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Immunotherapy for Cancer: What Patients Need to Know Before, During, and After Treatment

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Immunotherapy for Cancer: What Patients Need to Know Before, During, and After Treatment. Learn how cancer immunotherapy works, who benefits most, common side effects, long-term risks, and evidence-based complementary therapies that may improve recovery and quality of life.

Like radiation, surgery, and chemotherapy, immunotherapy for cancer can be a beneficial therapy yet cause short- and long-term damage to the cancer patient. In my experience, cancer patients benefit by knowing the pros and cons of their therapies as well as evidence-based therapies that can reduce their risk of side effects.

This is a general post about chemotherapy for cancer. I have also posted blogs about specific immunotherapy regimens such as Keytruda, Yervoy, and Opdivo.

I am a long-term survivor of an incurable blood cancer called multiple myeloma. My research and experience with evidence-based non-conventional therapies are the reason why I have lived in complete remission from my incurable blood cancer since achieving complete remission in early 1999. I have learned that the best way to manage cancer is to combine the best of conventional and evidence-based non-conventional therapies.

I have come to believe that therapy-induced side effects can be life-threatening while ruining quality of life. Consider therapies shown to reduce possible side effects.

Before beginning chemotherapy, consider:

Scroll down the page and post a question or a comment if there’s anything you’d like to know about radiation for cancer.

Good luck,

David Emerson

Concepts Central to Managing Your Cancer-

Immunotherapy Regimens-

If You’re Trying to Quit Smoking:

How Is Immunotherapy Different From Chemotherapy?

Concepts Central to Managing Your Cancer-

Immunotherapy for Cancer: What Patients Need to Know Before, During, and After Treatment

Immunotherapy has transformed cancer treatment over the past decade. Unlike chemotherapy, which attacks rapidly dividing cells, immunotherapy helps your own immune system recognize and destroy cancer cells.

For many cancers—including melanoma, lung cancer, kidney cancer, bladder cancer, lymphoma, and some colorectal cancers—immunotherapy has dramatically improved survival.

But immunotherapy is not a miracle drug.

Only some patients respond. Others experience immune-related side effects that can affect nearly any organ in the body.

Understanding what to expect before treatment begins—and knowing how to support your body throughout therapy—can improve both safety and quality of life.

What Is Cancer Immunotherapy?

Immunotherapy refers to treatments that stimulate or modify the immune system to fight cancer.

Unlike chemotherapy:

  • Immunotherapy doesn’t directly kill cancer cells.
  • It removes the “brakes” preventing immune cells from attacking tumors.
  • Responses may take weeks or months.
  • Some responses continue long after treatment ends.

The most common immunotherapy drugs are immune checkpoint inhibitors.

Examples include:

Drug Generic Name Target
Keytruda pembrolizumab PD-1
Opdivo nivolumab PD-1
Yervoy ipilimumab CTLA-4
Tecentriq atezolizumab PD-L1
Imfinzi durvalumab PD-L1
Libtayo cemiplimab PD-1

Which Cancers Are Treated With Immunotherapy?

Immunotherapy is commonly used for:

  • Melanoma
  • Lung cancer
  • Kidney cancer
  • Bladder cancer
  • Liver cancer
  • Hodgkin lymphoma
  • Head and neck cancers
  • Esophageal cancer
  • Gastric cancer
  • Triple-negative breast cancer
  • MSI-high colorectal cancer
  • Endometrial cancer
  • Cervical cancer

Researchers continue studying immunotherapy in dozens of additional cancers.

Before Starting Immunotherapy

Ask About Biomarker Testing

Many immunotherapy drugs work best only in tumors with specific biomarkers.

Examples include:

  • PD-L1 expression
  • MSI-H (Microsatellite instability)
  • dMMR (Mismatch repair deficiency)
  • Tumor mutational burden (TMB)

Not every patient benefits equally.

Understanding your biomarker profile helps determine whether immunotherapy is likely to help.

Discuss Your Autoimmune History

Because immunotherapy activates the immune system, patients with autoimmune diseases deserve special attention.

