Autonomic nervous system dysfunction in advanced cancer

Abstract

The autonomic nervous system (ANS) innervates every organ in the body and is largely involuntary. There have been reports of autonomic dysfunction in cancer patients, but most are case reports. There are suggestions that this abnormality may be common in advanced cancer. Inpatients and outpatients with advanced cancer were enrolled. Patients were excluded if they had a previous diagnosis of a disease associated with autonomic nervous system (ANS) abnormalities, or had taken or were taking drugs affecting the ANS. Autonomic function was evaluated using five bedside cardiovascular tests: (1) heart rate response to deep breathing, (2) heart rate response to standing, (3) heart rate response to the Valsalva maneuver, (4) blood pressure response to standing and (5) blood pressure response to static exercise. Each test result was scored according to a validated scale of 0,.5, or 1. The individual scores were added together and each patient received a dysfunction score: none (=0-1), mild (=1.5-2), moderate (=2.5-3) or severe (=3.5-5).Twenty-eight men and 22 women participated, median age was 64 years. The median ECOG performance status was 2. Lung and prostate cancer were the most common (N=9, 5). 245 tests were performed; 86 (35%) individual tests were normal or borderline. Composite dysfunction scores were calculated; all the participants had a score consistent with abnormality. The median number of symptoms was 6 (range 1-15). Twenty-eight rated at least one symptom as severe (median 2, range 0-5), but symptoms did not correlate with test abnormalities. The results reveal significant ANS dysfunction in advanced cancer. There are more invasive tests that may give more accurate descriptions of ANS abnormalities in this population. These tests may help define the lesion better than these simple bedside tests. Further research with sophisticated ANS testing is needed to clearly define this paraneoplastic syndrome.

The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer

“…[10][11][12] However, our findings are limited by small sample size and varying cancer sites. Prospective research with larger samples is needed to determine whether these abnormalities are more frequent in some types of cancer, whether they may be associated with neurotoxic chemotherapy, and whether their prevalence changes with palliative treatment or disease progression.…”

“…9 Autonomic dysfunction is a frequent paraneoplastic phenomenon. [10][11][12] In healthy individuals, autonomic cardiovascular responses reportedly decline after age 60 years 13 without approaching borderline or pathologic values of diagnostics tests, ie, Valsalva or VS ratio, breathing (expiration/inspiration [E/I] ratio); in patients close to age 80 years, the stand test (30/15 ratio) may become borderline. 14 The prevalence of autonomic dysfunction is 20% in patients with diabetes and 7% in patients with early diabetes.…”

“…10,11 In 50 patients with advanced cancer, only 35% of 245 tests for cardiovascular autonomic dysfunction were normal or borderline. 12 Autonomic dysfunction may contribute to fatigue along with orthostatic hypotension. Profound fatigue is 1 of the cardinal symptoms of Shy-Drager syndrome, a form of primary dysautonomia (multiple-system atrophy with predominant autonomic dysfunction).…”

A Chinese Decoction, Kuan-Sin-Yin, Improves Autonomic Function and Cancer-Related Symptoms of Metastatic Colon Cancer

“…35 The ANS comprises the sympathetic system (which helps the body use energy) and the vagal system (which helps conserve energy and promotes healing); they operate together in a dynamic balance, as in the TCM concept of yin and yang energy. When the sympathetic system calls up more energy, as during severe illness or stress, the ANS is thrown out of balance.…”

Changes in heart-rate variability of survivors of nasopharyngeal cancer during Tai Chi Qigong practice

“…Autonomic nervous system (ANS) dysfunction is common in cancer patients1 ) . Cancer treatments such as chemotherapy and radiotherapy may also cause a variety of cardiac complications2 ) .…”