Journal of Cancer Survivorship

, Volume 9, Issue 4, pp 699–706 | Cite as

Evidence of altered autonomic cardiac regulation in breast cancer survivors

  • Chiara Vigo
  • Wolfgang Gatzemeier
  • Roberto Sala
  • Mara Malacarne
  • Armando Santoro
  • Massimo Pagani
  • Daniela LuciniEmail author



Surgery and adjuvant therapy improved prognosis of breast cancer survivors. This improvement risks being offset by potential late-occurring cardiovascular toxicity of oncologic treatment and increased cardiometabolic risk profile associated with lifestyle changes. We address the hypothesis that in breast cancer survivors, multiple functional alterations might define a phenotype, characterized by vagal impairment, diminished aerobic fitness, increased metabolic risk, and reduced wellbeing.


We studied 171 sedentary asymptomatic women (106 cancer survivor—65 controls) of similar age (53 ± 8.6; 51 ± 8.1 years). Autonomic regulation was evaluated by autoregressive spectral analysis of R wave to R wave (RR) interval and systolic arterial pressure variability. Aerobic fitness was directly assessed by cardiopulmonary exercise test. Body mass index (BMI) and waist circumference served as proxies of metabolism. Fatigue and stress-related symptoms were evaluated with validated questionnaire.


Patients showed significantly smaller total RR variance (1644 ± 2363 vs 2302 ± 1561 msec2), smaller absolute power of low frequency (LF) (386 ± 745 vs 810 ± 1300 msec2) and high frequency (HF) (485 ± 1202 vs 582 ± 555 msec2) of RR interval variability and smaller spontaneous baroreflex sensitivity (15.0 ± 8.9 vs 21.9 ± 10 msec/mmHg), suggesting vagal impairment. VO2 peak and O2 pulse were lower in cancer survivors than in controls. Fatigue and stress-related somatic symptoms scores were higher, as was BMI and waist circumference.


Breast cancer survivors show multiple dysfunctions: vagal impairment, lower aerobic fitness, signs of altered metabolism, and higher perception of fatigue.

Implications for Cancer Survivors

We propose that the concept of clinical phenotype, which may accommodate multiple functional disturbances, might be useful in long-term personalized prevention programs for breast cancer survivors.


Cardiometabolic risk Autonomic nervous system Baroreflex sensitivity Cardiorespiratory fitness Lifestyle Secondary prevention 



Change from rest to active stand of LF power of RR variability in normalized units (nu)


Peak oxygen consumption at exercise peak


Arbitrary unit

4SQ score

Somatic stress symptom score


Source of funding

None to declare.

Conflict of interest

The authors declare they have no conflict of interest.

Supplementary material

11764_2015_445_MOESM1_ESM.doc (34 kb)
ESM 1 (DOC 33 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Chiara Vigo
    • 1
    • 2
  • Wolfgang Gatzemeier
    • 3
  • Roberto Sala
    • 1
    • 2
  • Mara Malacarne
    • 1
    • 2
  • Armando Santoro
    • 4
  • Massimo Pagani
    • 1
  • Daniela Lucini
    • 1
    • 2
    Email author
  1. 1.BIOMETRA DepartmentUniversity of MilanMilanItaly
  2. 2.Exercise Medicine UnitHumanitas Clinical and Research CenterMilanItaly
  3. 3.Breast UnitHumanitas Cancer CenterMilanItaly
  4. 4.Cancer CenterHumanitas Clinical and Research CenterMilanItaly

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