Non-pharmaceutical interventions to optimize cancer immunotherapy

ABSTRACT

The traditional picture of cancer patients as weak individuals requiring maximum rest and protection is beginning to dissolve. Too much focus on the medical side and one’s own vulnerability and mortality might be counterproductive and not doing justice to the complexity of human nature. Unlike cytotoxic and lympho-depleting treatments, immune-engaging therapies strengthen the immune system and are typically less harmful for patients. Thus, cancer patients receiving checkpoint inhibitors are not viewed as being vulnerable per se, at least not in immunological and physical terms. This perspective article advocates a holistic approach to cancer immunotherapy, with an empowered patient in the center, focusing on personal resources and receiving domain-specific support from healthcare professionals. It summarizes recent evidence on non-pharmaceutical interventions to enhance the efficacy of immune checkpoint blockade and improve quality of life. These interventions target behavioral factors such as diet, physical activity, stress management, circadian timing of checkpoint inhibitor infusion, and waiving unnecessary co-medication curtailing immunotherapy efficacy. Non-pharmaceutical interventions are universally accessible, broadly applicable, instantly actionable, scalable, and economically sustainable, creating value for all stakeholders involved. Most importantly, this holistic framework re-emphasizes the patient as a whole and harnesses the full potential of anticancer immunity and checkpoint blockade, potentially leading to survival benefits. Digital therapeutics are proposed to accompany the patients on their mission toward change in lifestyle-related behaviors for creating optimal conditions for treatment efficacy and personal growth.

KEYWORDS:

• Cancer immunotherapy
• circadian rhythm
• diet
• digital therapeutics
• microbiome
• physical activity
• stress management
• telemedicine

Acknowledgments

Original research inspiring this work was kindly supported by the Lungenliga St.Gallen-Appenzell based in St.Gallen, Switzerland (grant to MB), and the Stiftung Propter Homines based in Vaduz, Principality of Liechtenstein (grant to MB). Figures were created with BioRender.com.

Disclosure statement

TK is affiliated with the Centre for Digital Health Interventions (CDHI), a joint initiative of the Institute for Implementation Science in Health Care, University of Zurich, the Department of Management, Technology, and Economics at ETH Zurich, and the Institute of Technology Management and School of Medicine at the University of St.Gallen. CDHI is funded in part by CSS, a Swiss health insurer. TK is also cofounder of Pathmate Technologies, a university spin-off company that creates and delivers digital clinical pathways. However, neither CSS nor Pathmate Technologies were involved in this article. All other authors declare no conflicts of interest with relevance to this article. No medical writer or generative AI tool was involved in the preparation of the manuscript.

Author contributions

Wrote the first draft of the paper: MB, MHB

Wrote the final version of the paper: MB, FB, FR, TK, MJ, MF, MHB

Generated the figures: MB (with BioRender.com)

Approved the paper for publication: MB, FB, FR, TK, MJ, MF, MHB

Ethical approval and informed consent

Ethical approval and informed consent not applicable – review article.

Data availability statement

Data sharing not applicable – no new data generated.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.