Lung Center, Cantonal Hospital St.Gallen, St.Gallen, Switzerland.
Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland.
Oncoimmunology. 2023 Sep 28;12(1):2255459. doi: 10.1080/2162402X.2023.2255459. eCollection 2023.
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 , 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.
传统上,癌症患者被视为身体虚弱的个体,需要最大限度的休息和保护,这种观念正在逐渐改变。过分关注医学方面、自身的脆弱性和死亡率,可能会适得其反,也无法充分体现人性的复杂性。与细胞毒性和淋巴耗竭治疗不同,免疫激活疗法增强了免疫系统,对患者的伤害通常较小。因此,接受检查点抑制剂治疗的癌症患者,从免疫和身体方面来看,并不被视为脆弱。本文倡导采用整体方法来进行癌症免疫治疗,以赋予权力的患者为中心,关注个人资源,并从医疗保健专业人员那里获得特定领域的支持。本文总结了最近关于增强免疫检查点阻断疗效和改善生活质量的非药物干预措施的证据。这些干预措施针对行为因素,如饮食、体育活动、压力管理、检查点抑制剂输注的昼夜节律、以及放弃不必要的联合药物以减少免疫疗法的疗效。非药物干预措施普遍适用、广泛适用、可立即实施、可扩展且具有经济可持续性,为所有相关利益相关者创造价值。最重要的是,这种整体框架重新强调了患者作为一个整体,并充分利用了抗癌免疫和检查点阻断的潜力,可能带来生存获益。本文还提出了数字疗法,以帮助患者在改变与生活方式相关的行为方面做出改变,为治疗效果和个人成长创造最佳条件。