Understanding how immunotherapy works, why it differs from chemotherapy, and how supportive care can help
Immunotherapy has transformed cancer treatment over the last two decades and has become one of the most important advances in modern oncology.
Unlike chemotherapy, which directly attacks cancer cells, immunotherapy works by helping the body's own immune system recognise and attack cancer.
For some cancers, immunotherapy has produced remarkable improvements in survival and long-term disease control. However, because it works by stimulating the immune system, it can also create a unique set of challenges and side effects.
Understanding how immunotherapy works can help patients feel more confident and better prepared throughout treatment.
Understanding Immunotherapy
What Is Immunotherapy?
The immune system constantly monitors the body for infections, abnormal cells and potential threats.
Under normal circumstances, immune cells can identify and destroy many abnormal cells before they become a problem.
Cancer cells, however, often develop mechanisms that allow them to hide from the immune system or switch off immune responses.
Immunotherapy helps remove these barriers, allowing immune cells to recognise and attack cancer more effectively.
How Does Immunotherapy Work?
The immune system uses a complex system of "accelerators" and "brakes" to control its activity.
These controls help ensure that the immune system attacks threats without damaging healthy tissues.
Many cancers exploit these natural braking mechanisms to avoid immune attack.
Immunotherapy works by releasing some of these brakes, allowing immune cells to recognise and target cancer cells more effectively.
Immune Checkpoints: The Body's Safety Switches
One of the most important concepts in immunotherapy is the idea of immune checkpoints.
These checkpoints act as safety mechanisms that prevent excessive immune activity.
Cancer cells can sometimes activate these checkpoints to hide from the immune system.
Several immunotherapy drugs work by blocking these checkpoints.
PD-1 and PD-L1
PD-1 is a receptor found on immune cells.
PD-L1 is a protein that some cancer cells use to switch off immune responses.
Drugs such as:
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Pembrolizumab (Keytruda)
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Nivolumab (Opdivo)
block this interaction and allow immune cells to remain active against cancer.
CTLA-4
CTLA-4 is another checkpoint that can reduce immune activity.
Drugs such as:
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Ipilimumab
help release this brake and strengthen immune responses.
Which Cancers Can Be Treated With Immunotherapy?
Immunotherapy is now used for many cancers, including:
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Melanoma
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Lung cancer
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Kidney cancer
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Bladder cancer
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Head and neck cancers
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Hodgkin lymphoma
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Certain gastrointestinal cancers
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Some breast cancers
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Several other tumour types
The suitability of immunotherapy depends on the specific characteristics of the cancer.
Why Does Immunotherapy Sometimes Cause Side Effects?
Because immunotherapy stimulates the immune system, side effects differ from those seen with chemotherapy.
Instead of directly damaging tissues, immunotherapy may cause the immune system to become overly active and attack healthy organs.
These are known as Immune-Related Adverse Events (irAEs)
They can affect almost any organ system.
Most are manageable when recognised early, which is why reporting symptoms promptly is extremely important.
Common Side Effects of Immunotherapy
Not everyone experiences side effects, and many people tolerate treatment very well.
However, common challenges may include:
Fatigue
One of the most frequently reported symptoms.
Fatigue may fluctuate and can sometimes persist for months after treatment.
Skin Reactions
These may include:
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Rash
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Itching
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Dry skin
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Increased sensitivity
Digestive Symptoms
Some patients develop:
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Diarrhoea
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Abdominal discomfort
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Colitis (inflammation of the bowel)
Thyroid Dysfunction
Immunotherapy may affect thyroid function, potentially leading to:
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Fatigue
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Weight changes
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Temperature sensitivity
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Reduced energy levels
Joint and Muscle Pain
Some patients experience:
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Muscle aches
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Joint discomfort
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Stiffness
Sleep Disturbances
Changes in energy levels and immune activity may affect sleep quality.
Emotional Wellbeing
Living with cancer treatment uncertainty can affect confidence, resilience and emotional wellbeing.
When Should You Contact Your Oncology Team?
Because immunotherapy side effects involve the immune system, early reporting is essential.
Contact your oncology team promptly if you experience:
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A temperature of 38°C or above
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Persistent diarrhoea
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Significant skin rash
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New or worsening breathlessness
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Persistent cough
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Severe fatigue
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New pain
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Vision changes
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Severe headaches
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Confusion or neurological symptoms
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Any unusual or rapidly worsening symptoms
Always follow the specific advice provided by your oncology team, as local guidance may vary.
Early intervention often prevents more serious complications.
