Objective To evaluate the effect of nursing intervention based on active health concept on self-care ability, anxiety, and depression of patients with lung cancer during perioperative period. Methods Using a quasi-randomized controlled trial design, patients with lung cancer surgery in Department of Thoracic Surgery, West China Tianfu Hospital of Sichuan University from April to July 2025 were selected and divided into an intervention group and a control group according to the time of admission. The control group received routine enhanced recovery after surgery (ERAS) nursing, while the intervention group received multi-stage active health intervention based on ERAS. Exercise of Self-care Agency Scale (ESCA) and Hospital Anxiety and Depression Scale (HADS) were used to evaluate the nursing effects before intervention (T0), at the end of intervention (T1) and 1 month after discharge (T2). Linear mixed models were used for statistical analysis. Results A total of 132 patients were enrolled, including 69 in the intervention group and 63 in the control group. At T0, demographic and clinical characteristics were comparable between the two groups (P>0.05), except for depression scores (6.39±1.38 vs. 6.85±1.46, P<0.05). At T1 and T2, the ESCA scores in the intervention group were significantly higher than those in the control group (T1: 24.50±6.07 vs. 19.04±13.76, P<0.05; T2: 25.32±9.45 vs. 20.03±8.47, P<0.05). Furthermore, both anxiety scores (T1: 15.80±1.24 vs. 17.70±0.82; T2: 17.34±0.83 vs. 17.90±0.41) and depression scores (T1: 5.49±0.92 vs. 6.35±0.60; T2: 5.35±0.56 vs. 6.06±0.35) were significantly lower in the intervention group compared to the control group (P<0.05). Conclusions Perioperative nursing based on the concept of active health can effectively improve the self-care ability of patients with lung cancer and relieve anxiety and depression. This approach provides empirical evidence for deepening patient-centered care within ERAS and is worthy of further clinical promotion and optimization.