Mood alteration and heart rate variability in patients with cancer on treatment

Abstract

In this article, Deng and Song showed compelling evidence on the connection between heart rate variability (HRV) alterations and cancer in 127 cancer patients compared with healthy reference individuals, highlighting autonomic nervous system dysfunction as a significant physiological manifestation in cancer patients. We discussed that the reduced HRV may be associated with cancer treatments, e.g., operation, chemotherapy and pain control and psychological response such as depression and anxiety related to the affected cancer. A management such as medicine to mood disturbances related to cancer has been shown a benefit to improve HRV in cancer patients.

Key Words: Cancer; Chemotherapy; Heart rate variability; Mental stress; Heart

Core Tip: We discussed that the reduced heart rate variability may be associated with cancer treatments, e.g., operation, chemotherapy and pain control and psychological response such as depression and anxiety related to the affected cancer. A management such as medicine to mood disturbances related to cancer has been shown a benefit to improve heart rate variability in cancer patients.

INTRODUCTION

Deng and Song[1] presented compelling evidence on the connection between heart rate variability (HRV) alterations and cancer, highlighting autonomic nervous system dysfunction as a significant physiological manifestation in cancer patients. Their observational study of 127 cancer patients demonstrated that HRV, a non-invasive measure of autonomic function, is significantly abnormal in cancer patients compared to reference individuals, with pronounced reductions especially evident in advanced disease stages.

MECAHNISMS FOR REDUCED HRV IN CANCER AND MANAGEMENTS

Cancer treatments, including surgical interventions, chemotherapy, and pain management protocols, have substantial impacts on HRV patterns, reflecting treatment-induced autonomic modulation. Surgical procedures often trigger profound autonomic responses characterized by immediate sympathetic activation followed by gradual recovery, with HRV parameters frequently showing substantial reductions during the perioperative period[2]. These alterations can persist beyond the immediate recovery phase, indicating prolonged autonomic dysfunction. Chemotherapeutic agents, particularly anthracyclines, platinum compounds, and taxanes, have been associated with significant reductions in both time-domain and frequency-domain HRV parameters, suggesting these treatments may directly affect cardiac autonomic innervation[3,4]. The cardiotoxic effects of chemotherapy not only manifest as structural cardiac damage but also as functional autonomic dysregulation, potentially contributing to increased cardiovascular morbidity in cancer survivors. Furthermore, adequate pain control has emerged as a crucial factor influencing autonomic function in cancer patients. Uncontrolled pain triggers sympathetic hyperactivity, resulting in reduced HRV, while effective analgesic interventions can partially restore autonomic balance[5]. Notably, opioid analgesics demonstrate complex effects on HRV, with initial parasympathetic enhancement often followed by adaptation and potential long-term alterations in autonomic tone. These treatment-related autonomic changes highlight the importance of comprehensive cardiovascular monitoring throughout cancer treatment trajectories, with HRV assessment potentially serving as a valuable tool for early detection of treatment-induced cardiovascular complications.

Emerging evidence highlights the critical relationship between mood alterations in cancer patients and their impact on HRV, underscoring the complex interplay between psychological distress and autonomic nervous system regulation. A cancer diagnosis and subsequent treatments are frequently associated with heightened emotional stress, anxiety, and depression, which directly influence autonomic function, often manifesting as increased sympathetic activity and diminished parasympathetic tone, resulting in decreased HRV[6,7]. Chronic stress activation perpetuates autonomic imbalance, negatively affecting cardiovascular health, immune function, and potentially reducing overall prognosis and quality of life for cancer patients[8]. Given these implications, integrating psychological interventions into comprehensive cancer care has become increasingly critical. Mindfulness-based stress reduction[9], cognitive-behavioral therapy[10,11], supportive counseling[12], and structured psycho-oncological support have all demonstrated potential in modulating autonomic function, enhancing parasympathetic activity, and consequently improving HRV[12]. Mindfulness interventions, specifically, have shown promising results in reducing anxiety and depression, thereby attenuating sympathetic dominance and facilitating autonomic recovery[13]. Furthermore, relaxation techniques including yoga, meditation, and guided breathing exercises have proven effective in improving emotional well-being and autonomic regulation in cancer populations[11,13].

Pharmacological treatments, when indicated clinically, can complement psychological interventions, particularly in managing severe mood disturbances and their physiological consequences[14]. Additionally, adjunctive strategies such as music therapy and social support programs provide supplementary benefits, contributing significantly to emotional stabilization and physiological resilience, thereby supporting enhanced HRV outcomes[15,16]. Future research directions should aim at elucidating precise neurophysiological and psychological mechanisms linking mood disturbances to autonomic dysfunction, identifying potential patient-specific moderators, and rigorously evaluating intervention efficacy in long-term HRV improvement and cardiovascular risk mitigation. Embracing a biopsychosocial framework in oncology care can promote comprehensive patient management, fostering both emotional and physiological resilience, ultimately enhancing cancer patient outcomes and quality of life.

CONCLUSION

The intricate relationship between psychological distress and autonomic nervous system dysfunction underscores the importance of addressing mood alterations in cancer patients as a critical component of comprehensive oncology care. Persistent mood disturbances, such as anxiety and depression, significantly influence HRV, highlighting the necessity for integrative therapeutic approaches aimed at enhancing autonomic balance. Evidence-based psychological interventions, including mindfulness-based stress reduction, cognitive-behavioral therapy, and supportive counseling, demonstrate promising efficacy in restoring parasympathetic activity and mitigating sympathetic over activation. Additionally, complementary practices such as meditation, yoga, guided breathing exercises, and structured psycho-oncological support programs contribute substantially to emotional and physiological resilience. To optimize clinical outcomes, future research should further elucidate the mechanistic pathways linking psychological states to autonomic regulation, refine intervention modalities, and identify personalized factors that enhance responsiveness to these treatments. By recognizing and incorporating psychological well-being into cancer management, clinicians can foster a holistic, patient-centered approach that improves both cardiovascular function and overall quality of life for individuals affected by cancer.