Examples include:

  • Rheumatoid arthritis
  • Lupus
  • Crohn’s disease
  • Ulcerative colitis
  • Psoriasis
  • Multiple sclerosis
  • Treatment may still be appropriate, but monitoring is especially important.

Baseline Testing

Before treatment begins your oncologist may order:

  • CBC
  • Comprehensive metabolic panel
  • Thyroid function tests
  • Liver enzymes
  • Kidney function
  • Blood sugar
  • Cortisol
  • Hepatitis screening

These values help identify side effects later.

During Immunotherapy

Unlike chemotherapy, many patients feel surprisingly well during treatment.

Some continue working full-time.

Others experience only mild fatigue.

However, immune-related side effects can develop gradually.

The Most Common Side Effects

  • Fatigue
  • Rash
  • Itching
  • Diarrhea
  • Joint pain
  • Muscle aches
  • Fever
  • Thyroid dysfunction

Most are manageable when recognized early.

Serious Immune-Related Side Effects

Because immunotherapy activates immune cells, those cells sometimes attack healthy organs.

Potential complications include:

Lungs

  • Pneumonitis

Colon

  • Colitis

Liver

  • Hepatitis

Thyroid

  • Hypothyroidism
  • Hyperthyroidism

Adrenal glands

  • Adrenal insufficiency
  • Pituitary gland
  • Hypophysitis

Pancreas

  • Diabetes
  • Pancreatitis

Kidneys

  • Nephritis

Heart

  • Myocarditis

Brain and nerves

  • Neuropathy
  • Encephalitis
  • Guillain-Barré syndrome (rare)

Fortunately, most serious side effects are uncommon, but early treatment—often with corticosteroids—can prevent permanent damage.

Symptoms You Should Never Ignore

Contact your oncology team immediately if you develop:

  • Persistent diarrhea
  • Shortness of breath
  • Chest pain
  • Severe fatigue
  • Confusion
  • Vision changes
  • Yellow skin
  • Dark urine
  • Severe headaches
  • Fever

Do not assume these symptoms are “normal.”

Nutrition During Immunotherapy

Unlike chemotherapy, appetite is often preserved.

A Mediterranean-style diet emphasizing anti-inflammatory foods may help support immune function.

Focus on:

  • Fruits
  • Vegetables
  • Beans
  • Whole grains
  • Nuts
  • Olive oil
  • Fish

Limit:

  • Ultra-processed foods
  • Excess sugar
  • Excess alcohol

Exercise During Immunotherapy

Regular physical activity may help reduce:

  • Fatigue
  • Anxiety
  • Depression
  • Muscle loss

Most guidelines recommend:

  • 150 minutes weekly of moderate exercise
  • Strength training twice weekly
  • Daily walking

Always tailor activity to your energy level.

Evidence-Based Complementary Therapies

Current evidence supports several integrative approaches for improving symptoms and quality of life during immunotherapy.

Therapy Evidence Purpose
Exercise ★★★★★ Reduce fatigue, preserve muscle
Mediterranean diet ★★★★☆ Lower inflammation
Mindfulness meditation ★★★★☆ Anxiety reduction
Yoga ★★★★☆ Improve fatigue and sleep
Acupuncture ★★★★☆ Joint pain, neuropathy
Sleep optimization ★★★★★ Recovery
Vitamin D (if deficient) ★★★★☆ Immune health

Patients should always discuss supplements with their oncology team because some products may interfere with treatment or interact with medications.

After Immunotherapy Ends

One unique aspect of immunotherapy is that side effects can appear months—even years—after treatment ends.

Continue monitoring:

  • Thyroid function
  • Blood sugar
  • Adrenal function
  • Lung symptoms
  • Heart symptoms
  • Persistent fatigue

Many patients continue benefiting from immunotherapy long after treatment has stopped because immune memory remains active.

Questions to Ask Your Oncologist

  • Why do you recommend immunotherapy for my cancer?
  • What biomarkers support this decision?
  • How likely am I to respond?
  • What side effects are most common with my treatment?
  • Which symptoms require an emergency call?
  • How often will my blood work be checked?
  • What happens if serious side effects occur?
  • Can treatment be restarted after an immune-related adverse event?
  • Are there evidence-based complementary therapies you recommend?
  • What follow-up monitoring will I need after treatment ends?

