Is emotional wellbeing important for cancer treatment outcomes?

Silvia Grisendi
Oct 29
4 min read

Updated: Oct 30

It gives me huge hope to see how mind-body care is gaining evidence and attention in the context of integrative oncology.

Treatment prehabilitation, for example. The importance of PHYSICAL prehabilitation is well understood, and the work practitioners like me do with newly diagnosed clients puts much emphasis on shifting the ‘body terrain’ into a healthier state as possible, knowing that this can lead to better tolerance and response to treatment, faster recovery, and fewer complications.

What about MENTAL and EMOTIONAL prehabilitation?

In other words: can how we feel emotionally affect how well cancer treatment works?

I went back to look at a group of studies (mostly observational) that examined the impact of ‘emotional distress’ in cancer patients about to undergo immunotherapy treatment with immune checkpoint inhibitors (ICI). This is a type of therapy where the health of the immune system (and the body systems that support it, e.g. stress-response pathways, gut health) is key for a good response.

What they found is that higher levels of emotional distress experienced before ICI therapy was consistently associated with poorer outcomes.

These are measurable, statistically significant associations, reported in journals of the calibre of Nature Medicine, Journal of Clinical Oncology, and others, for example:

Emotional distress linked to response to immunotherapy treatment — One of the first studies reporting on the association between emotional distress and response to immunotherapy treatment.

Some of the key findings, in short:

In melanoma patients, higher emotional distress before ICI therapy had lower response rates and shorter relapse-free survival, even after adjusting for biological markers like interferon-gamma signature and tumour mutational burden (Ref 1).

Two-year relapse-free survival was 74% in distressed patients versus 91% in those without distress (Ref 1-2).

Similar findings were reported for non-small-cell lung cancer and broader cancer populations, where pre-treatment distress is associated with poorer overall survival and progression-free survival (Ref 3-5).

What is the key message?

It is important to say that association does not demonstrate causation.

It is also very important to say that these results do not suggest that having challenging emotions before treatment causes worse outcomes. I wish to make this very clear.

The key message to focus on from this set of findings is that there is huge healing potential intrinsic to supporting emotional wellbeing in patients who are preparing for treatment.

The impact of such studies is that supporting emotional wellbeing around treatment should not be optional, but a key piece of the healing puzzle.

What could be the mechanisms behind these findings?

Our mind-body system is complex and fascinating, but we know for sure that mental and emotional stress lead to elevated stress hormones (e.g. cortisol, adrenaline, etc.), and these can suppress the function of the immune system.

emotional wellbeing complements cancer treatment

So, helping patients feel supported, calm, and emotionally well-resourced can translate into a stronger and better functioning immune system. This in turn creates a positive synergy with the treatment itself.

How to support emotional wellbeing in practice?

I find that the best way to go is to acknowledge that every person is different, a personalised approach is always best.

In some cases I find that support involves first helping the person even see what is that they (their unique self) need in order to enhance their emotional wellbeing at such difficult times. The shock and trauma of the situation can make this difficult to pin down.

But even just making patients aware of this potential is a form of empowerment, at times where they may feel powerless. Guiding them towards modalities that may help them create the best possible internal environment for healing — be it as simple as taking time to breathe properly, to relax properly, to practice self-care, to receive care, to nurture the soul, meditate, practice gentle movement — can make such a difference.

That is the power of awareness and of a truly integrative approach, body, mind and soul.

References:

1) Fraterman, I., et al. (2023). Association between pretreatment emotional distress and neoadjuvant immune checkpoint blockade response in melanoma. Nature Medicine, 29, 3090-3099.

2) Reijers, I., et al. (2023). The impact of emotional distress on pathologic response and survival after neoadjuvant combination immune checkpoint blockade (ICB) in high-risk stage III melanoma. Journal of Clinical Oncology, Volume 43, Number 16_suppl.

3) Egeler, M.D., et al. (2025). The association between pretreatment emotional distress and response to tumor-infiltrating lymphocyte therapy in advanced melanoma. European Journal of Cancer, 227: 115640.

4) Zhou, J., et al. (2025). Association between pretreatment emotional distress and survival outcomes in patients with advanced non–small-cell lung cancer: An individual patient data meta-analysis of 4632 patients in 7 trials. Journal of Clinical Oncology, Volume 43, Number 16_suppl.

5) Zeng, Y., et al. (2024). Association between pretreatment emotional distress and immune checkpoint inhibitor response in non-small-cell lung cancer. Nature Medicine, 30, 1680- 88.