Aim <p>To explore the longitudinal causal relationship between anxiety and self-efficacy in lung cancer patients and the mediating role of resilience in the reciprocal relationships.</p> Design <p>A longitudinal observational&#xa0;study.</p> Methods <p>This study collected data on anxiety, resilience, and self-efficacy in 333 Chinese first-diagnosed lung cancer patients at three time points: T1 (preoperative hospitalization), T2 (one month after surgery), and T3 (three months after surgery).</p> Results <p>The results of cross-lagged panel modeling showed that there was a significant mediating effect of resilience, which mediated the weakening effect of anxiety at T1 on self-efficacy at T3 and mediated the weakening effect of self-efficacy at T1 on anxiety at T3.</p> Conclusion <p>These findings suggest that resilience longitudinally mediated the relationship between anxiety and self-efficacy in lung cancer patients.</p> Implications for the profession and/or patient care <p>Enhancing medical staff’s capacity to reduce the incidence of preoperative anxiety and improve self-efficacy in patients undergoing lung cancer surgery.</p> Impact <p>Future research could develop interventions related to resilience to buffer or even block the debilitating effects of anxiety on self-efficacy and enhance the weakening effects of self-efficacy on anxiety in lung cancer patients.</p> Patient or public contribution <p>This study directly involved the patients in hospital settings.</p> Reporting method <p>This study adhered to the STROBE guidelines for cohort studies.</p>