Key Takeaways

  • Immunotherapy helps your immune system fight cancer rather than directly killing cancer cells.
  • Biomarker testing helps determine who is most likely to benefit.
  • Many patients tolerate immunotherapy better than chemotherapy.
  • Serious immune-related side effects are uncommon but can affect nearly any organ.
  • Prompt reporting of new symptoms greatly improves safety.
  • Exercise, good nutrition, adequate sleep, and stress management can improve quality of life during treatment.
  • Some side effects may not appear until months after treatment has ended, making long-term follow-up essential

PeopleBeatingCancer Evidence Rating: Complementary Therapies During Immunotherapy

Complementary therapies may help patients remain active, manage fatigue, reduce stress, sleep better, and cope with treatment. However, very few have been proven in randomized clinical trials to increase the anticancer effectiveness of immunotherapy.

The PeopleBeatingCancer Evidence Rating evaluates each therapy according to:

  • The quality and quantity of human clinical research
  • Whether results have been reproduced
  • Whether major oncology guidelines recommend the therapy
  • Its safety when used alongside immunotherapy
  • Whether the evidence applies specifically to immunotherapy or more broadly to cancer supportive care

How to Read the PBC Evidence Rating

Rating Meaning
★★★★★ Strong clinical evidence and guideline support
★★★★☆ Good evidence, although some limitations remain
★★★☆☆ Promising or moderate evidence; more research needed
★★☆☆☆ Limited, preliminary, or mostly observational evidence
★☆☆☆☆ Insufficient evidence, conflicting findings, or meaningful safety concerns

