This pilot study aimed to determine if a biophilic Green Therapy or Virtual Reality environment can decrease an oncology patient’s pain and distress while receiving chemotherapy. A case-crossover pilot study was conducted in a comprehensive cancer infusion center. 33 participants with breast, gynecologic, gastrointestinal, pancreatic and prostate cancers were all included in three rooms in a random order at different cycles: control room, Green Therapy room, and Virtual Reality room to receive chemotherapy, respectively. Participants’ pain, distress, heart rate, blood pressure, and saliva cortisol were measured before and after infusion in each room. No statistical significance differences were shown in the changes of heart rate, systolic, or diastolic blood pressure, saliva cortisol, pain, or distress before and after infusion between the control, Green Therapy, and Virtual Reality rooms. However, more patients reported the experience as “fun” and “enjoyable” when they were in Green Therapy or Virtual reality room as compared to in the control room. Additionally, since participating in the study, 14 patients reported spending at least 30 min or more outside in nature. In this study, we found that patients’ heart rate, blood pressure, and self-reported distress levels were reduced after each biophilic intervention although results are not statistically significant. The study also suggested that biophilic interventions are safe and feasible and may complement the standard of care for oncology patients.

Pancreatic ductal adenocarcinoma (PDAC) is highly lethal, and many patients cannot undergo curative surgery due to frailty. Multimodal prehabilitation: combining exercise, nutrition, and psychological support improves functional readiness, but its biological impact on the PDAC tumor microenvironment (TME) is unclear. In this exploratory pilot study, we profiled resected PDAC tissues from prehabilitation-treated patients and matched controls using NanoString GeoMx Digital Spatial Profiling across immune, tumor, and stromal compartments (n = 4). Transcriptomic signatures were analyzed via differential expression, pathway enrichment, and MCP-counter deconvolution; protein-level validation used multiplex immunofluorescence (n = 8). Ligand–receptor modeling assessed cell–cell communication, and prognostic relevance was evaluated in TCGA-PDAC (n = 178). Prehabilitation was associated with increased NK-cell cytotoxicity, interferon response, and chemokine recruitment, as well as higher neutrophil signatures (p < 0.01) and reduced fibroblast signatures (p < 0.05). Tumor regions showed lower MAPK and PI3K/AKT activity, while stroma exhibited decreased TGF-β and Wnt signaling. Immunofluorescence confirmed neutrophil infiltration and reduced fibroblast density. TCGA analysis linked neutrophil-high/fibroblast-low profiles to longer survival (1044.6 vs. 458.7 days, p = 0.0052). These findings suggest prehabilitation may promote a more immune-active, less fibrotic TME in PDAC, resembling transcriptional states associated with improved survival. Prospective studies integrating biological and clinical endpoints are warranted.

Multimodal prehabilitation aims to enhance resilience to cancer therapy through exercise, nutrition, and psychological optimization. While prehabilitation can improve physical condition and functional status, its biologic influence on the tumor microenvironment (TME) remains poorly characterized. In pancreatic ductal adenocarcinoma (PDAC), the TME is dominated by immunosuppressive and desmoplastic features that limit immune cell infiltration and therapeutic efficacy. As an exploratory pilot analysis, this study characterized the cellular composition, spatial relationships, and functional signaling of the pancreatic TME in patients who underwent prehabilitation prior to surgical resection and those who did not. Tumor samples from eight patients (four prehabilitation, four control) were analyzed with a 34-plex protein panel using Imaging Mass Cytometry (IMC), categorizing the tumor–immune landscape and functional status at the single-cell resolution. Prehabilitation tumors demonstrated reduced neutrophil and epithelial/tumor cell density and enrichment of Natural Killer (NK), CD4⁺, and CD8⁺ T cells. Spatial analysis revealed an immune-permissive architecture in prehabilitation tumors, in contrast to immune-resistant patterns in controls. Functional marker analysis showed reduced activation and pro-tumor signaling in immunosuppressive populations, including Tregs (HLADR, pAkt, pNFκB) and Collagen⁺ CAFs (NOS2, pERK, pNFκB, pSTAT3). These preliminary findings raise the possibility that prehabilitation is associated with an immune-permissive TME in PDAC, supporting further investigation of its immunomodulatory potential in larger, prospectively designed cohorts.