Why Early Support Matters
Immunotherapy responses vary considerably between individuals.
Some people experience very few side effects, while others develop symptoms that affect quality of life and daily function.
Supportive care can often begin before significant difficulties develop.
By understanding the treatment pathway and monitoring likely areas of vulnerability, proactive strategies may be introduced early to help maintain function, resilience and wellbeing throughout treatment.
Depending on the individual, support may focus on:
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Fatigue management
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Sleep support
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Maintaining physical function
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Emotional resilience
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Recovery planning
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Education and self-management strategies
The goal is to support the individual throughout treatment while adapting to their changing needs.
How Rowan Health Supports Patients Receiving Chemotherapy
At Rowan Health, support is organised around personalised immunotherapy support protocols rather than standardised treatment packages.
Our goal is not only to support patients who develop treatment-related difficulties, but wherever possible to anticipate challenges and introduce supportive strategies before they significantly affect quality of life.
Importantly, supportive care complements oncology treatment and does not replace medical monitoring or specialist management of immune-related side effects.
Step 1 – Understanding the Immunotherapy Pathway
We begin by understanding:
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The cancer diagnosis
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The immunotherapy being received
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Previous treatments
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Current symptoms
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Recovery goals
Different immunotherapy regimens can produce different patterns of side effects and recovery needs.
Step 2 – Identifying Areas of Vulnerability
We assess areas commonly affected during treatment, including:
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Fatigue
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Sleep disruption
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Physical deconditioning
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Digestive symptoms
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Joint and muscle discomfort
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Emotional wellbeing
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Quality of life
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Recovery capacity
Our aim is to identify potential challenges early and support patients proactively whenever possible.
Step 3 – Building a Personalised Support Protocol
Depending on the individual's needs, the protocol may combine:
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Symptom management
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Rehabilitation
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Recovery support
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Education
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Self-management strategies
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Selected therapeutic interventions
These may include:
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Rehabilitation and manual therapy
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Acupuncture
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Neuro-coaching
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Lifestyle and recovery support
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Medical homeopathy
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Herbal medicine
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Fatigue-management strategies
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Sleep support
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Survivorship planning
The emphasis is always on selecting the right combination of support for the right person at the right time.
Step 4 – Monitoring, Adapting and Supporting Recovery
Immunotherapy treatment and recovery can evolve over time.
Protocols are reviewed regularly and adapted according to:
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Changes in symptoms
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Treatment progress
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Recovery priorities
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Quality-of-life goals
Support required during active treatment may differ considerably from that needed during rehabilitation and survivorship.
Our Goal
Our objective is not simply to respond to symptoms as they arise.
It is to provide proactive, coordinated support that helps individuals:
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Maintain function and independence
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Strengthen resilience
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Reduce the burden associated with treatment
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Improve quality of life
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Facilitate recovery and rehabilitation
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Navigate survivorship with confidence
By understanding the treatment pathway, anticipating likely challenges and adapting support over time, we aim to help patients navigate treatment and recovery as successfully as possible.
Areas We Commonly Support During Immunotherapy
Cancer-Related Fatigue
Helping individuals maintain energy, activity levels and daily function.
Sleep Difficulties
Supporting restorative sleep and recovery.
Digestive Symptoms
Supporting comfort and quality of life alongside medical care.
Joint and Muscle Discomfort
Helping maintain mobility and physical function.
Emotional Wellbeing
Supporting resilience, confidence and adaptation throughout treatment.
Recovery and Survivorship
Helping individuals rebuild function and quality of life after treatment.
Understanding Treatment, Recovery and Support
Explore our detailed guides:
Cancer Treatments
➡ Understanding Cancer & Cancer Treatments
➡ Understanding Hormonal Therapy
➡ Understanding Targeted Therapies
➡ Understanding Antibody-Based Therapies
➡ Understanding CAR-T Cell Therapy
Treatment challenges
➡ Why Side Effects Happen
➡ Cancer-Related Fatigue
➡ Chemo Brain
➡ Peripheral Neuropathy
➡ Xerostomia (Dry Mouth)
➡ Mucositis
➡ Skin and Nail Changes During Cancer Treatment
➡ Sleep Difficulties
Recovery & Support
➡ Cancer Support & Survivorship
➡ Carers' Wellbeing
➡ Supporting Recovery After Treatment
Need Support?
Every immunotherapy journey is different.
If you would like to discuss supportive care during treatment or recovery, Rowan Health offers personalised consultations designed around your diagnosis, treatment pathway, symptoms and recovery goals.