Preparing for Immunotherapy

Immunotherapy is a type of cancer treatment that helps your immune system recognise and fight cancer cells. 

Starting a new cancer treatment can feel overwhelming, and if your doctor has recommended immunotherapy, you probably have questions. Understanding more about this treatment, what to expect, and how to prepare can help put your mind at ease and boost your confidence going in. 

This guide explains what immunotherapy is and how it works, how treatments are given, and how to prepare for immunotherapy treatments, physically, practically, and emotionally.

Your immune system is your body’s natural defence system. It can recognise potential infections and other threats and fight them off to keep you healthy. But cancer cells can be sneaky and hide from your immune cells, or they can multiply too quickly for your immune system to stop them. 

Immunotherapy is a newer type of cancer treatment that uses medications to activate and train your immune system to detect and destroy hidden cancer cells. The drugs also help you produce more cancer-fighting immune cells. It differs from chemotherapy, which uses drugs to kill any rapidly dividing cells.

Immunotherapy doesn’t work on all cancers, but it may help treat some of these cancers:

• Head and neck
• Oesophageal
• Stomach
• Breast
• Colorectal
• Lung
• Mesothelioma
• Kidney
• Bladder
• Melanoma
• Cervical
• Some blood cancers

Not everyone is a candidate. The treatments work on tumours with certain biomarkers, so your doctors will test your cancer for these. Doctors also consider your cancer stage, how you have responded to previous treatments if you have had any, and your overall health before recommending the treatment. 

You might have immunotherapy on its own or alongside other treatments, like chemotherapy.

Proper medical preparation will ensure that treatments are safe and effective for you. In the weeks before treatment, your doctor will (1,2):

• Review your medical history and current medications.
• Examine you to assess your overall health.
• Order bloodwork and other tests, depending on your cancer type, to make sure your organs and immune system are working well.
• Explain what will happen during and after immunotherapy treatments, including follow-up testing to see how the treatments are working.

The type of immunotherapy treatments you’ll have, the schedule, and how long you’ll undergo treatments depend on your cancer type, stage, and health. 

Immunotherapy drugs can be given via an IV drip or injection under the skin, usually in cycles that last for two, three, four, or six weekly treatments. Each cycle is followed by a rest period that allows time for the treatment to activate cancer-fighting immune cells. Treatment cycles can continue for several months or up to two years, depending on your cancer and how your body responds.

Your medical team will tell you what to expect with your treatment plan and schedule. 

Some live vaccines, such as those for chickenpox or shingles, may not be safe while you’re on immunotherapy. Others, such as inactivated flu or COVID-19 vaccines, may be recommended, but should be given several weeks before starting immunotherapy.

Ask your doctor which vaccines are safe for you, and when to schedule them.

Immunotherapy treatment is considered an expensive cancer treatment. The costs also vary and depend on the healthcare system, whether care is public or private, and the type of treatment you receive. Your hospital’s billing department can help you understand the treatment costs and explore financial planning options.

Treatment side effects can vary from person to person, but might include (2,3):

• Fatigue
• Cough or shortness of breath
• Flu-like symptoms, like a fever or chills
• Headaches
• Bone or muscle pain
• Loss of appetite
• Diarrhoea
• Skin rashes or itchiness
• Immune-related inflammation, which can occur if your immune system becomes overstimulated and attacks healthy organs

Use a journal to track your symptoms, when they happen, how long they last, and whether they’re severe.  Always tell your medical team about any new, unusual, or uncomfortable symptoms because there are ways to manage them. 

While preparing for immunotherapy, don’t be afraid to lean on friends, family, social workers, and cancer support groups. Having a supportive team can give you the strength you need.

These things can also help you calm your nerves and cope with feelings of uncertainty:

• Stick to simple daily routines.
• Practice deep breathing, meditation, or visualisation (imagine a positive recovery).
• Listen to music or uplifting podcasts.
• Write down worries or questions.
• Talk to a behavioural health counsellor or other cancer survivors who have undergone the same treatment.

Your healthcare providers are experts and know your cancer best. Reach out to them anytime you have:

• Worries or concerns about your treatment, how long side effects might last, or how your cancer is responding.
• New or worsening symptoms or side effects, especially if they affect your nutrition or quality of life.
• Questions about whether you qualify for newer treatments or clinical trials.

Immunotherapy is a promising treatment for many cancer types, but there’s a lot to know about it, and that can feel overwhelming. Learning the basics and preparing yourself medically, physically, and emotionally can set your mind at ease and allow you to have a smoother experience and a better outcome. 

Stay in close contact with your medical team because they are the experts who can guide you through every step of your treatment and help you build the support system you need.