Impact of cancer and chemotherapy on autonomic nervous system function and cardiovascular reactivity in young adults with cancer: a case-controlled feasibility study

Abstract

BackgroundPreliminary evidence suggests cancer- and chemotherapy-related autonomic nervous system (ANS) dysfunction may contribute to the increased cardiovascular (CV) morbidity- and mortality-risks in cancer survivors. However, the reliability of these findings may have been jeopardized by inconsistent participant screening and assessment methods. Therefore, good laboratory practices must be established before the presence and nature of cancer-related autonomic dysfunction can be characterized. The purpose of this study was to assess the feasibility of conducting concurrent ANS and cardiovascular evaluations in young adult cancer patients, according to the following criteria: i) identifying methodological pitfalls and proposing good laboratory practice criteria for ANS testing in cancer, and ii) providing initial physiologic evidence of autonomic perturbations in cancer patients using the composite autonomic scoring scale (CASS).MethodsThirteen patients (mixed diagnoses) were assessed immediately before and after 4 cycles of chemotherapy. Their results were compared to 12 sex- and age-matched controls. ANS function was assessed using standardized tests of resting CV (tilt-table, respiratory sinus arrhythmia and Valsalva maneuver) and sudomotor (quantitative sudomotor axon reflex test) reactivity. Cardiovascular reactivity during exercise was assessed using a modified Astrand-Ryhming cycle ergometer protocol. Our feasibility criteria addressed: i) recruitment potential, ii) retention rates, iii) pre-chemotherapy assessment potential, iv) test performance/tolerability, and v) identification and minimizing the influence of potentially confounding medication. T-tests and repeated measures ANOVAs were used to assess between- and within-group differences at baseline and follow-up.ResultsThe overall success rate in achieving our feasibility criteria was 98.4 %. According to the CASS, there was evidence of ANS impairment at baseline in 30.8 % of patients, which persisted in 18.2 % of patients at follow-up, compared to 0 % of controls at baseline or follow-up.ConclusionsResults from our feasibility assessment suggest that the investigation of ANS function in young adult cancer patients undergoing chemotherapy is possible. To the best of our knowledge, this is the first study to report CASS-based evidence of ANS impairment and sudomotor dysfunction in any cancer population. Moreover, we provide evidence of cancer- and chemotherapy-related parasympathetic dysfunction – as a possible contributor to the pathogenesis of CV disease in cancer survivors.

Short-term combined exercise training improves cardiorespiratory fitness and autonomic modulation in cancer patients receiving adjuvant therapy

“…Regarding autonomic modulation, data of the present study corroborate with several evidence in the literature ( Adams et al, 2015 ; Palma et al, 2016 ; Vigo et al, 2015 ), once cancer patients demonstrated marked autonomic dysfunction at baseline in comparison with age-matched free-cancer controls (i.e., CG). Indeed, this phenomenon has been observed not only in patients diagnosed with breast cancer, but also in other kinds of cancer, such as gastrointestinal, pancreatic, colon ( Adams et al, 2015 ; Palma et al, 2016 ; Vigo et al, 2015 ). In the experiment of Vigo et al (2015) , for example, authors demonstrated that breast cancer survivors showed lower HRV, HF band of HRV, and baroreflex sensitivity than healthy controls.…”

Thermal Effects Associated with RF Exposures in Diagnostic MRI: Overview of Existing and Emerging Concepts of Protection

“…Induced stress includes rapid increase in sweat rate, coupled to skin blood flow and increased cardiac output and a potential decrease in arterial blood pressure [27,44,45]. Precise levels for temperatures at which biophysical control mechanisms are activated or may fail are not well established and may vary [46] as function of age, pregnancy, obesity and hypertension, or additional stress factors (e.g., diuretics, tranquillizers and sedatives, vasodilators, and some other drugs, chemotherapy or radiotherapy [47]).…”

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“…Autonomic innervation plays a key role in regulating heart rate, myocardial function and MBF (58). Its impairment is associated with the development and the progression of cardiovascular diseases in cancer patients (59).…”

“…In this context, a reduced heart rate variability has been reported in patients treated with vincristine (60), doxorubicin (61) and paclitaxel (62). Moreover, aberrant blood pressure variability and maladaptive orthostatic responses are frequently observed in patients taking paclitaxel, taxanes, vinca alkaloids and cisplatin (58). Finally, damage to the cardiac nervous system by CT or thoracic RT may lead to sympathetic-vagal imbalance leading to sinus tachycardia that, reducing diastolic time and enhancing cardiac oxygen consumption, progressively induces myocardial ischemia (4).…”