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Cardiovascular Autonomic Dysfunction in Patients with Cancer

  • Cardio-Oncology (SA Francis and RB Morgan, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Elucidating the mechanisms that contribute to adverse cardiovascular (CV) outcomes and reduce quality of life among patients with cancer is paramount. Cancer, certain cancer drugs, radiation therapy, cancer-associated lifestyle disturbances, and cancer-independent comorbidities combine to predispose oncology patients to autonomic dysfunction (AD). This review will explore the assessment, etiology, and clinical implications of AD in cancer patients and will speculate on therapeutic and research opportunities.

Recent Findings

AD is particularly prevalent among patients with advanced cancer, but studies suggest increased prevalence across the entire continuum of cancer survivors compared to cancer-free controls. Data on cancer therapy-induced injury to the autonomic nervous system are limited to small studies. AD has been reported after cranial, neck, and mediastinal radiation therapy. Although AD has been shown to confer increased risk of adverse CV outcomes in cancer-free patients, the prognostic relevance of AD in oncology patients is less well investigated. Markers of AD including elevated resting heart rate (HR), reduced HR variability, and abnormal HR recovery have been associated with shorter survival times in various cancer cohorts. Furthermore, AD has been implicated in the etiology of cancer-related fatigue and exercise limitation.

Summary

Multiple risk factors predispose oncology patients to AD, which is associated with adverse outcomes, including increased mortality, exercise limitation, and fatigue among this cohort. The contribution of AD to overall morbidity and mortality in cancer survivors has largely been overlooked to date. Further investigation is necessary to better understand cancer-treatment specific autonomic injury and to evaluate the role of various pharmacological and non-pharmacological interventions with potential to tackle the sympathovagal imbalance observed in cancer survivors.

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Authors and Affiliations

  1. School of Clinical Medicine, University College London Medical School, Gower Street, London, WC1E 6BT, UK

    Ben G. T. Coumbe

  2. Division of Cardiovascular Medicine, Brigham and Women’s Hospital Heart and Vascular Center/Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    John D. Groarke

  3. Cardio-Oncology Program, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA, USA

    John D. Groarke

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Correspondence to John D. Groarke.

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Ben G.T. Coumbe and John D. Groarke declare that they have no conflict of interest.

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This article is part of the Topical Collection on Cardio-Oncology

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Coumbe, B.G.T., Groarke, J.D. Cardiovascular Autonomic Dysfunction in Patients with Cancer. Curr Cardiol Rep 20, 69 (2018). https://doi.org/10.1007/s11886-018-1010-y

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