung safe. Also important that if you're smoking, to quit smoking, because we know that smoking can severely impact lung function. Again, that ability to take in oxygen and to get that oxygen to the rest of the body. Things like chemotherapy can also affect lung function. We know that it may affect the blood vessels that take up oxygen in the lung. Radiation, for example, can cause scarring in the lung post-radiation, particularly if we're radiating a nodule inside the lung or a lymph node in the middle part of the chest.

And lastly, immunotherapy. Immunotherapies are medicines that rev up our immune system to better recognize and attack cancer. Sometimes the immunotherapy can cause our own immune system to recognize and attack normal lung. So any scarring that can occur in the lung, both from immunotherapy or from radiation therapy, can affect our lung function.

What symptoms or breathing changes should survivors watch for and bring up to their care team?

That's an important question. If you've had cancer and you've received any systemic therapy, or if you've had surgery or radiation, and you develop new-onset shortness of breath, cough or chest pain, it's really important to bring these symptoms up to your health care team, and these should be evaluated to make sure that they are not concerning and to make sure that all sort of etiologies are ruled out, particularly if this is more acute in onset, occurring pretty quickly, or if these are persistent over time.

How can patients tell the difference between normal recovery and something that might need medical attention?

So normal recovery post-surgery or post-radiation should continuously get better over time, right? So if you had surgery and remove part of the lung, sure, the first couple of weeks postoperatively, post-surgery, are going to be difficult, right? It's going to take time for your tissues to heal and for your lung function to get better. But again, we expect day-to-day your lung function to improve. If three or four weeks after surgery you feel that your breathing is getting worse or the cough is getting worse, this is something to bring up with your medical team.

Are certain survivors, such as those who've had chest radiation or a history of smoking, at a higher risk for lung complications?

Folks who've had a history of smoking have higher rates of COPD, chronic obstructive pulmonary disease in the lung, have increased rates of emphysema. This is difficulty in the upper parts of the lung at transmitting oxygen to the blood vessels. So for sure, folks who've had a history of smoking are at increased rates of complications and side effects from therapy. Also, folks who had prior radiation are at increased risk of issues in the lung, particularly large fields of radiation for patients with lymphoma historically, or for lung radiation. We try to stay away from large fields of radiation nowadays, and we try to spare the normal tissues. Interestingly, folks who've had radiation in the past, when we've radiated portions of the heart or the blood vessels of the heart, can have cardiac or heart complications related to lack of blood flow going to the heart in those locations. So if you've had prior radiation or prior surgery and you're having symptoms of chest pain or shortness of breath, critical to discuss it with your health care team, absolutely.

What types of follow-up testing or monitoring help assess lung function after treatment?

After treatment, either surgery or radiation, it is important to follow with your medical oncology team, your health care practitioner team. I oftentimes will recommend getting CT scans of the chest to assess the lung parenchyma, the tissue. But it's also important to get pulmonary function tests. These are breathing tests that assess the capacity of the lung and the ability of the lung to diffuse oxygen into the blood so that your heart can pump it throughout the body. It's also important, if you're having shortness of breath and/or chest pain or symptoms of coronary artery disease, to be evaluated by a cardiologist. So things such as stress testing, for example, echocardiogram, an ultrasound of the heart, may be helpful to rule out or rule in some of these abnormalities.

Transcript has been edited for clarity and conciseness.

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