Complementary Therapies Used Alongside Immunotherapy

Complementary therapy PBC rating What the evidence suggests Important precautions
Individualized exercise ★★★★☆ Exercise has strong evidence across cancer populations for reducing fatigue, preserving strength and physical function, and improving quality of life. Direct studies involving patients receiving immune checkpoint inhibitors remain limited, so exercise should not yet be described as a proven way to improve immunotherapy response or survival. Exercise may need to be reduced or temporarily stopped during myocarditis, pneumonitis, severe colitis, adrenal insufficiency, neurologic toxicity, fever, or other serious immune-related adverse events.
Mindfulness, meditation and relaxation training ★★★★☆ Mindfulness-based interventions can help reduce anxiety, depression, stress, and emotional distress in people with cancer. These benefits relate primarily to symptom management and quality of life—not increased tumor response. SIO-ASCO guidelines support several mind-body approaches for anxiety and depression in adults with cancer. These practices should complement—not replace—medical evaluation of fatigue, confusion, headaches, sleep disruption, or mood changes that could reflect immune-related toxicity.
Yoga, tai chi or qigong ★★★☆☆ These gentle mind-body exercises may improve fatigue, sleep, mood, balance, mobility, and quality of life. Most studies involve breast cancer survivors or mixed cancer populations rather than patients specifically receiving immunotherapy. Modify movements for bone metastases, neuropathy, dizziness, joint inflammation, weakness, cardiovascular disease, or balance problems.
Acupuncture ★★★☆☆ Acupuncture has evidence for certain cancer-related symptoms, including pain, nausea, aromatase inhibitor–related joint pain, and some forms of neuropathy. Evidence specifically for immune checkpoint inhibitor side effects is limited. It has not been shown to prevent serious immune-related adverse events. Avoid needling infected or irradiated skin and use caution with low platelets, anticoagulants, lymphedema risk, or immune suppression. Seek an oncology-trained, licensed practitioner.
Mediterranean-style, plant-forward diet ★★★☆☆ A varied diet emphasizing vegetables, fruits, legumes, whole grains, nuts, fish, and unsaturated fats can support cardiovascular health, weight management, bowel function, and overall nutrition. Direct evidence that a Mediterranean diet improves immunotherapy outcomes is not yet conclusive. Patients with colitis, diarrhea, bowel obstruction risk, swallowing problems, or unintended weight loss may require temporary dietary modification and oncology nutrition support.
Dietary fiber from food ★★★☆☆ The gut microbiome may influence immune checkpoint inhibitor response. In an observational study of patients with melanoma, higher dietary fiber intake was associated with longer progression-free survival, particularly among patients who did not use over-the-counter probiotic supplements. This is promising but does not prove that fiber causes better immunotherapy outcomes. Increase fiber gradually. High-fiber diets may be inappropriate during active immune-related colitis, severe diarrhea, bowel narrowing, or certain gastrointestinal complications.
Sleep optimization ★★★☆☆ Consistent sleep routines, treatment of insomnia, and cognitive behavioral therapy for insomnia can improve fatigue, mood, concentration, and quality of life. There is no strong evidence that sleep interventions directly increase immunotherapy response. New extreme fatigue, weakness, dizziness, headaches, confusion, or excessive sleepiness should not automatically be blamed on poor sleep; these symptoms can signal thyroid, pituitary, adrenal, neurologic, or other immune-related toxicity.
Massage therapy ★★★☆☆ Massage may provide short-term relief from anxiety, muscle tension, pain, and stress in some cancer patients. It has not been shown to increase the effectiveness of immunotherapy or prevent immune-related side effects. Avoid deep pressure over tumors, blood clots, fragile bones, surgical sites, inflamed skin, ports, radiation injury, or areas affected by lymphedema unless cleared by the care team.
Vitamin D testing and correction of deficiency ★★☆☆☆ Correcting a documented vitamin D deficiency supports bone and general health. Observational studies have explored relationships between vitamin D status, immunity, and cancer outcomes, but supplementation has not been proven to improve checkpoint-inhibitor response. Avoid high-dose vitamin D without testing and supervision. Excess vitamin D can cause high calcium levels and kidney complications.
Oral probiotic supplements ★☆☆☆☆ Probiotic supplements cannot currently be recommended as a routine strategy for improving immunotherapy response. Microbiome findings are inconsistent, products differ substantially, and observational research has raised concern that some commercial probiotic use may be associated with poorer checkpoint-inhibitor outcomes. In contrast, fiber-rich foods have shown more encouraging associations. Do not begin a probiotic during immunotherapy without discussing it with the oncology team, especially during colitis, severe illness, immune suppression, central-line use, or hospitalization.
Fecal microbiota transplantation ★★☆☆☆ Early clinical research suggests that modifying the gut microbiome may eventually help overcome resistance to immunotherapy or treat difficult immune-mediated colitis. It remains investigational for improving cancer response and should be performed only in carefully controlled medical or clinical-trial settings. Unscreened or do-it-yourself fecal transplantation can transmit serious infections and should never be attempted.
Omega-3 fatty-acid supplements ★★☆☆☆ Omega-3 fats may help selected patients with nutrition, triglycerides, inflammation, or weight maintenance, but there is insufficient clinical evidence that supplements improve immunotherapy response or prevent immune-related adverse events. Higher doses may increase bleeding risk or interact with anticoagulant and antiplatelet medications. Food sources may be preferable for many patients.
Curcumin or turmeric supplements ★★☆☆☆ Laboratory studies suggest anti-inflammatory and immune-modulating effects, but reliable human evidence alongside checkpoint inhibitors is lacking. Because immunotherapy depends on immune activation, “anti-inflammatory” does not automatically mean helpful. Concentrated products may interact with anticoagulants, affect the liver or gallbladder, cause gastrointestinal symptoms, and complicate interpretation of treatment-related liver abnormalities.
Medicinal mushrooms, AHCC and immune-stimulating supplements ★☆☆☆☆ These products are frequently promoted as immune enhancers, but there is insufficient clinical evidence that they improve immune checkpoint inhibitor outcomes. “Stimulating the immune system” is not necessarily safe when treatment can already provoke immune attacks against healthy organs. Potential concerns include allergic reactions, liver injury, drug interactions, product contamination, and unpredictable immune effects. Obtain oncology approval before use.
High-dose antioxidant supplements ★☆☆☆☆ There is no convincing evidence that high-dose antioxidant supplements improve immunotherapy outcomes. Antioxidants from ordinary foods are different from pharmacologic-dose supplements. High-dose vitamins A, C or E, selenium, glutathione, and multi-ingredient antioxidant formulas may interact with treatment or other medications. Avoid assuming that “natural” means harmless.
Cannabis or cannabinoid products ★★☆☆☆ Cannabinoids may help selected patients with pain, nausea, appetite loss, or sleep problems. Evidence regarding checkpoint-inhibitor effectiveness is uncertain, and observational studies have reported conflicting results. Cannabis should therefore be considered a symptom-management option—not an immunotherapy enhancer. Possible effects include sedation, dizziness, cognitive impairment, falls, anxiety, drug interactions, and liver-enzyme changes. Product strength and purity vary.

Important Interpretation

A high evidence rating does not mean that a complementary therapy cures cancer or makes immunotherapy more effective.

For example, exercise and mindfulness receive relatively strong ratings because they can improve fatigue, function, emotional health, and quality of life. Direct evidence that they improve checkpoint-inhibitor response remains limited. Reviews of exercise during immune checkpoint inhibitor treatment continue to identify substantial gaps in clinical evidence.

Similarly, research connecting the gut microbiome with immunotherapy response is scientifically important but still evolving. Associations between fiber intake, microbial diversity, antibiotic exposure, and treatment outcomes do not prove that a particular food, probiotic, or microbiome product will help an individual patient.

Complementary Therapies Cannot Treat Immune-Related Adverse Events

Immune checkpoint inhibitors can cause inflammation of the lungs, colon, liver, thyroid, pituitary gland, adrenal glands, kidneys, heart, skin, nervous system, and other tissues.

These reactions may become serious or life-threatening. Current clinical guidelines emphasize early recognition, medical evaluation, treatment interruption when appropriate, corticosteroids, and other immune-suppressing medications—not supplements or dietary remedies.

Contact the oncology team promptly for new or worsening:

  • Diarrhea, abdominal pain or blood in the stool
  • Shortness of breath, coughing or chest pain
  • Severe weakness, dizziness or unusual fatigue
  • Headaches, confusion, vision changes or personality changes
  • Yellowing of the skin, dark urine or severe nausea
  • Rapid heartbeat, fainting or swelling
  • New numbness, muscle weakness or difficulty walking
  • Widespread rash, blistering or peeling skin

Do not attempt to manage these symptoms solely with herbs, supplements, probiotics, restrictive diets, acupuncture, or other complementary approaches.

The PeopleBeatingCancer Bottom Line

The most evidence-supported complementary strategies during immunotherapy are generally the least exotic:

  1. Remain physically active within your abilities.
  2. Eat a nutritionally adequate, plant-forward diet when tolerated.
  3. Protect sleep and emotional health.
  4. Use evidence-based symptom therapies such as mindfulness, yoga, massage, or acupuncture when appropriate.
  5. Report every new symptom early.
  6. Review every vitamin, herb, mushroom, probiotic, cannabis product, and supplement with the oncology team.

Complementary care is most valuable when it helps patients tolerate treatment, preserve function, manage symptoms, and maintain quality of life. It should support—not replace or delay—appropriate immunotherapy and the medical treatment of immune-related adverse events.

To Learn More:

Immunotherapy drugs

Immunotherapy Preparation-

General treatment guides

Side effect articles

Integrative oncology

Post Treatment-

Research References (PubMed)

  1. Robert C. A decade of immune-checkpoint inhibitors in cancer therapy. Nat Commun. 2020.
  2. Postow MA, Sidlow R, Hellmann MD. Immune-related adverse events associated with immune checkpoint blockade. N Engl J Med. 2018.
  3. Brahmer JR, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO Guideline Update. J Clin Oncol. 2021.
  4. Haanen JBAG, et al. ESMO Clinical Practice Guideline for management of toxicities from immunotherapy. Ann Oncol. 2022.
  5. National Comprehensive Cancer Network (NCCN). Management of Immunotherapy-Related Toxicities.
  6. Society for Immunotherapy of Cancer (SITC). Clinical Practice Guideline on Immune Checkpoint Inhibitor-Related Adverse Events.
  7. Schmid P, et al. Pembrolizumab for early triple-negative breast cancer. N Engl J Med. 2022.
  8. Wolchok JD, et al. Overall survival with combined nivolumab and ipilimumab. N Engl J Med. 2022.

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